Optimization of Workup Pathways to Decrease Radiotherapy Wait Times and Improving Patient Experience: A Single Centre Study

Abstract

Wait-times are challenging for certain radiotherapy (RT) centers, and benchmarking is challenging, given the different standards used. Beyond the standards of referral to consult and consult to treatment, certain centers have established a "ready-to-treat" (RTT) definition to address the reality of patients requiring further investigations from consult to enable a treatment plan. In this single RT center study, a Timely Access and Patient Support (TAPS) model of care has been implemented aiming to improve access to care and, ultimately, patient outcomes. Thiscomparative cohort study was conducted in a single mid-size RT center serving mainly rural communities as part of a larger multi-center academic institution. In collaboration with a Radiation Oncologist (RO), the TAPS clinic is run by a Nurse Practitioner who provides patient assessment and submits requisitions to ensure the patient has support services and is RTT by the time of RO consult. All newly suspected/diagnosed adult cancer patients referred to the center with a triage priority of ≥2 weeks were eligible. Non-metastatic breast and prostate cancers were excluded. Retrospective and prospective data were collected from patient medical records, and descriptive statistical analysis was performed. Pre- and post-TAPS clinic comparison was made for wait times and patient-reported outcomes (PROs) using the Edmonton Symptom Assessment System-revised. During the first 6 months of the study, 66 eligible patients were assessed in the TAPS clinic, prompting 177 orders including referrals (52%) (top 3: social worker 30%, dietitian 20%, and cancer patient navigator 11%), investigations (27%) (top 3: CT 21%, MRI 19%, and biopsy 25%), and interventions (21%). The most common cancers were thoracic (33%), GI (23%) and head and neck (14%). The mean wait time from referral to TAPS consult was 5 days compared to 15 days for pre-TAPS patients to be seen in RO consult. The mean wait time from referral to RTT was 33 days VS 40 days in the post- VS pre-TAPS setting.71% of post-TAPS patients were RTT at RO consult compared with 43% pre-TAPS. Post-TAPS patients reported less fatigue and anxiety and better overall well-being during CT simulation compared to pre-TAPS patients. Preliminary data of TAPS clinic implementation has shown the potential to positively impact RTT times and PROs for psychosocial distress by the time of RT planning. This data also sheds light on the topic of wait time definitions, the investigations required before RTT and the potential role of physician extenders within the health care team to facilitate accelerated workup of malignancies. While TAPS study data will help to inform local cancer care program operations, it is also considered relevant to the broader RT community and professional RT societies addressing standards related to RT access.