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The Supportive Care Needs of Cancer patients Receiving Radiation Therapy: A Retrospective Review of Radiation Therapists’ Referral Practices during the Treatment Delivery Process at a Large Cancer Centre
prostate (26/81; 32%). The bone metastases that were treated with SBRT were most commonly located in the pelvis (44/106; 41.51%) and almost half of the bone metastases were sclerotic (52/106; 49.06%) in nature. The most common dose fractionation schemes were 30 Gy/5 (30.2%) and 35 Gy/5 (42.5%). Local recurrence was observed in 8/106 (7.69%) of the lesions. On bivariate analysis, a significant association was found between local recurrence and PTV volume (p¼0.02). Fracture occurred in the region of treatment in 9/106 (8.49%) of the treated lesions. No significant association was found between fracture and any of the patient or tumour factors analyzed including previous radiation to the site of treatment and size of PTV treated. Conclusion/Impact/Outcomes: Even across multiple sites of disease and histologies, SBRT achieved excellent local control for non-spine bone metastases with an acceptable risk of fracture. PLENARY 7: PATIENT AND SUPPORTIVE CARE
The Supportive Care Needs of Cancer patients Receiving Radiation Therapy: A Retrospective Review of Radiation Therapists’ Referral Practices during the Treatment Delivery Process at a Large Cancer Centre Angela Turnerab and Dilshad Nathoob a - University of Toronto b - Sunnybrook Health Sciences Centre, Odette Cancer Centre Purpose/Aim: Approximately 400 patients are treated daily within the radiation therapy (XRT) department at our cancer centre. As part of their clinical interactions during the treatment delivery process, radiation therapists (RTs) may refer patients to a third party ‘‘RN Radiation Assessment Office’’ for non-technical issues. These referrals by RTs can result in patients experiencing longer than their anticipated wait times for treatment with the addition of this adhoc referral. This review aimed to identify issues that resulted in third party referrals by RTs. Data collected may highlight environmental or process issues which prevent RTs from managing patient issues that are within their scope of practice. Method/Process: A database of radiation therapy (XRT) patient referrals to the location ‘‘RN Assessment Office’’ in the MosaiqÔ electronic records (MER) was generated for this review. A four week period within the previous year was considered suitable by the investigators in order to produce a representative sample of referrals. Pre-determined referral categories were compiled based on the experiences of the investigators who are involved in clinical interactions during the XRT treatment delivery process. Data was extracted from two sources: i) The progress note tab within each patient MER and ii) the comments section of the referral checklist in the MER system. Results/Benefits/Challenges: Preliminary data indicates approximately 25% of the progress notes in the MER contain RT documentation prior to referral. The majority of referrals (29%) were related to patient skin reactions. Data analysis is ongoing. Conclusion/Impact/Outcomes: Absence of documentation by RTs in the progress note tab of the MER impaired the data collection. Anecdotal evidence suggests routine RT patient assessment during the treatment delivery process. Reinforcement of RT scope of practice, skills development and education regarding written communications may lead to increase in RT documentation as part of their routine patient assessment process.
Dosimetric Impacts on Skin Toxicity for Patients Using Topical Agents and Dressings in Radiotherapy Karen Tsea, Lyndon Morleya, Angela Cashellab, Annette Sperdutia, Maureen Mcquestionac and James C.L. Chowab a - Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
b - Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada c - Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada Purpose/Aim: Development of skin care and wound management practices for radiotherapy (RT) patients has been complicated by concerns regarding the potential skin dose enhancement when products are applied. Although some studies have addressed the dosimetric impact of creams and dressings used during RT, there are inconsistencies seen in the literature research on what the standard care should be when using topical agents and applying dressings on the skin during treatment. Moreover, due to the extensive variety of products used in RT departments among different institutions, there is not one study that has investigated a widespread of common products with a common investigative question. This study evaluated the dosimetric impact on skin dose using a variety of topical agents and dressings. Method/Process: Superficial dose enhancement was measured in the presence of twelve topical agents, five dressings (dry and wet simulations), and three clinical materials for comparison. Dose measurements were carried out using a MOSFET detector under a 1-mm PMMA, 6-MV photon beam, 100 MU, 10 x 10 cm2 field at 100-cm SSD. The topical agents were distributed evenly (1.5mm) over a phantom. Extrapolations were made for 0.5 mm thickness for the topical agents to provide values of a clinically meaningful thickness. Results/Benefits/Challenges: Relative reference doses were 128% (under thermoplastic mask), 158% (under 5-mm SuperflabTM bolus) and 171% (under 10-mm SuperflabTM bolus). No topical agents approached these values for reasonable (0.5 mm) or excessive (1 mm) applications. Two agents (DesitinÒ 40% Zn and SilvasorbÒ gel) exceeded the dose under thermoplastic mask at unrealistic thicknesses (1.5 mm) with doses of 133% and 129%, respectively. Relative dose under dry dressings was 110% or less. Dressings maximally saturated with water produced higher dose enhancement (133% for wet MepilexÒ lite and 141% for wet MepilexÒ Ag transfer). Conclusion/Impact/Outcomes: The evaluated topical agents and dry dressings did not increase superficial dose to a concerning level, even with excessive thicknesses applied and the assumption that they would be present for every RT fraction delivered. Wet dressings should be expected to produce a bolus effect, however substantially less than applying the 5-mm bolus. Medical rationales for designing skin care instructions and wound management should be pursued unhindered by anecdotal concerns for dosimetric implications.
Through the Lens of Our Patients: BCCA Radiation Therapy Satisfaction Survey Overhaul Ben Lee, Kelly Earnshaw and Amanda Bolderston BC Cancer Agency Purpose/Aim: The BC Cancer Agency implemented the use of patient satisfaction surveys in 1999. Currently, there is a great deal of variation between the 6 cancer centres with respect to survey content, dissemination, collection, and analysis. In order to better evaluate the dimensions of patient experience in a patient-centric care model, our initiative aims to review existing survey variations and design a standard, simplified provincial survey. Method/Process: Using a working group that consists of clinical educators, radiation therapists, and a professional practice leader, we collaborated on examining the pre-existing surveys and constructing a prototype. The new survey was designed to reflect the most relevant dimensions of care through a patient’s lens. According to a literature review, these elements include patient involvement, clinical quality, access and convenience, and overall satisfaction. An environmental scan over a national educator forum was also performed to get some insight on how other Canadian centers were evaluating patient satisfaction. A deliberate decision was made to keep the survey short
Conference Proceedings from RTi3 2016/Journal of Medical Imaging and Radiation Sciences 47 (2016) S1-S25
S13
The Supportive Care Needs of Cancer patients Receiving Radiation Therapy: A Retrospective Review of Radiation Therapists’ Referral Practices during the Treatment Delivery Process at a Large Cancer Centre Angela Turnerab and Dilshad Nathoob a - University of Toronto b - Sunnybrook Health Sciences Centre, Odette Cancer Centre Purpose/Aim: Approximately 400 patients are treated daily within the radiation therapy (XRT) department at our cancer centre. As part of their clinical interactions during the treatment delivery process, radiation therapists (RTs) may refer patients to a third party ‘‘RN Radiation Assessment Office’’ for non-technical issues. These referrals by RTs can result in patients experiencing longer than their anticipated wait times for treatment with the addition of this adhoc referral. This review aimed to identify issues that resulted in third party referrals by RTs. Data collected may highlight environmental or process issues which prevent RTs from managing patient issues that are within their scope of practice. Method/Process: A database of radiation therapy (XRT) patient referrals to the location ‘‘RN Assessment Office’’ in the MosaiqÔ electronic records (MER) was generated for this review. A four week period within the previous year was considered suitable by the investigators in order to produce a representative sample of referrals. Pre-determined referral categories were compiled based on the experiences of the investigators who are involved in clinical interactions during the XRT treatment delivery process. Data was extracted from two sources: i) The progress note tab within each patient MER and ii) the comments section of the referral checklist in the MER system. Results/Benefits/Challenges: Preliminary data indicates approximately 25% of the progress notes in the MER contain RT documentation prior to referral. The majority of referrals (29%) were related to patient skin reactions. Data analysis is ongoing. Conclusion/Impact/Outcomes: Absence of documentation by RTs in the progress note tab of the MER impaired the data collection. Anecdotal evidence suggests routine RT patient assessment during the treatment delivery process. Reinforcement of RT scope of practice, skills development and education regarding written communications may lead to increase in RT documentation as part of their routine patient assessment process.
Dosimetric Impacts on Skin Toxicity for Patients Using Topical Agents and Dressings in Radiotherapy Karen Tsea, Lyndon Morleya, Angela Cashellab, Annette Sperdutia, Maureen Mcquestionac and James C.L. Chowab a - Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
b - Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada c - Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada Purpose/Aim: Development of skin care and wound management practices for radiotherapy (RT) patients has been complicated by concerns regarding the potential skin dose enhancement when products are applied. Although some studies have addressed the dosimetric impact of creams and dressings used during RT, there are inconsistencies seen in the literature research on what the standard care should be when using topical agents and applying dressings on the skin during treatment. Moreover, due to the extensive variety of products used in RT departments among different institutions, there is not one study that has investigated a widespread of common products with a common investigative question. This study evaluated the dosimetric impact on skin dose using a variety of topical agents and dressings. Method/Process: Superficial dose enhancement was measured in the presence of twelve topical agents, five dressings (dry and wet simulations), and three clinical materials for comparison. Dose measurements were carried out using a MOSFET detector under a 1-mm PMMA, 6-MV photon beam, 100 MU, 10 x 10 cm2 field at 100-cm SSD. The topical agents were distributed evenly (1.5mm) over a phantom. Extrapolations were made for 0.5 mm thickness for the topical agents to provide values of a clinically meaningful thickness. Results/Benefits/Challenges: Relative reference doses were 128% (under thermoplastic mask), 158% (under 5-mm SuperflabTM bolus) and 171% (under 10-mm SuperflabTM bolus). No topical agents approached these values for reasonable (0.5 mm) or excessive (1 mm) applications. Two agents (DesitinÒ 40% Zn and SilvasorbÒ gel) exceeded the dose under thermoplastic mask at unrealistic thicknesses (1.5 mm) with doses of 133% and 129%, respectively. Relative dose under dry dressings was 110% or less. Dressings maximally saturated with water produced higher dose enhancement (133% for wet MepilexÒ lite and 141% for wet MepilexÒ Ag transfer). Conclusion/Impact/Outcomes: The evaluated topical agents and dry dressings did not increase superficial dose to a concerning level, even with excessive thicknesses applied and the assumption that they would be present for every RT fraction delivered. Wet dressings should be expected to produce a bolus effect, however substantially less than applying the 5-mm bolus. Medical rationales for designing skin care instructions and wound management should be pursued unhindered by anecdotal concerns for dosimetric implications.
Through the Lens of Our Patients: BCCA Radiation Therapy Satisfaction Survey Overhaul Ben Lee, Kelly Earnshaw and Amanda Bolderston BC Cancer Agency Purpose/Aim: The BC Cancer Agency implemented the use of patient satisfaction surveys in 1999. Currently, there is a great deal of variation between the 6 cancer centres with respect to survey content, dissemination, collection, and analysis. In order to better evaluate the dimensions of patient experience in a patient-centric care model, our initiative aims to review existing survey variations and design a standard, simplified provincial survey. Method/Process: Using a working group that consists of clinical educators, radiation therapists, and a professional practice leader, we collaborated on examining the pre-existing surveys and constructing a prototype. The new survey was designed to reflect the most relevant dimensions of care through a patient’s lens. According to a literature review, these elements include patient involvement, clinical quality, access and convenience, and overall satisfaction. An environmental scan over a national educator forum was also performed to get some insight on how other Canadian centers were evaluating patient satisfaction. A deliberate decision was made to keep the survey short
Conference Proceedings from RTi3 2016/Journal of Medical Imaging and Radiation Sciences 47 (2016) S1-S25
S13