title: An innovative rapid response radiotherapy program to reduce waiting time for palliative radiotherapy.
abstract: BACKGROUND
  Waiting for radiation therapy (RT) in Ontario has been a major problem for the past decade. In 1996, the Toronto-Sunnybrook Regional Cancer Centre (TSRCC) initiated a Rapid Response Radiotherapy Program (RRRP) to provide timely palliative RT for symptom relief of patients with terminal cancer.
  
  
  OBJECTIVE
  This study reviews the clinical activity of the RRRP over the past 8 years to evaluate if we are meeting the objectives of the program.
  
  
  METHODS
  From the TSRCC oncology patient information system (OPIS) database, we retrieved the number of patients referred to the RRRP, their demographics, diagnosis and treatment for the calendar years 1996 to 2003 inclusive. We calculated the time interval between referral to consultation, consultation to simulation and the percentage of cases who started RT on their initial consultation for all new cases referred to the RRRP.
  
  
  RESULTS
  From 1996 to 2003, the number of cases seen in consultation increased from just over 200 cases annually in the first 2 years to about 500 cases per year in the last 4 years, for a total of 3,290. There were 1,792 (54%) men and 1,498 (46%) women; median age was 69 years (range, 21-95 years). Breast, lung, genitourinary and gastrointestinal primaries accounted for over 80% of all referrals. The majority was referred for palliative treatment of symptomatic bone (70%) or brain (14%) metastases. The dose fractionation for bone metastases was a single 8-Gy fraction in 45%, 20 Gy in five fractions in 42%, 30 Gy in ten fractions in 4% and other dose fractionations in 9%. Nearly 90% were seen within 2 weeks of referral (38% within 1 week). Eighty-five percent were simulated on the day of their initial consultation. Sixty percent started their RT treatment on the day of their consultation visit. The overall median interval from referral to treatment was 8 days.
  
  
  CONCLUSIONS
  Over the past 8 years, the annual number of new cases referred to the RRRP has doubled. The overall median interval from referral to consultation was 8 days. Sixty percent were simulated, planned and started treatment on the day of their initial consultation. We therefore are meeting our goal of providing rapid access to palliative RT for symptomatic cancer patients.
authors.affiliation: Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Danjoux
authors.forename: E
authors.initials: E
authors.lastname: Chow
authors.forename: A
authors.initials: A
authors.lastname: Drossos
authors.forename: L
authors.initials: L
authors.lastname: Holden
authors.forename: C
authors.initials: C
authors.lastname: Hayter
authors.forename: M
authors.initials: M
authors.lastname: Tsao
authors.forename: T
authors.initials: T
authors.lastname: Barnes
authors.forename: E
authors.initials: E
authors.lastname: Sinclair
authors.forename: M
authors.initials: M
authors.lastname: Farhadian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities / Q000706:statistics & numerical data; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000532:radiotherapy*; D009864:Ontario; D010166:Palliative Care / Q000379:methods* / Q000706:statistics & numerical data; D015397:Program Evaluation; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D035703:Therapies, Investigational; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists