title: Reducing Patient Waiting Times for Radiation Therapy and Improving the Treatment Planning Process: a Discrete-event Simulation Model (Radiation Treatment Planning).
abstract: OBJECTIVE
  We analysed the radiotherapy planning process at the London Regional Cancer Program to determine the bottlenecks and to quantify the effect of specific resource levels with the goal of reducing waiting times.
  
  
  METHODS
  We developed a discrete-event simulation model of a patient's journey from the point of referral to a radiation oncologist to the start of radiotherapy, considering the sequential steps and resources of the treatment planning process. We measured the effect of several resource changes on the ready-to-treat to treatment (RTTT) waiting time and on the percentage treated within a 14 calendar day target.
  
  
  RESULTS
  Increasing the number of dosimetrists by one reduced the mean RTTT by 6.55%, leading to 84.92% of patients being treated within the 14 calendar day target. Adding one more oncologist decreased the mean RTTT from 10.83 to 10.55 days, whereas a 15% increase in arriving patients increased the waiting time by 22.53%. The model was relatively robust to the changes in quantity of other resources.
  
  
  CONCLUSIONS
  Our model identified sensitive and non-sensitive system parameters. A similar approach could be applied by other cancer programmes, using their respective data and individualised adjustments, which may be beneficial in making the most effective use of limited resources.
authors.affiliation: Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: V
authors.initials: V
authors.lastname: Babashov
authors.affiliation: Department of Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.
authors.forename: I
authors.initials: I
authors.lastname: Aivas
authors.affiliation: Ivey Business School, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. Electronic address: mbegen@ivey.uwo.ca.
authors.forename: M A
authors.initials: MA
authors.lastname: Begen
authors.affiliation: Department of Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.
authors.forename: J Q
authors.initials: JQ
authors.lastname: Cao
authors.affiliation: Department of Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Rodrigues
authors.affiliation: Department of Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.
authors.forename: D
authors.initials: D
authors.lastname: D'Souza
authors.affiliation: Department of Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Lock
authors.affiliation: Ivey Business School, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: G S
authors.initials: GS
authors.lastname: Zaric
mesh_terms: D003198:Computer Simulation; D019091:Critical Pathways; D006801:Humans; D009369:Neoplasms / Q000532:radiotherapy*; D009864:Ontario; D010347:Patient Care Planning; D018787:Radiation Oncology / Q000592:standards / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D061665:Time-to-Treatment; D014850:Waiting Lists; D000078329:Workforce
keywords: Discrete-event simulation; modelling; radiotherapy; waiting time