issues knowledge – all patients who might benefit must see a clinical oncologist access – how...
TRANSCRIPT
Issues
Knowledge – all patients who might benefit must see a Clinical Oncologist
Access – how can we best get the patients to the technology
Opportunity – to be treated by the best staff with the best technique available
Describing a Cutting Edge Radiotherapy Service
Trish FisherClinical Director
Specialised Cancer Services
Simon PledgeLead Clinician Radiation Services
The Vision
The Sheffield Teaching Hospitals Corporate Strategy is entitled ‘Excellence as Standard’ and although Weston Park Hospital has a tradition of leading the field in Radiotherapy despite providing an efficient rapid service, recent operating conditions have stretched the service and resulted in a degree of stagnation.
Our vision is to move back to the Premier Division of Radiotherapy Providers in the UK.
The VisionAll patients who might benefit from radiotherapy
should receive it
All patients should receive their treatment promptly
All patients should receive state of the art treatment if appropriate
The patient experience should be optimal
Involvement in cutting edge research
All patients who might benefit from radiotherapy should receive it
The number of fractions delivered to the North Trent population are not at the NRAG recommended levels
Current (as at Mar 2011) : 55,376 fractionsNRAG Recommendations: 72,000 fractions
Lack of sufficient Clinical Oncology input into MDTs leading to Radiotherapy not being considered as an option
Patients not always discussed again at the MDT for consideration of subsequent treatment e.g. to review post operative histology
Radiotherapy not presented as a treatment option in the patients consultation with the clinician
Travel time to Radiotherapy Treatment Centre is a deterring factor for the patient
Potential Issues
Access Levels
Lack of General appreciation of Radiotherapy in STH
Anonymous eSurvey of STH Consultants n= approx 600
As of 10/6/11 78 responses 70% involved in Cancer care
Excluding those who felt they didn’t need to over half did not feel they knew enough about radiotherapy to discuss the treatment with patients
Over half thought an update/departmental visit would be useful
Potential Issues
Access Levels
Audit commenced to establish which MDTs are lacking sufficient Clinical Oncology input – qualified observers will then be focused on those MDTs
NSSGs to review and, where necessary revise, protocols regarding re-discussion at the MDT after initial treatment with either surgery or chemotherapy – audit against those guidelines to ensure protocols are followed
Encourage referral to Clinical Oncology for borderline / unenthusiastic patients – NSSGs to review referral protocols
Survey patients treated in the peripheral units re travel times
Next Steps
Access Levels
All patients should receive their treatment promptly
Cancer Waiting Time targets (62 day and 31 day subsequent treatments) should be achieved for all patients
We continue to aspire to meet the RCR targets of 14 days for palliative treatment and 28 days for radical treatment
Lack of available operational Linac hours (based on current staff establishment within Radiotherapy) – one machine currently not fully staffed
Increasing demand affects waiting times Late referral to a Clinical Oncologist due to sub optimal
patient pathways
Potential Issues
Waiting Times
31 Day Subsequent Treatment: Radiotherapy Treatments Percentage of Patients Meeting Standard
90%92%94%96%98%100%102%
Apr May Jun Jul Aug Sep Oct Nov Dec J an Feb Mar
2009/102010/112011/12
Radiotherapy Activity - 2005-06 to 2012-13
46,000
48,000
50,000
52,000
54,000
56,000
58,000
60,000
2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13
Fra
ctio
ns
0
50,000
100,000
150,000
200,000
250,000
Exp
osu
res
Fractions Exposures
Work ongoing to devise a methodology which calculates available capacity within Radiotherapy at a point in time
Waiting times monitoring information updated regularly Focused work on tightening referral pathways – review
current patient pathways and set aspirational targets for significant points
Next Steps
Waiting Times
All patients should receive state of the art treatment if appropriate
We are currently not in a position to provide technologically advanced forms of Radiotherapy where previously we’ve
led the field in many areas of development
Under provision of Image Guided Radio Radiotherapy (IGRT)Under provision of Intensive Modulated Radiotherapy (IMRT)No provision of Stereotactic Body Radiotherapy (SBRT)Under provision of In Vivo DosimetryLinacs do not have the required technological capability
Potential Issues
Technologies
IGRT development plan - prioritise tumour sites for extension of IGRT, including new technologies as they become available, e.g. on set kV imaging and seed implants
IMRT development plan - determine groups of patients / tumour groups who could benefit most from IMRT
SBRT development plan – business case in progress for lung cancer
In Vivo Dosimetry development plans – identify groups of patients / tumour groups who could benefit most
Linac replacement programme underway with commitment made to support two LA replacements - further discussion
required re other imminent replacements
Next Steps
Technologies
Technologies – Resource implications 1
IMRTCurrently around 17% of our radical fractions delivered via IMRT
UK centres aiming for 33%
- N Trent we estimate over 40% because of case mix
Recently surveyed Oncologist opinion at WPH
- aim for 54%
Increase to1090 IMRT plans per year from 361 would require- Successful restructuring of Radiotherapy Physics and full recruitment to plan
- A few more Physicists and Dosimetrists
- Takes no account of the expected 3% increase in workload generally
Technologies – Resource implications 2
SBRT- Particularly resource-intensive especially linac time
IGRT- Resource implications for both Radiography and Physics staff time
- How many staff depends on clinical demand for IGRT – not yet evaluated
In vivo dosimetry- Can be absorbed thanks to innovative software developed in house
Patient Experience
Holistic patient centred approach at all times
Patient information room recently opened
Patient Information and Paediatric Clinical Specialist Radiographer – no current funding
Actively seek feedback and respond to it
How to Improve Cancer SurvivalKings Fund June 2011
“It is more important to improve access to surgery and radiotherapy than access to cancer drugsIn terms of overall allocation of resources, this suggests that the
contribution of the Cancer Drugs Fund to improving overall outcomes will be very limited”
“There is significant variation across England in the numbers of patients receiving surgery and radiotherapy, and in the use of the most up-to-date techniques”
“As acknowledged by the government in 2007, continued investment
is needed to increase England’s radiotherapy capacity”