The Association of Change in Weight During Radiotherapy Treatment With Clinical Outcomes in Patients With Stage I-III Esophageal Cancer.

Esophageal carcinoma (EC) and nutritional status are strongly linked due to swallowing disruptions and treatment-related toxicities. Therefore, malnutrition and weight loss (WL) occur in 85% and 79% of EC patients, respectively. WL is frequently associated with worse EC patient outcomes, however, WL during radiation therapy (RT) and EC patient outcomes have not been well established. The purpose of this study is to retrospectively review the association of WL during RT treatment of EC with clinical outcomes. Non-metastatic EC patients from our institution treated between 2010 and 2018, receiving total prescribed dose >40 Gy and aged >18 years, were included. Patients were analyzed by WL during RT, with categories of ≥5% vs. <5% and ≥10% vs. <10%. Patient characteristics and treatment regimens were similar across all WL groups. In univariate analysis, ≥5% and ≥10% WL were significantly associated with both worse overall survival (OS) and progression-free survival (PFS), and ≥10% WL was significantly associated with increased local recurrence. In multivariate analysis, ≥5% WL was significantly associated with OS and PFS. With both ≥5% and ≥10% WL throughout the radiation treatment being detrimental to OS and PFS. The importance of nutritional support in EC patients receiving radiotherapy is further validated.

The palliative clinical specialist radiation therapist: A CAMRT White Paper.

Palliative radiation therapy (pRT) is an effective tool for people with incurable cancer, in the treatment of many cancer-related symptoms such as pain, bleeding and dyspnea. As utilization rates for palliative radiation therapy increase, the demands on the healthcare system continue to grow. Radiation Therapists with advanced knowledge, skills and judgements began demonstrating their ability to practice autonomously in 2004, with the development of the Clinical Specialist Radiation Therapist (CSRT) role. Since this time, CSRTs with a specific focus in pRT (pCSRT) have been increasing in both numbers as well as their positive effects on the cancer care system. Integrating a pCSRT into the existing pRT system has resulted in increased access to and quality of pRT being delivered to palliative cancer patients. The benefits of the addition of pCSRTs to the cancer care system include increasing system capacity and increasing quality of care. This white paper provides information related to the improvements that can be realized in a RT program related to the care and treatment of its palliative patients by adding a pCSRT to the interprofessional healthcare team and suggest it as one of many strategies that can be undertaken to make improvements to access and quality of care.

A Canadian experience of palliative advanced practice radiation therapy TIPS: Training, implementation, practice and sustainability.

The concept of the Advanced Practice Radiation Therapist (APRT) was created in 2004, in response to pressures on the radiation treatment sector in Ontario. This led to development, piloting and integration of the Clinical Specialist Radiation Therapist (CSRT) into Ontario's cancer care framework. A national certification process, competency profile and protected title of APRT(T) were established in 2017, under the Canadian Association of Medical Radiation Technologists (CAMRT), in collaboration with Cancer Care Ontario/Ontario Health. This report describes the approach to development, validation and measuring impact of the CSRT role in Ontario, specifically in palliative care (pCSRT). It also presents information to assist jurisdictions interested in developing a pCSRT position, describing competency development, assessment, and assumption of practice, and providing some keys to success. This is foundational for consistent expansion of the pCSRT role to other regions to continue to increase system capacity while improving the quality of cancer care.

Utilizing Quality Improvement Methods to Examine the Radiation Therapy Pathway for Patients Requiring Palliative Radiation Therapy at a Community Cancer Center.

BACKGROUND: At a community cancer center, during weekly quality improvement huddles, the radiation therapy team expressed stress and frustration with the pretreatment pathway for patients requiring palliative radiotherapy. As the department was meeting provincial targets with respect to wait times, it was unknown why the consensus around the department reflected discomfort and stress. METHODS: Four radiation therapists formed a quality improvement project team, intent on utilizing a data-driven improvement cycle to investigate and address opportunities to improve the discomfort around this pretreatment pathway. After defining the process and identifying the customers (the health care providers operating in this pathway), the team conducted interviews with each person, transcribing answers verbatim, and grouping results by discipline. Utilizing the interview themes, each discipline identified one or two priorities to measure, as well as metrics to capture the magnitude and prevalence of these priorities. RESULTS: Each discipline's priorities were measured and analyzed. The identified issues brought forward at the weekly quality improvement huddles were not as prevalent as expected. Minor changes were implemented for priority issues. CONCLUSION: The team focused on the four principles of quality improvement: the patient, team, process, and data to address the expressed discomfort around this specific radiation therapy pathway. The results dispelled some of the myths among teams and provided solutions to areas where minor improvements were required. Utilizing the data, an evidence-informed timeline was validated, encouraging task deadlines to be more evenly distributed across the pathway. Plans to monitor this pathway are being established. The team was successful in contributing to a growing culture of continuous improvement at this community cancer center.

Understanding and Addressing the Informational Needs of Radiation Therapists Concerning the Management of Anxiety and Depression in Patients Receiving Radiation Therapy Treatment.

PURPOSE: Cancer Care Ontario has mandated that all health care professionals working within oncology centres in Ontario should routinely screen and address symptoms of anxiety and depression in cancer patients. This study aims to assess the informational needs of radiation therapists (RTs) concerning the discussion and management of anxiety and depression symptoms in patients receiving radiation therapy treatment. It will also attempt to determine whether RTs believe that reviewing patients' self-reported symptoms should be included as part of their routine patient assessment. METHODS: A questionnaire was initially piloted at the host institution to six randomly chosen RTs and then sent via e-mail to all radiation therapists practising in Ontario, Canada (N = 921). The online questionnaire consisted of multiple choice questions and was divided into the following four themes: (1) RT comfort levels surrounding the topics of anxiety and depression; (2) management of anxiety and depression in cancer patients; (3) further education needed/requested in anxiety and depression symptom management; and (4) the Edmonton Symptom Assessment System (ESAS). Data analyses included the calculation of means and two sample two-sided t tests to examine the relationships between various demographics and responses. RESULTS: RTs feel more comfortable in the discussion of issues surrounding anxiety when compared with depression. The most common positive factor affecting RTs' comfort levels addressing emotional distress is previous experience with patients who have expressed these symptoms; whereas, the most common adverse factor affecting comfort levels is the lack of education regarding emotional distress. Eighty-seven percent of RTs would like further education surrounding anxiety and depression symptom management. Seventy-eight percent of RTs agree that ESAS is an important tool for symptom management; however, only 16% actually use this tool in their clinical practice. CONCLUSIONS: Although RTs within Ontario feel fairly comfortable addressing anxiety and depression symptoms, they have indicated that further education regarding these topics would be useful. Further research into seamlessly incorporating ESAS into RTs' daily practice should be considered.