ESTRO 2024 - Abstract Book

S2790

Interdisciplinary - Health economics & health services research

ESTRO 2024

semi-structured interview was scheduled at a time point convenient for the interviewee by the same researcher (CAM) where the historical perspective of events during the selected period were discussed and documented. Of the interviews, 7 were documented only in writing and 15 were recorded. All interviews were summarized and categorized in themes relating to technical -, organizational -, treatment-related changes and others. Treatment related events for the two larger diagnosis groups, breast cancer and prostate cancer, were studied separately. Data on the number of linacs in use, number of patients treated and fractions delivered during the studied period were then extracted from the RT database.

Results:

During the studied period of time, there were between 10 and 13 linacs in use and between 2940 and 4465 patients were treated yearly. The years 2015 to 2018 were dominated by recurring problems with the treatment machines. Queues built up and at worst, the start of treatment for some patients had to be postponed. The capacity of handling periodic variations and other disturbances was low and the staff was exhausted due to many unplanned interruptions. In 2018 a large procurement was closed to update the machinery and secure future replacements on time. In connection with updating equipment, the databases of the two sites were merged together in late 2019. In 2018-2019, an improvement project was initiated with the purpose to first map the current and the desired workflow in the RT process, acknowledging authority requirements. The project was supported by external expertise but also engaged in-house staff representing each workflow task. The project resulted e.g . in a paperless workflow being introduced throughout all steps of the RT-process in early 2020. The workload and queue build-up continued to be high during this period of time. During the pandemic in 2019-2020, the department could maintain overall capacity. Routines for booking patients were improved and pre-booked time slots for some diagnoses were introduced following the introduction of standardized care pathways for cancer. There was a decreased inflow of patients, likely because of fear to seek care and limitations in the pre-diagnostic care. Following the pandemic, around mid 2021, weekly production planning was introduced at the RT department to optimize the utilization rate and better monitor waiting times for patients. For breast cancer, the influx of patients was uneven due to limitations in surgical care in spring 2019. For prostate cancer, the influx of patients with curative intent doubled from 2015 to 2021. There were three major fractionation schedule changes during the studied period of time, introduction of simultaneously integrated boost (SIB) treatments and fast-forward fractionation for breast cancer in 2020 and ultra-hypofractionation for prostate cancer in 2019.