Management and Workflow

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Breast Cancer Radiation Therapy

Abstract

Radiation therapy (RT) is an important modality of breast cancer patients, regardless of disease stage. In breast cancer, in addition to curative indications, RT is a major modality for palliation or symptom control and, recently, used as an ablative non-invasive treatment to oligometastatic patients or in case of oligo-progression. New RT techniques and protocols (limited number of fractions) allow for minimal morbidity and minimal interference with quality of life (QOL) and other cancer treatments. There are a number of RT techniques, and different RT doses and fractionation, which are used according to the clinical indication. In some cases, concomitant treatment of systemic therapy and RT is indicated. However, RT is a complex modality, and there is a need for a multidisciplinary team of radiation oncologists, nurses, radiation technicians, dosimetrists and physicists to plan and apply treatments. These new indications for RT, together with the global increase in cancer incidence and higher need for RT, put much higher demands on efficient treatment management and workflow. Therefore, this section will discuss workflow adjustment and optimisation processes and give additionally some practical hints that are based on experience at several radiation oncology departments.

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References

  1. Borras JM, Barton M, Grau C, Corral J, Verhoeven R, Lemmens V, et al. The impact of cancer incidence and stage on optimal utilization of radiotherapy: methodology of a population based analysis by the ESTRO-HERO project. Radiother Oncol. 2015;116:45–50.

    Article  Google Scholar 

  2. Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378:1707–16.

    Article  CAS  Google Scholar 

  3. Palma DA, Olson R, Harrow S, Gaede S, Louie AV, Haasbeek C, et al. Stereotactic ablative radiotherapy for the comprehensive treatment of oligometastatic cancers: long-term results of the SABR-COMET phase II randomized trial. J Clin Oncol. 2020;38:2830–8.

    Article  Google Scholar 

  4. Miriyala R, Thakur P, Singh A, Gupta A, Yadav B, Kumar N, et al. Workflow management in radiation oncology: the impact on a high volume department. Br J Health Care Manag. 2018;24:302–7.

    Article  Google Scholar 

  5. Grau C, Defourny N, Malicki J, Dunscombe P, Borras JM, Coffey M, et al. Radiotherapy equipment and departments in the European countries: final results from the ESTRO-HERO survey. Radiother Oncol. 2014;112:155–64.

    Article  Google Scholar 

  6. EBCC. EBCC-12 Manifesto. EBCC-12 European Breast Cancer Conference. Virtual 2020. https://conferences.eortc.org/ebcc12/.

  7. Lievens Y, Defourny N, Coffey M, Borras JM, Dunscombe P, Slotman B, et al. Radiotherapy staffing in the European countries: final results from the ESTRO-HERO survey. Radiother Oncol. 2014;112:178–86.

    Article  Google Scholar 

  8. Vieira B, Demirtas D, van de Kamer JB, Hans EW, van Harten W. Improving workflow control in radiotherapy using discrete-event simulation. BMC Med Inform Decis Mak. 2019;19:199.

    Article  Google Scholar 

  9. Willmann J, Poortmans P, Monti AF, Grant W, Clementel E, Corning C, et al. Development of staffing, workload and infrastructure in member departments of the European Organisation for Research and Treatment of Cancer (EORTC) radiation oncology group. Radiother Oncol. 2020;155:226–31.

    Article  Google Scholar 

  10. Zubizarreta E, Van Dyk J, Lievens Y. Analysis of global radiotherapy needs and costs by geographic region and income level. Clin Oncol (R Coll Radiol). 2017;29:84–92.

    Article  CAS  Google Scholar 

  11. Gupta S, King WD, Korzeniowski M, Wallace DL, Mackillop WJ. The effect of waiting times for postoperative radiotherapy on outcomes for women receiving partial mastectomy for breast cancer: a systematic review and meta-analysis. Clin Oncol (R Coll Radiol). 2016;28:739–49.

    Article  CAS  Google Scholar 

  12. van Maaren MC, Bretveld RW, Jobsen JJ, Veenstra RK, Groothuis-Oudshoorn CG, Struikmans H, et al. The influence of timing of radiation therapy following breast-conserving surgery on 10-year disease-free survival. Br J Cancer. 2017;117:179–88.

    Article  Google Scholar 

  13. Manyam BV, Yu N, Meier T, Suh JH, Chao ST. A review of strategies for optimizing workflow, quality improvement, and patient safety within radiation oncology departments. Appl Radiat Oncol. 2018:7–12.

    Google Scholar 

  14. Hanna TP, King WD, Thibodeau S, Jalink M, Paulin GA, Harvey-Jones E, et al. Mortality due to cancer treatment delay: systematic review and meta-analysis. BMJ. 2020;371:m4087.

    Article  Google Scholar 

  15. NVRO. Waiting times. https://www.nvro.nl/kwaliteit/indicatoren.

  16. Kim CS, Spahlinger DA, Kin JM, Coffey RJ, Billi JE. Implementation of lean thinking: one health system’s journey. Jt Comm J Qual Patient Saf. 2009;35:406–13.

    PubMed  Google Scholar 

  17. Simons PA, Houben R, Benders J, Pijls-Johannesma M, Vandijck D, Marneffe W, et al. Does compliance to patient safety tasks improve and sustain when radiotherapy treatment processes are standardized? Eur J Oncol Nurs. 2014;18:459–65.

    Article  Google Scholar 

  18. Simons PA, Houben R, Vlayen A, Hellings J, Pijls-Johannesma M, Marneffe W, et al. Does lean management improve patient safety culture? An extensive evaluation of safety culture in a radiotherapy institute. Eur J Oncol Nurs. 2015;19:29–37.

    Article  Google Scholar 

  19. Simons P, Backes H, Bergs J, Emans D, Johannesma M, Jacobs M, et al. The effects of a lean transition on process times, patients and employees. Int J Health Care Qual Assur. 2017;30:103–18.

    Article  Google Scholar 

  20. Al-Balushi MM, Al-Mandhari Z. Implementing lean management techniques at a radiation oncology department. Sultan Qaboos Univ Med J. 2018;18:e362–e6.

    Article  Google Scholar 

  21. Nabelsi V, Plouffe V. Breast cancer treatment pathway improvement using time-driven activity-based costing. Int J Health Plann Manag. 2019;34:e1736–e46.

    Article  Google Scholar 

  22. Koch R. The 80/20 principle: the secret to success by achieving more with less. Nicholas Brealey Publishing; 2017.

    Google Scholar 

  23. Harvey HB, Sotardi ST. The Pareto principle. J Am Coll Radiol. 2018;15:931.

    Article  Google Scholar 

  24. Pillai M, Adapa K, Das SK, Mazur L, Dooley J, Marks LB, et al. Using artificial intelligence to improve the quality and safety of radiation therapy. J Am Coll Radiol. 2019;16:1267–72.

    Article  Google Scholar 

  25. Poortmans PMP, Takanen S, Marta GN, Meattini I, Kaidar-Person O. Winter is over: the use of artificial intelligence to individualise radiation therapy for breast cancer. Breast. 2020;49:194–200.

    Article  Google Scholar 

  26. Korreman S, Eriksen JG, Grau C. The changing role of radiation oncology professionals in a world of AI—just jobs lost—or a solution to the under-provision of radiotherapy? Clin Transl Radiat Oncol. 2021;26:104–7.

    Article  Google Scholar 

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Correspondence to Jana Jaal .

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Jaal, J., Poortmans, P., Kaidar-Person, O. (2022). Management and Workflow. In: Kaidar-Person, O., Meattini, I., Poortmans, P. (eds) Breast Cancer Radiation Therapy. Springer, Cham. https://doi.org/10.1007/978-3-030-91170-6_10

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  • DOI: https://doi.org/10.1007/978-3-030-91170-6_10

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-91169-0

  • Online ISBN: 978-3-030-91170-6

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