A Feasibility Study of Mepitel Film for the Prevention of Breast Radiation Dermatitis in a Canadian Center.

PURPOSE: Severe radiation dermatitis (RD) is distressing and may have adverse long-term effects including fibrosis and telangiectasia. Treatment interruptions due to severe RD may increase the risk of recurrence. Two randomized trials of Mepitel film demonstrated efficacy in preventing severe RD in breast cancer, but this product has not been widely adopted in North America. We aimed to assess the feasibility and efficacy of Mepitel film for prevention of breast RD at a Canadian center. METHODS AND MATERIALS: Patients were stratified based on breast size and receipt of postmastectomy radiation therapy. The primary outcome was RD grade using the Common Terminology Criteria for Adverse Events. Secondary outcomes included moist desquamation, patient- and clinician-reported symptoms of skin toxicity, and cosmetic outcomes. RESULTS: Thirty patients receiving external beam radiation therapy to the breast or chest wall were enrolled. Two patients (6.7%) discontinued use of the Mepitel film before completing radiation therapy. No patients developed grade 3 RD or higher. Five patients (17.9%) developed grade 2 RD: 3 (10.7%) had moist desquamation, and 2 (7.1%) had brisk erythema without moist desquamation. CONCLUSIONS: Mepitel film completely prevented grade 3 RD. Rates of moist desquamation and grade 2 RD were lower with Mepitel film than in studies using aqueous cream, but unlike previous trials of Mepitel film we did not achieve complete prevention of moist desquamation. Further research is needed to confirm the efficacy of Mepitel film versus standard prophylaxis for RD and identify the patients who will benefit the most from the film.

Going Lean to Improve the Patient Experience in a High-Throughput Brachytherapy Program.

PURPOSE: This article describes how a targeted application of Lean methodology in a high-volume brachytherapy department can result in significant and sustained change that benefits patients and staff. METHODS AND MATERIALS: In November 2013, staff and physicians carried out a 3-day Kaizen (rapid improvement) Event with three identified goals: to reduce same-day patient wait times, to reduce staff-hours spent scheduling patients, and to increase the utilization of the brachytherapy operating room (OR). RESULTS: At the Lean Event, staff drew up a future state that included a standard booking process (standard booking times for procedures, a booking guideline, and OR schedule reviews) and shortly after the event, time checks, or procedure checkpoints, were introduced to make teams aware of how each case proceeds through key milestones. The implementation of these changes led to a reduction in the average same-day wait times for patients by 37 minutes and 2 seconds and eliminated the need for a team of seven to eight staff to meet weekly to create a feasible OR schedule. Instead, a team of two to three reviews the schedule with the goal of optimizing the utilization of the OR on anesthesia-staffed days and, as a result, OR utilization has gone from 59% to 97%. CONCLUSIONS: By using Lean methodology and by emphasizing the Lean concepts of measurement, standardization, simplification, and staff participation, the Brachytherapy Leadership team was able to address barriers to change and improve the department's quality metrics. If an institution has to choose between starting on a small-scale project with Lean or not at all, organizations are encouraged to start with a targeted application of Lean and then expand by conducting research on quality and/or striking a quality improvement committee.