Survey of Canadian specialised palliative radiotherapy programs

Despite having been established in Canada in 1996, there has not been an environmental survey of dedicated palliative radiotherapy (PRT) programs reported to date. We comprehensively reviewed specialised Palliative Radiation Oncology Programs (PROP) - also known as 'fast track' or 'rapid access' clinics - nationally.

An email inviting participation via an embedded web-based link outlining consent was sent via REDCap™ to 44 RT centres. The survey included open-ended and multiple-choice questions exploring program goals, patient volumes, indications, capacity, PRT schedules, and team composition. Aggregate anonymized responses were extracted and descriptive statistics calculated.

The response rate was 81.8% (36/44): 38.9% (14/36) centres currently operate a PROP, 17/36 (47.2%) have never had a program and 5/36 (13.9%) operated a program that has now closed. Fundamental program goals include: expediting appointments and treatment; educating trainees; facilitating access to the wider multidisciplinary team and community supports; centralising research; providing additional symptom management strategies; advanced care planning; facilitating access for underserved populations; and supporting caregivers. Referrals are co-managed by multiple team members including radiation oncologists, radiation therapists and nurses. Most common referrals are for bone and brain metastases. All sites have reserved simulation slots and 2/3 have reserved treatment slots. Nearly 3/4 of centres operate 2-5 half days per week, some with advanced care providers such as nurse practitioners.

Dedicated PRT clinics provide essential team-based, personalised care. Multidisciplinary collaboration, a local champion and engagement of leadership is integral to the success of these PRT programs, which form a national community of practice.