Better Care Through Hypofractionation

ABSTRACT

Aim: In the context of the COVID-19 pandemic, the radiation oncology department at our institution aimed to adapt its approach by analyzing and expanding the use of hypofractionation in order to be able to continue treating patients according to prescribed timelines, to reduce the risks of patient and staff exposure to COVID-19 and minimize the risks of service interruptions due to departmental outbreaks. Process Site specific treatment groups were asked to review existing literature on hypofractionation. Practice guides were then developed for each tumour site and a hypofractionation policy was created. To ensure close follow-up of this policy, weekly meetings were established in each treatment group in which all cases were reviewed. The use of non-hypofractionated schedules had to be justified by the treating physician. Data were collected to analyze the impact of these measures on the service. Patients were surveyed to gauge the level of safety felt during their treatments. Benefits/Challenges When the same number of patients treated per year is maintained, hypofractionation increases availability at treatment machines, allowing reallocation of human resources. For example, technologists could be allocated to other tasks such as quality improvement initiatives, patient education and research. Hypofractionation also reduces overall costs to cancer programs, where potential savings from the reduced costs could be reinvested in new technologies and radiotherapy equipment. Fewer fractions also increase patient comfort, reduce the number of visits and improve waiting room management. This approach also increases the capacity to prepare for the next wave of patients that is anticipated post-pandemic due to decreased access to diagnosis and care during the past two years. Impact/Outcomes: The use of hypofractionation quickly became common practice in our centre. In only a few months, the number of fractions given per new treatment start fell from 10.81 in 2019-2020 to 8.29 in 2020-2021. The sustainability of this practice change is maintained, as hypofractionation is now standard practice for most tumour sites at our institution. Satisfaction amongst patients regarding this change during the first wave of the pandemic was very high (70% very satisfied and 30% satisfied). Radiotherapy centres facing human resource shortages as well as the health care network as a whole would benefit from expanding the use of hypofractionation in their centres. Copyright © 2022