Establishing a Place for Advanced Practice in Skin Cancer Radiation Therapy: Experiences of Two Urban Cancer Centres

Abstract

According to the United States Census Bureau, by 2030 the population will increase to approximately 365 million. The number of new cancer cases in Ontario is projected to increase by more than 60% by 2020, and double by 2028. Skin cancer is the most common form of cancer in North America. With over 1.3 million new cases each year, it constitutes nearly 40% of all diagnosed cancers and the incidence is steadily increasing. Predictions are 1 in every 5 North Americans will develop skin cancer in their lifetime. Due to changes in lifestyle and the environment, an aging population and a greater awareness of skin cancer there has been an increased demand for radiation therapy. Quality patient care from referral to treatment and patient follow-up, calls for dedicated interdisciplinary expertise. Radiation Therapists (RTs) are already fully integrated members of the oncology healthcare team. We looked at their skills and how they could benefit both patient and physician. Radiation treatments are typically planned and administered by RTs, they assess and monitor patient reactions to treatment. Opportunity arose to develop advanced practice (APRT) roles by harnessing the RT's unique skill set, adding positive clinical impact. A series of projects were funded to investigate the feasibility of this new health care provider role in radiation: APRT Development (2004-2006), CSRT (APRT) Demonstration (2007-2010), CSRT (APRT) Sustainability (2010-2014). This study shows some of the positive impacts the RT's evolution into the APRT had on two successful multi-disciplinary skin cancer clinics and will show the audience where APRT could be useful in their clinics. Competencies were fulfilled in 3 areas: Clinical, Technical, Research/Education/Knowledge Translation. Evaluations were completed in: Wait times, Access to care, Delegation of activities, Service enhancement, Patient satisfaction, Team acceptance, Competence, Patient safety, and Education and training. The APRT took on many projects; e.g., to see if the development of clearly defined booking guidelines combined with the triaging of all new referrals to the skin clinic by the skin APRT reduced the wait time from referral to consult. This resulted in significant improvement, with 87% of patients now meeting their consult target, compared to 21% previously. Concordance data was collected after taking the history and examining patients with skin cancer, using the radiation oncologist as gold standard. Concordance of 96% dose prescription, 94% field placement, and 98% establishment of treatment plan were found. The results showed that an APRT role produced several benefits: decreased workload of physicians, increased patient throughput, improved resource utilization, and improved wait times. An APRT fully trained in basic skin radiation therapy can free up oncologists' time to pursue more complicated skin cancer cases and allow them to see more new patients, thereby reducing wait times for services and increased access for patients.