ESTRO 37 Abstract book

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ESTRO 37

There were 41 countries with a population of under 1 million; 15 were classified as High Income Countries (HIC), 15 Upper Middle Income Countries (UMIC), 10 Lower Middle Income Countries (LMIC) and one Low Income Country (LIC). 28 countries were islands. Populations ranged from 799 (Holy See) to 886450 (Fiji) and the total number of cancer cases occurring in small countries was 21,043 (range by country from 4 to 2476). Overall the total number of radiotherapy cases in small countries was 10982 (range by country from 2 to 1239). Radiotherapy was available in all HIC islands with 80 or more new cases of cancer in 2012 but was not available in any LMIC island. Fiji was the only LMIC island with a large radiotherapy caseload. Similar caseloads in non- island LMIC all had radiotherapy services. Where radiotherapy was available, the number of megavoltage (MV) machines (Cobalt and Linear accelerator) ranged from 0.9 to 11.5 MV Machines per 1000 new cases of cancer. Conclusion Geographical location, economic status, and cancer burden were significant factors small countries establishing local radiotherapy facilities. This is reflected in our findings that no LMIC islands offer radiotherapy services. Radiotherapy was available in all HIC islands but was not available in any LMIC island. Most small non- island HIC did not have radiotherapy services presumably because of the easy access to radiotherapy in neighbouring countries. OC-0068 Can Advanced Practice Radiation Therapists improve access to radiotherapy? N. Harnett 1 1 Harnett Nicole, Academic Radiotherapy, Toronto, Canada Purpose or Objective Background : From 2004 to 2016, Ontario Canada evaluated the development and impact of advanced practice radiation therapists (APRT) in radiation treatment (RT) programs across the province. As part of that project, a competency profile was developed the described the expanded scope of practice assigned to the APRT. In general, the expanded scope included activities that were traditionally performed by radiation oncologists (RO). The acquisition of the various competencies by those engaged in the pilot study was assessed such that when suitable competence was acquired, those activities could be shared or delegated to the APRT to improve efficiency or effectiveness of the RT program. It is hypothesized that this advanced practitioner could be deployed to areas where radiation therapy knowledge is lacking in order to close that gap and work with the local medical teams to enable the delivery of safe, quality radiation therapy. Material and Methods Method : During development, APRTs were paired with a RO supervisor to identify and work towards learning goals. APRTs used a variety of methods to develop competence including self directed learning, formal courses, one-on-one instruction from members of the RT team. Once it was felt the APRT had achieved competence, concordance studies were employed to compare APRT performance with gold standard performance. Metrics for the studies were drawn from literature where possible (ie. DICE co-efficient, conformity index, centre of mass calculations, etc.) and developed de novo when no validated tool existed (3- point Likert scale for RO to assess concordance and impact of APRT decisions). Activities assessed included, for example, ontreatment review, new patient assessment and decision to treat, obtaining consent, disclosing results of diagnostic tests, serving as expert technical consultants, patient physical exam, medication

consultation, prescribing treatment, contouring high risk volumes, delineating treatment field, etc. Results Over the course of the project, 25 APRTs completed a range of concordance studies. A “pass score” of 90% concordance was set to denote “competence”. APRTs were able to achieve a concordance of 90% or higher in 100% of the assessments. This led to the approval of 32 medical directives (5 pending approval) and innumerable delegated acts at the local facilities. Conclusions APRTs demonstrated that with appropriate education and training, they were able to perform to an acceptable standard on a variety of activities traditionally performed by a RO. Future work includes characterizing the knowledge gap in underserviced regions and describe the competencies that APRTs could offer to bolster the existing team’s capabilities and improve access to quality radiation treatment. OC-0069 Process Mining in Oncology to assess adherence to clinical guidelines from existing data log C. Casà 1 , F. Cellini 2 , J. Lenkowicz 3 , A. Damiani 3 , V. Lanzotti 3 , N. Dinapoli 4 , C. Masciocchi 3 , R. Gatta 3 , V. Valentini 4 1 Gemelli ART- Department of Radiation Oncology- Fondazione Policlinico A. Gemelli- Università Cattolica del Sacro Cuore – Rome- Italy, Gemelli ART- Department of Radiation Oncology, Rome- Italy, Italy 2 Università Cattolica del Sacro Cuore, Radiation Oncology - Gemelli ART, Rome, Italy 3 KBO Labs- Gemelli ART- Department of Radiation Oncology- Fondazione Policlinico A. Gemelli- Università Cattolica del Sacro Cuore – Rome- Italy, KBO Labs- Gemelli ART- Department of Radiation Oncology, Rome, Italy 4 Gemelli ART- Department of Radiation Oncology- Fondazione Policlinico A. Gemelli- Università Cattolica del Sacro Cuore – Rome- Italy, Gemelli ART- Department of Radiation Oncology, Rome, Italy Purpose or Objective Aim is to exploit process mining (PM) techniques to develop a system able to detect, compare and verify adherence of clinical activities to Guidelines (GL) and good clinical practice (GCP) by reading information contained in existing Electronic Health Records (EHR), without additional data management burden. Material and Methods A regional consensus-based clinical GL (fig.1) concerning the clinical management of patients affected by locally advanced rectal cancer (LARC) was translated and implemented as a computer-interpretable GL. Subsequently, EHR data regarding diagnostic and therapeutic pathways of 485 patients affected by LARC were automatically read as a valid input, called event- log, by the PM software. In this event-log, each patient had a series of events and event’s attributes. The occurrence of an event can trigger logical conditions allowing the patient to move from a state of the GL to another one. Adherence analysis to the clinical GL was performed considering the ratio between the number of patients in pre-defined completion states and patients that entered the GL. Moreover, a focused analysis to verify the major dropout condition from GL and a conformity analysis of the waiting time from treatment to surgery in the different branches of the GL were performed.