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Palliative Radiotherapy:�What can we achieve together in Wales?

High quality; rapid, easy access; good decision making and communication;

excellent education, training and career development opportunities.

Chris Sillman, Nicki Davies, Mau-Don Phan, Pat Evans, Rebecca Crawford, Steve Hill, Matt Cuyes,Mick Button

20^th September 2023

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Why? What is palliative radiotherapy?

Important

Urgent symptom control and emergency radiotherapy
Unwell patients with advanced cancer symptoms
Only delivered at main Cancer Centres – involves multiple steps/patient visits

Large volume of work amongst oncology teams

Up to 2000 patients/year across Wales

We want to improve

Quality of care for patients and working lives of clinical staff

Newly established targets: treating patients faster

Training, ways of working and career development opportunities

Recruitment, retention, job satisfaction

Direct and wider benefits for patients, staff, cancer and wider NHS services

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Why? Other drivers for change

Workforce

Many teams affected; clinical oncology shortfalls

NHS capacity/demand

All aspects – planned and acute services, ambulance/transport, community teams

Cost of living, social + environmental aspects

Radiotherapy often involve multiple visits to a distant cancer centre

National policies/strategic direction

Prudent Healthcare, Value based healthcare, new ways of working post Covid

Palliative radiotherapy is an area that we want and need to improve in Wales – for patients, carers, healthcare professionals and NHS services

Historically, no specific focus on this subject in Wales
Quality of care paramount for patients and staff

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What have we done

All 3 cancer centres collaborating

Multi-disciplinary input
Built on previous work each centre was already doing
Contacts beyond Wales – England and Canada

Community of practice focussed on palliative radiotherapy

New for Wales
Understanding strategic opportunities and future vision; direct and indirect benefits; practical developments

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Swansea Bay UHB

The service
Achievements: Patient satisfaction/statistical data
Staff training & development
What have we learned?
What are the next steps for the service?

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Betsi Cadwaladr UHB

The Service

Weekly palliative clinic (training) overseen by one Consultant
4-5 patients per week scheduled

Staff Training & development

Academic training for 2 radiographers including MSc modules and SPR training courses
Competency levels achieved for spine and long bones (other sites ongoing)

What have we learned?

How advanced practice can increase efficiency and reduce waiting times for patients in pain
Improves recruitment and retention and aids staff morale

Challenges

Resignation of supervising Consultant – service development currently paused.
A lead development radiographer on the project passed away suddenly.

The future?

Needs strategic direction and support
Work towards an All Wales improved palliative service for patients

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Velindre University NHS Trust

Academic training for 2 radiographers

MSc modules completed in preparation for more advanced/independent practice

Once weekly specialist palliative RT clinic established

Consultant lead, multi-disciplinary input, 3-5 patients/week
Focus on patient care, training and upskilling radiographers

Same day clinic review/decision, planning CT, then treatment another visit
High quality

Patient satisfaction

Average 9.6/10 (Initial pilot data)

Fewer visits to hospital

Everything completed in just 2 visits for 90% of patients (initial pilot data)
72% treated with just 1 radiotherapy treatment compared to 42% baseline

Faster treatment

Median 2 days, baseline 8 days (initial pilot data)
Median 3.7 days (reflecting increasing system pressures)

Good clinical training: radiographers and medical trainees

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Benefits

Direct

Faster, high quality treatment for patients
Swim lane mapping

Radiographer lead pathway is likely to be cost efficient

Up to 140 minutes/patient consultant oncologist time
£57/hour cost saving if activity moved to a band 7 radiographer
Up to 2000 patients/year across Wales

Fewer fractions of RT needed

Greater uses of single treatments

Frees up Linac capacity
Reduces travel, time for patients, carbon emissions, impact on carers, transport

Wider

Use a palliative RT attendance to have future care priorities conversations with patients – shifting future care?

Career development opportunities
Improving working lives for clinical staff

Influenced nationally on the importance of this subject

International contacts/connections
Important links with value based healthcare teams
Getting Wales ready for other developments

Research, new techniques

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What next?

More work to do

National multi-disciplinary community of practice
Highlighted an important area of improvement for cancer teams in Wales
Shown that we can deliver such improvements + the benefits of this
Needs to be established more formally – Welsh Cancer Network, Clinical Oncology Sub Committee, HEIW, local operational teams
Wider aspects to explore

Access, education, ‘value’ of palliative RT to patients, reducing variation, decision making about future health priorities, new radiotherapy developments

Advancing Radiotherapy Cymru Academy

£3 million, joint funded through Moondance Foundation and the NHS in Wales

All Wales, supporting best practice in radiotherapy: innovation, workforce development, training

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Summary

Thanks to everyone involved in this

We have demonstrated that we can deliver high quality, rapid access palliative radiotherapy alongside good patient experience and good staff training/development opportunities

Direct and indirect/wider benefits of this
More work to do: ARC Academy creates exciting opportunities

We still need to find a way to deliver/embed the operational changes

Change in the NHS isn’t always easy and often requires initial investment; clinical pressures incredibly high