Improving the use of patient-reported outcomes among patients receiving radiation therapy during the COVID-19 pandemic.

INTRODUCTION: The use of Patient-Reported Outcomes (PROs) is an important part of care for patients receiving radiation therapy. Established processes for patients to complete symptom screening using PROs were disrupted by the COVID-19 pandemic. This study reports the implementation of a Radiation Therapist led "champion" model to support the use of PROs during the COVID-19 pandemic. METHODS: Patient charts were audited May 3 to May 22, 2020 to measure the initial impact of the pandemic on weekly completion rates of PROs for patients receiving active radiation treatment. Beginning May 25, 2020, two Radiation Therapists acted as champions to promote the use of PROs among patients and staff. Weekly completion rates of PROs were monitored from May 25, 2020 to May 28, 2021. The type of Patient Reported Outcome Measure (PROM) utilized and treatment intent was also recorded. RESULTS: After implementing the champion model, the weekly completion of PROs increased to an average of 47.0 ± 11.7 (47.5 ± 12.6%) from the initial baseline average of 8.7 ± 1.5 (9.4 ± 2.1%). For PROs completed, the distribution of PROMs was an average of 37.2 ± 9.6 (47.7 ± 12.7%) and 9.8 ± 3.5 (47.0 ± 16.9%) for the Revised Edmonton Symptom Assessment Scale (ESAS-r) and the Expanded Prostate Cancer Index Composite (EPIC) respectively. An average of 5.1 ± 2.9 (26.3 ± 12.7%) and 41.9 ± 10.1 (52.4 ± 14.1%) was recorded for palliative and curative intent respectively. DISCUSSION: An increased number of PROs were completed after implementing the Radiation Therapist led champion model. Patients receiving a radical course of treatment more frequently completed PROs, which in part reflects the longer treatment courses with increased opportunity for PROs to be completed. CONCLUSION: The Radiation Therapist led champion model supported ongoing monitoring and completion of PROs during the COVID-19 pandemic and has now been integrated into the department's standard clinical practice.

Magnetic Vortex States in Toroidal Iron Oxide Nanoparticles: Combining Micromagnetics with Tomography.

Iron oxide nanorings have great promise for biomedical applications because of their magnetic vortex state, which endows them with a low remanent magnetization while retaining a large saturation magnetization. Here we use micromagnetic simulations to predict the exact shapes that can sustain magnetic vortices, using a toroidal model geometry with variable diameter, ring thickness, and ring eccentricity. Our model phase diagram is then compared with simulations of experimental geometries obtained by electron tomography. High axial eccentricity and low ring thickness are found to be key factors for forming vortex states and avoiding net-magnetized metastable states. We also find that while defects from a perfect toroidal geometry increase the stray field associated with the vortex state, they can also make the vortex state more energetically accessible. These results constitute an important step toward optimizing the magnetic behavior of toroidal iron oxide nanoparticles.

Collaborating with the Community: Improving Patient Access to Palliative Radiation Therapy.

PURPOSE: Palliative radiation therapy (PRT) has an essential role in cancer symptom control but is underutilized in Ontario. This initiative aimed to implement an educational outreach intervention to improve knowledge of and access to PRT among interprofessional palliative health care teams across an Ontario Local Health Integration Network. METHODS AND MATERIALS: A needs assessment was completed from June to September 2018 with interprofessional palliative health care teams. Participants completed a survey to identify perceived opportunities, barriers, and enablers to recommending or referring patients for PRT. Thematic analysis informed content of the educational outreach intervention and included how to access PRT, common indications, case studies, and side-effect management after completing PRT. The educational outreach intervention was completed from October 2018 to January 2019. Participants completed a survey, and results were analyzed using descriptive statistics. The number of patients who received PRT was determined by cross-referencing the regional database with the radiation oncology information system. RESULTS: Although 22.9% of participants had previously recommended or referred patients, 96.2% of participants agreed or strongly agreed that they are likely to recommend or refer patients for PRT after the educational outreach intervention (n = 131). An increase was observed in the number of patients receiving PRT from the community during the intervention period. CONCLUSIONS: The educational outreach intervention improved knowledge and the likelihood of interprofessional palliative health care teams providing access to PRT for patients in the community. More patients now receive PRT, conveying improved symptom control and quality of life.

Balancing Projects and Operations to Improve Organizational Capability.

Radiation therapy projects are necessary to improve organizational performance, implement new technology, and integrate evidence-based practices into the clinical environment. Although large-scale projects may have dedicated resources, relatively smaller scale projects may instead redirect resources from operational activities. This article explores how to facilitate continuous improvement by applying project management principles to health care projects at the level of the clinical team or department. Concepts described will focus on understanding the operational value of projects, common project management methodologies that can be applied, and strategies to resource smaller scale projects while continuing to meet operational demands.

Development of a Collaboration Model between Two Cancer Centres to Maintain Patient Access to Radiation Therapy during the Replacement of a Sole CT Simulator at a Regional Cancer Centre.

INTRODUCTION: Replacement of a sole computed tomography (CT) simulator at a Regional Cancer Centre risks interruption of patient access to radiation therapy clinical services. This study reports a collaboration model between two cancer centres to maintain patient access to radiation therapy during the replacement period. METHODS: Representatives from each cancer centre collaborated to plan and facilitate offsite CT simulation. Activities required were identified and included process coordination, patient consent, patient registration, requisitions, appointment bookings, immobilization equipment, staffing strategy, clinical practice protocols, data transfer, and cost recovery. The logistics of each activity were planned and mapped, with roles identified to perform each activity. During the 2-week replacement duration, from April 30 to May 11, 2018, patients consulted for radiotherapy were offered offsite CT simulation. RESULTS: A detailed process was developed to outline the flow of activities for successful coordination of offsite CT simulations. A total of 14 patients consented to radiation treatment during the CT simulator replacement downtime, of which 8 patients agreed to offsite CT simulation. A total of 11 body regions were simulated for the 8 patients. CT images acquired offsite were electronically transferred to the primary cancer centre to proceed with treatment planning and delivery. DISCUSSION: A collaboration model between two cancer centres was successfully developed and implemented to maintain patient access to radiation therapy during the replacement of a sole CT simulator at a regional cancer centre. CONCLUSION: This strategy and process developed could be valuable for future major equipment upgrades/replacements at other centres.

Outcomes of Peer Review for Radiotherapy Treatment Plans With Palliative Intent.

PURPOSE: Peer review of a proposed treatment plan is increasingly recognized as an important quality activity in radiation medicine. Although peer review has been emphasized in the curative setting, applying peer review for treatment plans that have palliative intent is receiving increased attention. This study reports peer review outcomes for a regional cancer center that applied routine interprofessional peer review as a standard practice for palliative radiotherapy. METHODS AND MATERIALS: Peer review outcomes for palliative radiotherapy plans were recorded prospectively for patients who began radiotherapy between October 1, 2015, and September 30, 2017. Recommended and implemented changes were recorded. The content of detailed discussions was recorded to gain insight into the complexities of palliative treatment plans considered during peer review. RESULTS: Peer review outcomes were reviewed for 1,413 treatment plans with palliative intent. The proportions of detailed discussions and changes recommended were found to be 139 (9.8%) and 29 (2.1%), respectively. The content of detailed discussions and changes recommended was categorized. Major changes represented 75.9% of recommended changes, of which 84.2% were implemented clinically. CONCLUSION: Many complexities exist that are specific to palliative radiotherapy. Interprofessional peer review provides a forum for these complexities to be openly discussed and is an important activity to optimize the quality of care for patients with treatment plans that have palliative intent.

Applying Project Management Processes to Successfully Complete Projects in Radiation Medicine.

The healthcare environment is complex and subject to continuous change. Decision makers must navigate through an increasing volume of information and incorporate new evidence into clinical practices. Implementing processes that effectively respond to this demand is essential. This article introduces project management processes and presents how they can be included into organizational practices to systematically deliver results. Initial strategies to develop a project management process include implementing project charters, developing and following project plans, and monitoring project status to ensure the intended purpose of the project is achieved. The integration of project management processes enhances the planning and implementation of evidence-based practices and supports the continuous improvement of care experienced by patients.