title: Clinic offering affordable radiation therapy to increase access to care for patients enrolled in hospice.
abstract: OBJECTIVE
  A majority of patients enrolled in hospice have advanced cancer. Most of them are burdened by symptoms related to uncontrolled tumor growth. Although palliative radiation therapy (RT) is highly effective, only 1% of hospice patients are ever referred. Commonly cited concerns include high treatment cost, burden of travel for multiple visits, and a perceived reluctance of radiation oncologists to deliver single-fraction RT.
  
  
  METHODS
  A clinic offering affordable RT to patients in hospice was developed to simplify the intake, reduce cost, and minimize travel to a single visit. The goal was to evaluate, simulate and plan treatment, and treat patients with a single fraction of palliative RT within a 4-hour period.
  
  
  RESULTS
  The initial 18-month experience is reported in this Health Information Portability and Accountability Act-compliant report that was approved by the Virginia Commonwealth University Institutional Review Board. Eight referrals were received from local hospice agencies that had not referred any patients in previous years. A telephone screening process avoided unnecessary travel for two patients who were not candidates for RT. Two additional patients who were evaluated with a same-day computed tomography simulation were not good candidates for RT. Ultimately, four patients were successfully treated with single-fraction palliative RT of 8 Gy. None had to disenroll from hospice.
  
  
  CONCLUSIONS
  This novel program increased access to palliative RT for patients in hospice who would otherwise not have been referred. The main challenge identified was a need for ongoing educational activities at hospice agencies where staff turnover may be high and understanding about palliative RT can be limited.
authors.affiliation: Massey Cancer Center, Virginia Commonwealth University; Hunter Holmes McGuire Veterans Affairs Hospital, Richmond, VA; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, MD; and Blanchard Valley Health System, Findlay, OH jschuste@mcvh-vcu.edu.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Schuster
authors.affiliation: Massey Cancer Center, Virginia Commonwealth University; Hunter Holmes McGuire Veterans Affairs Hospital, Richmond, VA; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, MD; and Blanchard Valley Health System, Findlay, OH.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Smith
authors.affiliation: Massey Cancer Center, Virginia Commonwealth University; Hunter Holmes McGuire Veterans Affairs Hospital, Richmond, VA; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, MD; and Blanchard Valley Health System, Findlay, OH.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Coyne
authors.affiliation: Massey Cancer Center, Virginia Commonwealth University; Hunter Holmes McGuire Veterans Affairs Hospital, Richmond, VA; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, MD; and Blanchard Valley Health System, Findlay, OH.
authors.forename: Stephen
authors.initials: S
authors.lastname: Lutz
authors.affiliation: Massey Cancer Center, Virginia Commonwealth University; Hunter Holmes McGuire Veterans Affairs Hospital, Richmond, VA; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, MD; and Blanchard Valley Health System, Findlay, OH.
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Anscher
authors.affiliation: Massey Cancer Center, Virginia Commonwealth University; Hunter Holmes McGuire Veterans Affairs Hospital, Richmond, VA; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, MD; and Blanchard Valley Health System, Findlay, OH.
authors.forename: Drew
authors.initials: D
authors.lastname: Moghanaki
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000592:standards*; D017051:Hospice Care / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics / Q000532:radiotherapy*; D010166:Palliative Care / Q000191:economics / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data; D014768:Virginia