title: The Vancouver rapid access clinic for palliative lung radiation, providing more than just rapid access.
abstract: OBJECTIVE
  The Vancouver Rapid Access (VARA) clinic aimed to deliver urgent palliative radiotherapy (RT) and holistic care to patients with newly diagnosed incurable lung cancer. The purpose of this paper is to describe the 9-month pilot phase of the clinic and to compare its efficacy to standard practice.
  
  
  METHODS
  A multidisciplinary team performed the initial consult, and if appropriate, the patient received RT the same day and was connected with supportive services as required. Patient and treatment details were prospectively collected. A retrospective chart review of similar patients in standard practice 1 year prior to VARA was performed. Variables compared between VARA and standard practice included RT wait times and supportive service referrals.
  
  
  RESULTS
  During the pilot phase, 58 patients were assessed. Forty percent were inpatients, and 62% had an ECOG 2 or higher. Fifty-four patients received RT; the majority (72%) received RT on the same day as their consultation, compared to 41% in standard practice (p < 0.001). The most common sites treated were the bone (42%), lung (34%), and brain (14%). More than half of VARA patients (54%) were referred to an additional health service such as home care nursing compared to 31% of standard practice patients (p = 0.01). The VARA clinic decreased the proportion of patients double-booked into an oncologists schedule from 23 to 13% (p < 0.001).
  
  
  CONCLUSIONS
  The VARA clinic has improved wait times for palliative RT, increased patient access to supportive services, and improved the workload for lung radiation oncologists. This clinic could serve as a model for other patients with incurable cancer.
authors.affiliation: Radiation Therapy Program, BC Cancer Agency Vancouver Centre, Vancouver, BC, Canada.
authors.forename: Shilo
authors.initials: S
authors.lastname: Lefresne
authors.forename: Eric
authors.initials: E
authors.lastname: Berthelet
authors.forename: Rosemary
authors.initials: R
authors.lastname: Cashman
authors.forename: Karen
authors.initials: K
authors.lastname: Levy
authors.forename: Mitchel
authors.initials: M
authors.lastname: Liu
authors.forename: Hannah
authors.initials: H
authors.lastname: Carolan
authors.forename: Michael
authors.initials: M
authors.lastname: McKenzie
authors.forename: Paula
authors.initials: P
authors.lastname: Kostuik
authors.forename: Robert
authors.initials: R
authors.lastname: Olson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D002170:Canada; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000451:nursing* / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D012017:Referral and Consultation; D012189:Retrospective Studies; D014218:Triage