Rapid Access Palliative Radiation Therapy Clinics: The Evidence Is There, but Where Are the Clinics? An Australian and New Zealand Perspective.

PURPOSE: First developed in Canada in the 1990s, Rapid Access Palliative Radiation Therapy (RAPRT) clinics have subsequently spread internationally to expedite treatment for near end-of-life patients, sparing them the need for multiple visits to the department. A "classical" RAPRT clinic is herein defined as "a dedicated clinic specifically established to enable (ideally) same day consultation, planning for, and delivery of palliative radiation treatment." The aim of this work was to determine the current status of these clinics in Australia and New Zealand (ANZ). METHODS AND MATERIALS: A phone survey of all 100 Australian and 10 NZ radiation therapy centers was conducted in March and April 2021. The Chief Medical Officers of the 2 large private practices (GenesisCare and Icon) also approved the survey and answered on behalf of their 57 centers. A single page questionnaire was used, seeking information on the logistics and clinical details of past and present RAPRT clinics, and reasons why other centers do not have one. RESULTS: The survey response rate was 100%. There are only 3 current RAPRT clinics (2.7%). The dominant treatment indication is bone metastases (85%-90%), with most patients receiving single fractions (60%-90%), but commencement on the same day is variable (35%-90%). Five other clinics (4.5%) closed after 4 months to 7 years, but the clinical features were similar. By far, the most common reason (95%) given by the 107 centers without a current RAPRT clinic was that these patients are accommodated using existing resources. CONCLUSIONS: Classical RAPRT clinics have not been widely embraced in ANZ. There are alternative strategies such as the Advanced Practice Radiation Therapist model and techniques to avoid the conventional computed tomography-simulation step, which may also expedite treatment for palliative patients.

The prone technique for breast irradiation - is it ready for clinical trials?

PURPOSE: Our aim was to determine whether a radiotherapy technique for treating breast cancer patients in a prone position could be developed as a means of reducing toxicity. We also aimed to consider its suitability for testing in a large randomized study. METHODS AND MATERIALS: Based on the sparse literature and techniques currently used at other centres, we designed a simple technique for simulation and treatment in the prone position. A specialised patient positioning device was designed to allow the breast to hang vertically downwards away from the chest wall and away from the contralateral breast. Planning and treatment were performed, and clinical data on the first 40 patients treated were reviewed. RESULTS: The reasons given by clinicians for choosing the prone technique included a large, pendulous breast shape (36 patients), an elevated risk of pneumonitis (three patients) and inability to adopt a supine position due to arthritis (one patient). The treatment was well tolerated, although 50% of the patients still developed moist desquamation. All but one patient completed their full course of radiotherapy. Dosimetric analysis revealed high levels of dose homogeneity and low doses to surrounding normal structures. With a median follow-up of 11 months, only one patient has developed metastatic disease, and one has locally recurred. CONCLUSIONS: This study shows that prone breast irradiation for patients with large or pendulous breasts can be readily developed in radiotherapy treatment centers and could be tested for efficacy in a large, multi-centre randomized trial.

Do cancer follow-up consultations create anxiety?

INTRODUCTION: Recent literature has suggested that follow- up visits provide psychological support for patients with cancer, but largely without objective evidence. AIMS: To examine the psychological impact of follow-up consultations on cancer patients and identify factors that influence patient anxiety. METHODS: Patients attending a routine follow-up at Liverpool Cancer Therapy Centre were surveyed. Using the State & Trait Anxiety Inventory (STAI), anxiety scores were obtained before and after consultation. RESULTS: Two hundred and thirty-one patients participated, 199 patients were treated with curative intent, 62% were male. The mean anxiety score was higher in females and in palliative cases. Lower levels of social support, poor perception of own health and receiving bad news during consultation were associated with higher STAI scores. Satisfaction with cancer treatment was associated with lower STAI scores. There was a small but statistically significant reduction of anxiety scores after consultation (p = 0.02). CONCLUSIONS: When measured objectively, specialist consultation appears to have a small, but statistically significant, positive impact on the level of patient anxiety. Patient satisfaction correlated well with the patient anxiety levels.