A new model of care - developing an RTT led regional radiotherapy late effects service
Lisa Durrant,
United Kingdom
MO-0562
Abstract
A new model of care - developing an RTT led regional radiotherapy late effects service
Authors: Lisa Durrant1, Alexandra Board2, Samantha Bostock3, Hazel Clarke4, Emma Crozier5, Vicki Hands1, Suzanne Hill6, Zoe Walker7
1Somerset NHS Foundation Trust, Beacon Radiotherapy, Taunton, United Kingdom; 2Royal Devon University Healthcare NHS Foundation Trust, Radiotherapy Department, Exeter, United Kingdom; 3Gloucester Hospitals NHS Foundation Trust, Gloucestershire Oncology Centre, Cheltenham, United Kingdom; 4Royal United Hospitals NHS Foundation Trust, Radiotherapy Department, Bath, United Kingdom; 5Royal Cornwall Hospitals NHS Trust, Radiotherapy Department, Truro, United Kingdom; 6Torbay and South Devon NHS Foundation Trust, Radiotherapy Department, Torquay, United Kingdom; 7University Hospitals Bristol and Weston NHS Foundation Trust, Radiotherapy Department, Bristol, United Kingdom
Show Affiliations
Hide Affiliations
Purpose or Objective
Managing radiotherapy (RT) late effects (LE) is a growing challenge, symptoms can arise 3 months to decades after RT. 1 million people will be living with cancer or its consequences by 2030 [1]. Adults with LE struggle to access support [2], responsibility for LE care is unclear and few dedicated LE services exist.
The UK RT Service Specification (RSS, 2019) [3] proposed a model for LE care (common LE managed locally, complex LE at specialist centres), but lacked detail on service structure or outcome measures. Radiation therapist (RTT) led services are effective [4], yet often comprise a single site-specific RTT (i.e. pelvis) working in isolation. Regionally care is inequitable, training unstructured and data not standardised. These disparities blight the development and commissioning of new services and add little to the evidence of the scale, burden or management of LE.
A novel RTT led regional service has been developed to 1) provide symptom management and support for adults with RT LE from any tumour site, 2) develop a network of support and training for RTTs, 3) collect useful and harmonised data about LE and service provision.
Material and Methods
Data from an established RTT led LE service, collated 22/01/21, formed a blueprint for the regional model. Stakeholder support/funding was gained from secondary care (hospitals), primary care (GP’s), cancer charities, cancer alliances, commissioners and patients with LE.
Competency frameworks from accredited professional bodies were reviewed for an RTT training package with post graduate education, group supervision and weekly mentoring [6].
Evidence and tools to demonstrate the scale and burden of LE, standardised documents for referral criteria, consultation and multi-disciplinary (MDT) discussion were scrutinised. Screening tools (i.e. Alert-B [5]) and patient reported outcome measures (PROMS) were evaluated in an RTT focus group to define core outcome data.
Results
LE RTTs were recruited in 7 of 8 RT centres in South-West UK from 1/8/22. Initial scoping identified local and regional services for LE patients (lymphoedema, pain management etc). Training enabled RTTs to identify LE, make treatment decisions supported by a regional MDT, and develop local clinics and pathways.
Core outcome data were defined including EORTC site specific PROMS, QLQ-C30 and EQ 5D-5L quality of life (QoL) measures as per the National Cancer QoL dataset. Data entry dashboards were built to gather anonymised regional data for analysis.
In the first 10 weeks, 44 patients accessed the regional LE service (1/8/22- 11/10/22), all centres had referrals; pelvis (61% - prostate, gynaecological and colorectal), breast (30%), head & neck (7%), brain (2%).
Conclusion
The regional RTT LE service is a novel model allowing patients to access local LE care, collecting data for an accurate picture of LE and enhancing RTT roles. It could easily be scaled to a national model to aid commissioning/business planning, enabling much needed LE services to become widely available.