Fosmire H

Background: Palliative radiotherapy plays an important role in metastatic lung cancer (LC) treatment. Of VHA LC patients, 46% present with metastatic disease. The American Society for Radiation Oncology (ASTRO) has developed evidenced-based guidelines regarding management of metastatic LC.

Methods: In May 2016, an electronic survey of 84 VHA Radiation Oncologists (ROs) was conducted to assess metastatic LC management. Information on years in practice, employment status, academic appointment, board certification, and familiarity with ASTRO lung cancer guidelines was obtained. Two clinical scenarios were presented to glean opinions on dose/fractionation schemes preferred, preferences for/ against concurrent chemotherapy, and use of endobronchial brachytherapy (EBB) and/or YAG laser technology. Survey results were assessed for concordance with ASTRO guidelines.

Results: The survey response rate was 64%. Among respondents, 96% were board certified, 90% held academic appointments, 85% were full-time employees, 11% were part-time employees, and 3% were employed on contract. When asked about use of palliative radiotherapy for lung cancer, 88% were familiar with ASTRO guidelines, 13% had used Stereotactic Body Radiotherapy (SBRT) for palliation, and 26% referred to outside centers for EBB.

Clinical Scenarios: Case 1 – Metastatic (M1b) disease with local chest wall pain and 3 month life expectancy: All respondents recommended palliative radiotherapy, and most (98%) did not recommend concurrent chemotherapy. The fractionation schemes most often used were 20 Gy in 5 fractions (69%) and 30 Gy in 10 fractions (22%).

Case 2 – Metastatic (M1a) disease with endobronchial tumor blockage: 87% of the respondents would use conventional radiotherapy for symptoms such as hemoptysis, intractable cough, and pain, and the remainder would use SBRT. Almost half of respondents (49%) recommended EBB or YAG lung re-expansion before external beam radiotherapy.

Conclusion: In our study of VHA ROs and their knowledge of management of advanced (M1a/M1b) lung cancer, we found no distinction in clinical decisions based on demographic profiles. Almost all reported knowledge of evidence-based treatment guidelines for palliative radiotherapy of lung cancer and most recommended treatment according to current guidelines.”

Background: Palliative radiotherapy plays an important role in metastatic lung cancer (LC) treatment. Of VHA LC patients, 46% present with metastatic disease. The American Society for Radiation Oncology (ASTRO) has developed evidenced-based guidelines regarding management of metastatic LC.

Methods: In May 2016, an electronic survey of 84 VHA Radiation Oncologists (ROs) was conducted to assess metastatic LC management. Information on years in practice, employment status, academic appointment, board certification, and familiarity with ASTRO lung cancer guidelines was obtained. Two clinical scenarios were presented to glean opinions on dose/fractionation schemes preferred, preferences for/ against concurrent chemotherapy, and use of endobronchial brachytherapy (EBB) and/or YAG laser technology. Survey results were assessed for concordance with ASTRO guidelines.

Results: The survey response rate was 64%. Among respondents, 96% were board certified, 90% held academic appointments, 85% were full-time employees, 11% were part-time employees, and 3% were employed on contract. When asked about use of palliative radiotherapy for lung cancer, 88% were familiar with ASTRO guidelines, 13% had used Stereotactic Body Radiotherapy (SBRT) for palliation, and 26% referred to outside centers for EBB.

Clinical Scenarios: Case 1 – Metastatic (M1b) disease with local chest wall pain and 3 month life expectancy: All respondents recommended palliative radiotherapy, and most (98%) did not recommend concurrent chemotherapy. The fractionation schemes most often used were 20 Gy in 5 fractions (69%) and 30 Gy in 10 fractions (22%).

Case 2 – Metastatic (M1a) disease with endobronchial tumor blockage: 87% of the respondents would use conventional radiotherapy for symptoms such as hemoptysis, intractable cough, and pain, and the remainder would use SBRT. Almost half of respondents (49%) recommended EBB or YAG lung re-expansion before external beam radiotherapy.

Conclusion: In our study of VHA ROs and their knowledge of management of advanced (M1a/M1b) lung cancer, we found no distinction in clinical decisions based on demographic profiles. Almost all reported knowledge of evidence-based treatment guidelines for palliative radiotherapy of lung cancer and most recommended treatment according to current guidelines.”

Background: Palliative radiotherapy plays an important role in metastatic lung cancer (LC) treatment. Of VHA LC patients, 46% present with metastatic disease. The American Society for Radiation Oncology (ASTRO) has developed evidenced-based guidelines regarding management of metastatic LC.

Methods: In May 2016, an electronic survey of 84 VHA Radiation Oncologists (ROs) was conducted to assess metastatic LC management. Information on years in practice, employment status, academic appointment, board certification, and familiarity with ASTRO lung cancer guidelines was obtained. Two clinical scenarios were presented to glean opinions on dose/fractionation schemes preferred, preferences for/ against concurrent chemotherapy, and use of endobronchial brachytherapy (EBB) and/or YAG laser technology. Survey results were assessed for concordance with ASTRO guidelines.

Results: The survey response rate was 64%. Among respondents, 96% were board certified, 90% held academic appointments, 85% were full-time employees, 11% were part-time employees, and 3% were employed on contract. When asked about use of palliative radiotherapy for lung cancer, 88% were familiar with ASTRO guidelines, 13% had used Stereotactic Body Radiotherapy (SBRT) for palliation, and 26% referred to outside centers for EBB.

Clinical Scenarios: Case 1 – Metastatic (M1b) disease with local chest wall pain and 3 month life expectancy: All respondents recommended palliative radiotherapy, and most (98%) did not recommend concurrent chemotherapy. The fractionation schemes most often used were 20 Gy in 5 fractions (69%) and 30 Gy in 10 fractions (22%).

Case 2 – Metastatic (M1a) disease with endobronchial tumor blockage: 87% of the respondents would use conventional radiotherapy for symptoms such as hemoptysis, intractable cough, and pain, and the remainder would use SBRT. Almost half of respondents (49%) recommended EBB or YAG lung re-expansion before external beam radiotherapy.

Conclusion: In our study of VHA ROs and their knowledge of management of advanced (M1a/M1b) lung cancer, we found no distinction in clinical decisions based on demographic profiles. Almost all reported knowledge of evidence-based treatment guidelines for palliative radiotherapy of lung cancer and most recommended treatment according to current guidelines.”

Background: Radiation Oncology had 8.5 day access in March 2017 and desired to achieve same day access as per VA Secretary David M. Shulkin’s goal. In addition, we wanted to decrease the time from diagnosis to first treatment for cancer patients. This took 45 days for non-small cell lung cancer in March 2016 and ROPA (radiation oncology practice assessment) required 28 days between diagnosis and first treatment.

Methods: We developed use of an e-consult process to screen and workup patients the same day that the consult is received. This allowed workup, pathology review, and other team consultations to occur in parallel, therefore decreasing time between diagnosis and first treatment of any kind. Our Radiation Oncology nurses reorganized their workflow to track each step in the workup and contact patients when they miss a step. We also track the time that it takes our MSA to reach a patient to schedule a face to face meeting, discovering that it requires multiple telephone calls
throughout the day in order to reach a patient.

Conclusions: We have been able to reliably complete consults within 1 day since initiating this process. We have been able to decrease the time between consult made and patient scheduled from 4 to 2 days. We have been able to decrease the time between consult made and patient seen face to face in Radiation Oncology from 7 to 3 days. Time from diagnosis to first treatment of any kind decreased from 45 days to 39 days.

Background: Radiation Oncology had 8.5 day access in March 2017 and desired to achieve same day access as per VA Secretary David M. Shulkin’s goal. In addition, we wanted to decrease the time from diagnosis to first treatment for cancer patients. This took 45 days for non-small cell lung cancer in March 2016 and ROPA (radiation oncology practice assessment) required 28 days between diagnosis and first treatment.

Methods: We developed use of an e-consult process to screen and workup patients the same day that the consult is received. This allowed workup, pathology review, and other team consultations to occur in parallel, therefore decreasing time between diagnosis and first treatment of any kind. Our Radiation Oncology nurses reorganized their workflow to track each step in the workup and contact patients when they miss a step. We also track the time that it takes our MSA to reach a patient to schedule a face to face meeting, discovering that it requires multiple telephone calls
throughout the day in order to reach a patient.

Conclusions: We have been able to reliably complete consults within 1 day since initiating this process. We have been able to decrease the time between consult made and patient scheduled from 4 to 2 days. We have been able to decrease the time between consult made and patient seen face to face in Radiation Oncology from 7 to 3 days. Time from diagnosis to first treatment of any kind decreased from 45 days to 39 days.

Background: Radiation Oncology had 8.5 day access in March 2017 and desired to achieve same day access as per VA Secretary David M. Shulkin’s goal. In addition, we wanted to decrease the time from diagnosis to first treatment for cancer patients. This took 45 days for non-small cell lung cancer in March 2016 and ROPA (radiation oncology practice assessment) required 28 days between diagnosis and first treatment.

Methods: We developed use of an e-consult process to screen and workup patients the same day that the consult is received. This allowed workup, pathology review, and other team consultations to occur in parallel, therefore decreasing time between diagnosis and first treatment of any kind. Our Radiation Oncology nurses reorganized their workflow to track each step in the workup and contact patients when they miss a step. We also track the time that it takes our MSA to reach a patient to schedule a face to face meeting, discovering that it requires multiple telephone calls
throughout the day in order to reach a patient.

Conclusions: We have been able to reliably complete consults within 1 day since initiating this process. We have been able to decrease the time between consult made and patient scheduled from 4 to 2 days. We have been able to decrease the time between consult made and patient seen face to face in Radiation Oncology from 7 to 3 days. Time from diagnosis to first treatment of any kind decreased from 45 days to 39 days.