Meta palliation.

Top Line: Rapid access palliative radiation clinics sound great.

The Study: A rapid access palliative radiation clinic is formally defined as “a dedicated clinic specifically established to enable (ideally) same day consultation, planning, and delivery of palliative radiation treatment.” The operative word there is dedicated because this does not include providing the service for patients on an ad hoc basis. To better understand barriers to implementing rapid access clinics, a survey was sent to 100 rad onc clinics in Australia and 10 in New Zealand with a response rate of 100%. Currently only 3 of 110 surveyed centers offer such rapid access clinics, mostly for bone mets (85%-90%) treated in a single-fraction (60%-90%). Virtually all of the remaining clinics (95%) cited adequate existing alternative accommodations as reasons for not providing these dedicated clinics. The authors recognize “private radiation practices operate under business models that provide opportunities to drive greater efficiencies in workflow than typically observed in public systems”...so are they on to something? Let’s back up for a minute. What’s the real goal here? One is to minimize the time from referral to treatment for painful metastatic disease. The second, equally important goal, is to lessen treatment burden by minimizing the number of visits required to achieve that rapid treatment. What fixes logistical implementation challenges while at the same time achieving these goals? That’s right, virtual consults. Clinicians can often accommodate an urgent virtual consultation the same day—it doesn’t get more rapid or convenient than that. Then, upon better understanding the patient’s travel burden and any potential role for more complex treatment, he/she can be set up for the individualized quickest and easiest solution. If the patient is close, maybe a sim that afternoon and treatment the next day is best. If they live far, maybe coming in a couple of days for both sim and treatment is best.

TBL: With rapid access virtual consults, perhaps there is less need for the more complicated dedicated rapid access palliative radiation clinic. | Roos, Int J Radiat Oncol Biol Phys 2021