Prompt Pain Relief from Bone Metastases: The Virtual Simulation Program

Abstract

<h3>Purpose/Objective(s)</h3> Patients commonly present to radiation oncology with painful bone metastases. A major bottleneck in delaying treatment of these patients is scheduling a separate CT simulation appointment. We implemented an alternative radiation planning workflow, which utilized a pre-existing diagnostic CT scan "virtual simulation" in lieu of acquiring an additional CT simulation scan. We hypothesized this would significantly decrease the time interval between initial consultation and treatment start date. <h3>Materials/Methods</h3> Patients meeting strict criteria were selected for virtual simulation. This included only those with painful bone metastases in the thorax/abdomen/pelvis/upper femur who would be treated with palliative intent using standard AP/PA or opposed lateral fields. A recent (within 30 days) diagnostic CT scan clearly visualizing the target volume and surrounding anatomy was required for treatment planning and for daily IGRT treatment purposes. Descriptive statistics were used to analyze time from consultation to start of treatment in virtual versus in-person simulation patients. Before and after the virtual simulation study period, surveys were administered to all stakeholders (physicians, nurses, dosimetrists, physicists, and radiation therapists) to assess staff satisfaction of virtual simulation workflow using a Likert scale. Staff were surveyed on their stress levels, how rushed they felt, and overall level of satisfaction. A 1–5-point scale was used with higher numbers indicating worse outcomes such as increased stress, being more rushed, and less satisfaction. <h3>Results</h3> 24 patients were palliatively treated for painful bone metastases as part of this pilot virtual simulation project from May 2021 to January 2022. Median number of fractions for all courses was one fraction. A reference group of 40 patients palliatively treated with in-person CT simulation from February 2021 to July 2021 was also retrospectively reviewed. Median time from consult to start of treatment for in-person CT simulation patients was 167 hours (6.96 days). In comparison, median time from consult to start of treatment for virtual simulation patients was 71 hours (2.96 days). Median duration of treatment itself was 12 minutes for virtual simulation patients versus 9 minutes for in-person simulation patients. 20 surveys were collected prior to the virtual simulation while 15 surveys were collected after the time period. For virtual versus in-person workflows, staff felt less rushed (2.5 vs. 2.8), less stressed (2.0 vs. 2.5), and more satisfied overall (1.86 vs. 2.76). <h3>Conclusion</h3> The virtual simulation program decreased time from consult to start of treatment for patients requiring urgent palliative radiotherapy for painful bone metastases by 57.5% (6.96 vs. 2.96 days). The alternative virtual workflow did not decrease overall staff satisfaction.