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Impact of an Advanced Practice Provider Directed Palliative Bone Metastasis Radiation Therapy Clinic on Patient Care
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DOI：10.1016/j.adro.2024.101712.png)
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Abstract
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Patients commonly present to a radiation oncologist (RO) with bone metastases requiring palliative radiation therapy (RT). The standard referral workflow can be inefficient, causing delays in time to RO evaluation and treatment. We created an advanced practice provider (APP)-led rapid access palliative RT clinic (PRC) to manage bone metastases and address these care barriers. Following institutional review board approval, all outpatients receiving palliative RT for bone metastases from June 2021 to June 2023 were retrospectively reviewed. Patients treated in the 12 months after the creation of the PRC represented the PRC cohort. A comparison cohort (pre-PRC) included patients treated in the 6 months before the creation of the PRC using a typical RO workflow. Critical analysis assessed the impact of the PRC in reducing the time from referral to evaluation by RO (TTE) and time from referral to treatment (TTT) for patients receiving palliative RT. An independent t test was used to analyze TTE and TTT between the PRC and pre-PRC cohorts. Seventy-nine and 148 patients were treated in the pre-PRC and PRC periods, respectively. The median RT dose delivered was 8 Gy in 1 fraction for both cohorts. The mean TTE was 10.4 days (SD, 10.2) for the pre-PRC cohort versus 6.4 days (SD, 7.8) (P = .005) for the PRC cohort. The mean TTT was 20.7 days (SD, 17.5) in the pre-PRC cohort versus 16.0 days (SD, 13.7) in the PRC cohort (P = .01). The APP-led PRC significantly decreases TTE and TTT in patients requiring palliative RT for bone metastases. Additional analyses are underway to evaluate the impact of the APP-led PRC on patient and physician satisfaction and the effect of the PRC on bone metastasis-related emergency room visits and hospitalizations. (c) 2025 The Authors. Published by Elsevier Inc. on behalf of American Society for Radiation Oncology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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RADIOTHERAPY
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