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Does a radiographer-led palliative radiotherapy pathway provide an efficient service for patients with symptoms of advanced cancer? The Northampton experience

Published online by Cambridge University Press:  06 May 2020

M. Graveling Open the ORCID record for M. Graveling [Opens in a new window] ,
K. Jarral  and
A. Gore
M. Graveling*
Affiliation:
South East Midlands Oncology Centre, Radiotherapy Department, Northampton General Hospital, Cliftonville, NorthamptonNN1 5BD, UK
K. Jarral
Affiliation:
South East Midlands Oncology Centre, Radiotherapy Department, Northampton General Hospital, Cliftonville, NorthamptonNN1 5BD, UK
A. Gore
Affiliation:
South East Midlands Oncology Centre, Radiotherapy Department, Northampton General Hospital, Cliftonville, NorthamptonNN1 5BD, UK
*
Author for correspondence: Michael Graveling, South East Midlands Oncology Centre, Radiotherapy Department, Northampton General Hospital, Cliftonville, NorthamptonNN1 5BD, UK. E-mail: [email protected]
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Abstract

Aim:

To investigate whether a radiographer-led radiotherapy pathway can provide an efficient service for patients requiring treatment for symptomatic skeletal metastases.

Materials and Methods:

A retrospective review of 425 courses of palliative radiotherapy was conducted. Data was analysed assessing diagnosis, dose/fractionation, time from referral to treatment, gender, age, inpatient/outpatient status and referring clinic location for radiographer- and clinical oncologist-led cohorts.

Results:

Patients aged ≥70 years were more likely to be planned by radiographers (n = 162/57, p < 0·001). Patients were more likely to be treated with 8 Gy in single fraction than with 20 Gy in five fractions (n = 279/136, p = 0·012). The median referral to treatment time in 8-Gy single-fraction prescriptions was 3 days for radiographer-led versus 7 days for clinical oncologist-led cohorts. In all patients and in 20 Gy in five-fraction prescriptions, it was 4 versus 8 days. A comparison of all prescriptions (p < 0·001), 8 Gy in single-fraction (p < 0·001) and 20 Gy in five-fraction prescriptions (p = 0·001) showed radiographer-led procedures as enabling faster access to treatment in each category.

Findings:

A radiographer-led service can facilitate faster access to treatment than a clinical oncologist-led pathway for an appropriately selected patient caseload.

Keywords

palliative radiotherapyradiographer-led planningrole extension
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 20 , Issue 2 , June 2021 , pp. 126 - 131
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Office for National Statistics. Health profile for England: 2018. London: Office for National Statistics, 2018. https://www.gov.uk/government/publications/health-profile-for-england-2018. Accessed on 2nd April 2020.Google Scholar
Smittenaar, C R, Peterson, K A, Stewart, K, Moitt, N. Cancer incidence and mortality projections in the UK until 2035. Br J Cancer 2016; 115: 1147–1155. https://doi:10.1038/bjc.2016.304 CrossRefGoogle Scholar
Office for National Statistics. Cancer registration statistics, England: 2017. London: Office for National Statistics, 2019. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/cancerregistrationstatisticsengland/2017. Accessed on 2nd April 2020.Google Scholar
Cancer Research UK. Vision for Radiotherapy 2014-2024. London: Cancer Research UK, 2014. https://www.cancerresearchuk.org/sites/default/files/policy_feb2014_radiotherapy_vision2014-2024_final.pdf. Accessed on 2nd April 2020.Google Scholar
Spencer, K, Parrish, R, Barton, R, Henry, A. Palliative radiotherapy. BMJ 2018; 360: k821. https://doi.org/10.1136/bmj.k821 CrossRefGoogle ScholarPubMed
Department of Health. Radiotherapy services in England 2012, 2012. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/213151/Radiotherapy-Services-in-England-2012.pdf. Accessed on 2nd April 2020.Google Scholar
Royal College of Radiologists. Clinical Oncology UK workforce census report 2018. London: Royal College of Radiologists, 2019. https://www.rcr.ac.uk/publication/clinical-oncology-uk-workforce-census-2018-report. Accessed on 2nd April 2020.Google Scholar
Cancer Research UK. Full team ahead: understanding the UK non-surgical cancer treatments workforce. London: Cancer Research UK, 2017. https://www.cancerresearchuk.org/sites/default/files/full_team_ahead-full_report.pdf. Accessed on 2nd April 2020.Google Scholar
Duffton, A, Devlin, L, Tsang, Y, Mast, M, Leech, M. Advanced practice: an ESTRO RTTC position paper. Tech Innov Patient Support Radiat Oncol 2019; 10: 16–19.CrossRefGoogle Scholar
Field, L J, Snaith, B A. Developing radiographer roles in the context of advanced and consultant practice. J Med Radiat Sci 2013; 60: 11–15. https://doi:10.1002/jmrs.2 CrossRefGoogle Scholar
Hardy, M, Johnson, L, Sharples, R, Boynes, S, Irving, D. Does radiography advanced practice improve patient outcomes and health service quality? A systematic review. Br J Radiol 2016; 89 (1062); 20151066. https://doi:10.1259/bjr.20151066 CrossRefGoogle ScholarPubMed
Health and Care Professions Council. Standards of conduct, performance and ethics. London: Health and Care Professions Council, 2012. https://www.hcpc-uk.org/standards/standards-of-conduct-performance-and-ethics/. Accessed on 2nd April 2020.Google Scholar
Royal College of Radiologists. Radiotherapy Prescribing Framework for those not on the Specialist Register for Clinical Oncology. London: Royal College of Radiologists, 2014. https://www.rcr.ac.uk/posts/radiotherapy-prescribing-framework-those-not-specialist-register-clinical-oncology. Accessed on 2nd April 2020.Google Scholar
Society and College of Radiographers. Code of Professional Conduct. London: Society and College of Radiographers, 2013. https://www.sor.org/learning/document-library/code-professional-conduct. Accessed on 2nd April 2020.Google Scholar
Society and College of Radiographers. Education and career framework for the radiography workforce. London: Society and College of Radiographers, 2013. https://www.sor.org/learning/document-library/education-and-career-framework-radiography-workforce. Accessed on 2nd April 2020.Google Scholar
Society and College of Radiographers. The Scope of Practice 2013. London: Society and College of Radiographers, 2013. https://www.sor.org/learning/document-library/scope-practice-2013. Accessed on 2nd April 2020.Google Scholar
National Institute of Health and Care Excellence. Metastatic spinal cord compression in adults (QS56). Manchester: NICE, 2014. https://www.nice.org.uk/Guidance/qs56. Accessed on 8th August 2019.Google Scholar
Jett, J R, Schild, S E, Kesler, K A, Kalemkerian, G P. Treatment of small cell lung cancer. Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2013; 143 (5 Suppl): e400S–e419S. https://doi:10.1378/chest.12-2363 CrossRefGoogle Scholar
Health Research Authority. Governance Arrangements for NHS Research Ethics Committees. London: Health Research Authority, 2017. https://www.hra.nhs.uk/planning-and-improving-research/policies-standards-legislation/governance-arrangement-research-ethics-committees/. Accessed 2nd April 2020.Google Scholar
Health Research Authority. UK policy framework for health and social care research. London: Health Research Authority, 2017. https://www.hra.nhs.uk/planning-and-improving-research/policies-standards-legislation/uk-policy-framework-health-social-care-research/. Accessed 2nd April 2020.Google Scholar
Joint Collegiate Council for Oncology. Reducing delays in cancer treatment - some targets. London: Joint Collegiate Council for Oncology, 1993. https://www.rcr.ac.uk/system/files/publication/field_publication_files/reducingdelaysincancertreatment.pdf. Accessed on 2nd April 2020.Google Scholar
Royal College of Radiologists. Radiotherapy dose fractionation, 3rd edition. London: Royal College of Radiologists, 2019. https://www.rcr.ac.uk/publication/radiotherapy-dose-fractionation-third-edition. Accessed on 2nd April 2020.Google Scholar
Specialised Commissioning Team. Clinical Commissioning Policy: Palliative radiotherapy for bone pain. London: NHS England, 2016. https://www.england.nhs.uk/wp-content/uploads/2018/07/Palliative-radiotherapy-for-bone-pain.pdf. Accessed on 2nd April 2020.Google Scholar
Lutz, S, Balboni, T, Jones, J et al. Palliative radiation therapy for bone metastases: update of an ASTRO Evidence-Based Guideline. Pract Radiat Oncol 2017; 7: 4–12. http://doi.org/10.1016/j.prro.2016.08.001 CrossRefGoogle Scholar
Rich, S E, Chow, R, Raman, S et al. Update of the systematic review of palliative radiation therapy fractionation for bone metastases. Radiother Oncol 2018; 126 (3): 547–557. https://doi:10.1016/j.radonc.2018.01.003 Google Scholar
Job, M, Holt, T, Bernard, A. An evaluation of an advanced practice role in palliative radiation therapy. J Med Radiat Sci 2019; 66: 96–102. https://doi:10.1002/jmrs.318 CrossRefGoogle Scholar
Lacey, C, Ockwell, C, Locke, I, Thomas, K, Hendry, J, McNair, H. A prospective study comparing radiographer- and clinician-based localization for patients with metastatic spinal cord compression (MSCC) to assess the feasibility of a radiographer-led service. Br J Radiol 2015; 88: 20150586. doi: 10.1259/bjr.20150586.CrossRefGoogle Scholar
Goldfinch, R, Allerton, R, Khanduri, S, Pettit, L. The impact of the introduction of a palliative MacMillan consultant radiographer at one UK cancer centre. Br J Radiol 2016; 89: 20160286. http://doi.org/10.1259/bjr.20160286 CrossRefGoogle Scholar
Morris, M, O’Donovan, T, Ofi, B, Flavin, A. A rapid access palliative clinic to reduce waiting time for palliative radiotherapy in a regional cancer centre in Ireland. Int J Integr Care 2017; 17 (5): A158,1-8. http://doi.org/10.5334/ijic.3466 CrossRefGoogle Scholar
Thavarajah, N, Wong, K, Zhang, L et al. Continued success in providing timely palliative radiation therapy at the Rapid Response Radiotherapy program: a review of 2008-2012. Curr Oncol 2013; 20 (3): e206–e211. https://doi:10.3747/co.20.1342 CrossRefGoogle Scholar
Lefresne, S, Berthelet, E, Cashman, R et al. The Vancouver rapid access clinic for palliative lung radiation, providing more than just rapid access. Support Care Cancer, 2015; 23: 125–132. https://doi:10.1007/s00520-014-2345-6 CrossRefGoogle Scholar
Danielson, B, Fairchild, A. Beyond palliative radiotherapy: a pilot multidisciplinary brain metastases clinic. Support Care Cancer 2012; 20: 773–781. https://doi:10.1007/s00520-011-1149-1 CrossRefGoogle Scholar
Dennis, K, Linden, K, Balboni, T, Chow, E. Rapid access palliative radiation therapy programs: an efficient model of care. Future Oncol 2015; 11 (17) 2417–2426. https://doi:10.2217/fon.15.153 CrossRefGoogle Scholar
Berger, M L, Dreyer, N, Anderson, F, Towse, A, Sedrakyan, A, Normand, S-L. Prospective observational studies to assess comparative effectiveness: the ISPOR good research practices task force report. Value Health 2012; 15 (2): 217–230. https://doi.org/10.1016/j.jval.2011.12.010 CrossRefGoogle Scholar