Rapid Access Palliative Radiotherapy clinics - the evidence is there, but where are the clinics? An Australian and New Zealand perspective.

Abstract

PURPOSE\nFirst developed in Canada in the 1990s, Rapid Access Palliative Radiotherapy (RAPRT) clinics have subsequently spread internationally to expedite treatment for near end-of-life patients, sparing them the need for multiple visits to the department. A classical RAPRT clinic is herein defined as a dedicated clinic specifically established to enable (ideally) same day consultation, planning for, and delivery of palliative radiation treatment . The aim of this work was to determine the current status of these clinics in Australia and New Zealand (ANZ).\n\n\nMETHODS AND MATERIALS\nA phone survey of all 100 Australian and 10 NZ radiotherapy centres was conducted in March-April 2021. The Chief Medical Officers of the two large private practices (GenesisCare and Icon) also approved the survey and answered on behalf of their 57 centres. A single page questionnaire was utilized, seeking information on the logistics and clinical details of past and present RAPRT clinics, and reasons why other centres do not have one.\n\n\nRESULTS\nThe survey response rate was 100%. There are only three current RAPRT clinics (2.7%). The dominant treatment indication is bone metastases (85-90%), most patients receiving single fractions (60-90%), but commencement on same day is variable (35-90%). Five other clinics (4.5%) closed after 4 months to 6 years, but the clinical features were similar. By far the commonest reason given by the 107 centers without a current RAPRT clinic is that these patients are accommodated using existing resources (95%).\n\n\nCONCLUSIONS\nClassical RAPRT clinics have not been widely embraced in ANZ. There are alternative strategies such as the Advanced Practice Radiation Therapist model and techniques to avoid the conventional CT-simulation step which may also expedite treatment for palliative patients.