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Radiation therapy, along with surgery and systemic therapy, is a primary therapeutic modality for cancer management. At least half of cancer patients receive radiation as part of their treatment regimen.1 Multiple studies demonstrate that radiotherapy is underutilized worldwide.2 One reason for underutilization of radiotherapy globally is poor access to this treatment modality. Factors that contribute to poor access include long wait times for consultation, delays in treatment initiation, distance to a treatment facility, and poor coordination of care.
Taskforce Findings
The presence of onsite radiation oncology and its impact on utilization of radiotherapy is poorly studied. The Veterans Health Administration (VHA) Palliative Radiotherapy Taskforce recently conducted a survey to determine the barriers to referral and timeliness of treatment for palliative radiotherapy within the VHA.3 Key findings of this study comparing centers with onsite radiation departments with centers without onsite radiation departments include:
a. Radiation consults are more likely to be completed within 1 week of consult request at centers with onsite radiation therapy (68% vs 31%, respectively; P = .01).
b. Centers with onsite radiation therapy more frequently deliver emergent treatment within 24 hours for patients with spinal cord compression, an emergency condition in which prompt radiation can prevent or minimize long-term neurologic disability (94% vs 70%, respectively; P = .01).
c. Referring practitioners with onsite radiation departments are less likely to report difficulty contacting a radiation oncologist as a barrier to referral for palliative radiotherapy (0% vs 20%, respectively; P = .006).
d. Referring practitioners with onsite radiotherapy report patient travel as a barrier to referral for palliative radiotherapy less frequently (28% vs 71%, respectively; P < .001).
e. Practitioners with onsite radiation oncology departments are more likely to have multidisciplinary tumor boards (31% vs 3%, respectively; P = .01) and are more likely to be influenced by radiation oncology recommendations at tumor boards (69% vs 44%, respectively; P = .02).
Based on the findings of this study, the VHA Palliative Radiotherapy Taskforce has prepared this consensus statement regarding the importance of onsite radiation oncology departments at VHA medical centers. More information regarding our 5 key findings and their implications for patient care are as follows:
Timeliness of Radiation Oncology Consultation
Delays in radiation oncology consultation, which can also delay treatment initiation, are associated with poor satisfaction among both patients and referring clinicians.4 Wait times have been identified as a barrier to utilization of radiotherapy by both patients and clinicians.5,6 Furthermore, delays in initiation of definitive therapy have been associated with worse outcomes, including worse overall survival.7,8 Our survey study demonstrates that consults for palliative radiotherapy are occurring in a more timely manner at centers with onsite radiation departments. Radiation oncology consults are more frequently completed within 1 week at centers with onsite radiation oncology departments compared with centers without onsite radiation oncology departments (68% vs 31%, P = .01). This trend would likely be seen for nonpalliative, definitive cases as well. The presence of radiation oncology departments onsite at VHA medical centers is an important component of timely care for veterans to optimize outcomes of cancer treatment.
Timely Delivery of Radiotherapy for Oncologic Emergencies
There are a few scenarios in which emergent radiation treatment, within 24 hours, is indicated. These include malignant spinal cord compression, uncal herniation from brain metastasis, superior vena cava syndrome, and tumor hemorrhage.9 Studies on management of metastatic spinal cord compression demonstrate that delays in treatment are associated with reduced ambulation10 as well as loss of sphincter function and incontinence.11
Our study demonstrates that VHA medical centers with onsite radiotherapy more frequently deliver radiotherapy within 24 hours for patients with metastatic spinal cord compression. This timely delivery of treatment is critical to optimizing functional status and quality of life in patients requiring treatment for oncologic emergencies. Revisiting treatment pathways for such situations at regular intervals is crucial given that residents and staff may rotate and be unfamiliar with emergency protocols.
Communication With Radiation Oncologists
Several studies have demonstrated that the inability to contact a radiation oncologist and poor communication result in decreased referrals for palliative radiotherapy.12,13 Our study demonstrates that onsite radiation oncology is associated with improved ability to contact a radiation oncologist. About 20% of clinicians at facilities without onsite radiation oncology reported difficulty contacting a radiation oncologist, compared with 0% at facilities with onsite radiation departments (P = .006).
It is possible that increased radiation oncology presence at VHA medical centers, through attenuation of barriers related to contacting a radiation oncologist and improved communication, would lead to increased use of radiotherapy. Increased communication between referring clinicians and radiation oncologists also can help with education of those clinicians making the referral. Since knowledge gaps have been identified in multiple studies as a barrier to referral for radiotherapy, such communication and increased education on the role of radiotherapy could increase use.12-14
Patient Travel
Patient ability to travel was the most commonly reported barrier (81%) to referral for palliative radiotherapy in our study. Travel time and transportation difficulties have been established in multiple studies as barriers to radiotherapy for both definitive and palliative management.15-18 Travel for radiotherapy was much less frequently reported as a barrier among respondents with onsite radiation oncology departments compared with those without onsite radiation departments (28% vs 71%, respectively; P < .001).
It is therefore possible that expansion of VHA radiation oncology services, allowing for provision of onsite radiotherapy at more VHA facilities, would reduce travel burden. Increasing travel accommodations for patients and provision of patient lodging on hospital campuses, which is already offered at some VHA medical centers (ie, Fisher House Foundation), could also help attenuate this barrier.
Multidisciplinary Tumor Boards
Our study demonstrates that centers with onsite radiation departments more frequently hold multidisciplinary tumor boards compared with centers without radiation departments (31% vs 3%, respectively; P = .01). Multidisciplinary tumor boards allow subspecialties to meet regularly to communicate about patient care and can help mitigate barriers related to communication and education of the referring health care practitioners.
As cases are discussed in multidisciplinary tumor boards, health care practitioners have the opportunity to make recommendations and provide education on potential benefits and/or downsides of treatments offered by their respective specialties. Several studies have demonstrated that cases discussed at multidisciplinary tumor boards are more likely to be referred for radiation therapy.19-21 Furthermore, multidisciplinary tumor boards have been associated with improved treatment outcomes.22
Conclusions
In this consensus statement the VHA Palliative Radiotherapy Taskforce recommends the optimization of use of radiotherapy within the VHA. Radiation oncology services should be maintained where present in the VHA, with consideration for expansion of services to additional facilities. Telehealth should be used to expedite consults and treatment. Hypofractionation should be used, when appropriate, to ease travel burden. Options for transportation services and onsite housing, or hospitalization, should be understood by practitioners and offered to patients to mitigate barriers related to travel.
1. Barton MB, Jacob S, Shafiq J, et al. Estimating the demand for radiotherapy from the evidence: a review of changes from 2003 to 2012. Radiother Oncol. 2014;112(1):140-144. doi:10.1016/j.radonc.2014.03.024
2. Atun R, Jaffray DA, Barton MB, et al. Expanding global access to radiotherapy. Lancet Oncol. 2015;16(10):1153-1186. doi:10.1016/S1470-2045(15)00222-3
3. Gutt R, Malhotra S, Hagan MP, et al. Palliative radiotherapy within the Veterans Health Administration: barriers to referral and timeliness of treatment. JCO Oncol Pract. 2021;17(12):e1913-e1922. doi:10.1200/OP.20.00981
4. Agazaryan N, Chow P, Lamb J, et al. The timeliness initiative: continuous process improvement for prompt initiation of radiation therapy treatment. Adv Radiat Oncol. 2020;5(5):1014-1021. Published 2020 Mar 10. doi:10.1016/j.adro.2020.01.007
5. Gillan C, Briggs K, Goytisolo Pazos A, et al. Barriers to accessing radiation therapy in Canada: a systematic review. Radiat Oncol. 2012;7:167. Published 2012 Oct 12. doi:10.1186/1748-717X-7-167
6. Hanna TP, Richardson H, Peng Y, Kong W, Zhang-Salomons J, Mackillop WJ. A population-based study of factors affecting the use of radiotherapy for endometrial cancer. Clin Oncol (R Coll Radiol). 2012;24(8):e113-e124. doi:10.1016/j.clon.2012.01.007
7. Ho AS, Kim S, Tighiouart M, et al. Quantitative survival impact of composite treatment delays in head and neck cancer. Cancer. 2018;124(15):3154-3162. doi:10.1002/cncr.31533
8. Cone EB, Marchese M, Paciotti M, et al. Assessment of time-to-treatment initiation and survival in a cohort of patients with common cancers. JAMA Netw Open. 2020;3(12):e2030072. Published 2020 Dec 1. doi:10.1001/jamanetworkopen.2020.30072
9. Mitera G, Swaminath A, Wong S, et al. Radiotherapy for oncologic emergencies on weekends: examining reasons for treatment and patterns of practice at a Canadian cancer centre. Curr Oncol. 2009;16(4):55-60. doi:10.3747/co.v16i4.352
10. Laufer I, Zuckerman SL, Bird JE, et al. Predicting neurologic recovery after surgery in patients with deficits secondary to MESCC: systematic review. Spine (Phila Pa 1976). 2016;41 (Suppl 20):S224-S230. doi:10.1097/BRS.0000000000001827
11. Husband DJ. Malignant spinal cord compression: prospective study of delays in referral and treatment. BMJ. 1998;317(7150):18-21. doi:10.1136/bmj.317.7150.18
12. Samant RS, Fitzgibbon E, Meng J, Graham ID. Family physicians’ perspectives regarding palliative radiotherapy. Radiother Oncol. 2006;78(1):101-106. doi:10.1016/j.radonc.2005.11.008
13. McCloskey SA, Tao ML, Rose CM, Fink A, Amadeo AM. National survey of perspectives of palliative radiation therapy: role, barriers, and needs. Cancer J. 2007;13(2):130-137. doi:10.1097/PPO.0b013e31804675d4
14. Chierchini S, Ingrosso G, Saldi S, Stracci F, Aristei C. Physician and patient barriers to radiotherapy service access: treatment referral implications. Cancer Manag Res. 2019;11:8829-8833. Published 2019 Oct 7. doi:10.2147/CMAR.S168941
15. Longacre CF, Neprash HT, Shippee ND, Tuttle TM, Virnig BA. Travel, treatment choice, and survival among breast cancer patients: a population-based analysis. Womens Health Rep (New Rochelle). 2021;2(1):1-10. Published 2021 Jan 11. doi:10.1089/whr.2020.0094
16. Yang DD, Muralidhar V, Mahal BA, et al. Travel distance as a barrier to receipt of adjuvant radiation therapy after radical Prostatectomy. Am J Clin Oncol. 2018;41(10):953-959. doi:10.1097/COC.0000000000000410
17. Sundaresan P, King M, Stockler M, Costa D, Milross C. Barriers to radiotherapy utilization: Consumer perceptions of issues influencing radiotherapy-related decisions. Asia Pac J Clin Oncol. 2017;13(5):e489-e496. doi:10.1111/ajco.12579
18. Ambroggi M, Biasini C, Del Giovane C, Fornari F, Cavanna L. Distance as a barrier to cancer diagnosis and treatment: review of the literature. Oncologist. 2015;20(12):1378-1385. doi:10.1634/theoncologist.2015-0110
19. Bydder S, Nowak A, Marion K, Phillips M, Atun R. The impact of case discussion at a multidisciplinary team meeting on the treatment and survival of patients with inoperable non-small cell lung cancer. Intern Med J. 2009;39(12):838-841. doi:10.1111/j.1445-5994.2009.02019.x
20. Brännström F, Bjerregaard JK, Winbladh A, et al. Multidisciplinary team conferences promote treatment according to guidelines in rectal cancer. Acta Oncol. 2015;54(4):447-453. doi:10.3109/0284186X.2014.952387
21. Pillay B, Wootten AC, Crowe H, et al. The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: A systematic review of the literature. Cancer Treat Rev. 2016;42:56-72. doi:10.1016/j.ctrv.2015.11.007
22. Freytag M, Herrlinger U, Hauser S, et al. Higher number of multidisciplinary tumor board meetings per case leads to improved clinical outcome. BMC Cancer. 2020;20(1):355. Published 2020 Apr 28. doi:10.1186/s12885-020-06809-1
Radiation therapy, along with surgery and systemic therapy, is a primary therapeutic modality for cancer management. At least half of cancer patients receive radiation as part of their treatment regimen.1 Multiple studies demonstrate that radiotherapy is underutilized worldwide.2 One reason for underutilization of radiotherapy globally is poor access to this treatment modality. Factors that contribute to poor access include long wait times for consultation, delays in treatment initiation, distance to a treatment facility, and poor coordination of care.
Taskforce Findings
The presence of onsite radiation oncology and its impact on utilization of radiotherapy is poorly studied. The Veterans Health Administration (VHA) Palliative Radiotherapy Taskforce recently conducted a survey to determine the barriers to referral and timeliness of treatment for palliative radiotherapy within the VHA.3 Key findings of this study comparing centers with onsite radiation departments with centers without onsite radiation departments include:
a. Radiation consults are more likely to be completed within 1 week of consult request at centers with onsite radiation therapy (68% vs 31%, respectively; P = .01).
b. Centers with onsite radiation therapy more frequently deliver emergent treatment within 24 hours for patients with spinal cord compression, an emergency condition in which prompt radiation can prevent or minimize long-term neurologic disability (94% vs 70%, respectively; P = .01).
c. Referring practitioners with onsite radiation departments are less likely to report difficulty contacting a radiation oncologist as a barrier to referral for palliative radiotherapy (0% vs 20%, respectively; P = .006).
d. Referring practitioners with onsite radiotherapy report patient travel as a barrier to referral for palliative radiotherapy less frequently (28% vs 71%, respectively; P < .001).
e. Practitioners with onsite radiation oncology departments are more likely to have multidisciplinary tumor boards (31% vs 3%, respectively; P = .01) and are more likely to be influenced by radiation oncology recommendations at tumor boards (69% vs 44%, respectively; P = .02).
Based on the findings of this study, the VHA Palliative Radiotherapy Taskforce has prepared this consensus statement regarding the importance of onsite radiation oncology departments at VHA medical centers. More information regarding our 5 key findings and their implications for patient care are as follows:
Timeliness of Radiation Oncology Consultation
Delays in radiation oncology consultation, which can also delay treatment initiation, are associated with poor satisfaction among both patients and referring clinicians.4 Wait times have been identified as a barrier to utilization of radiotherapy by both patients and clinicians.5,6 Furthermore, delays in initiation of definitive therapy have been associated with worse outcomes, including worse overall survival.7,8 Our survey study demonstrates that consults for palliative radiotherapy are occurring in a more timely manner at centers with onsite radiation departments. Radiation oncology consults are more frequently completed within 1 week at centers with onsite radiation oncology departments compared with centers without onsite radiation oncology departments (68% vs 31%, P = .01). This trend would likely be seen for nonpalliative, definitive cases as well. The presence of radiation oncology departments onsite at VHA medical centers is an important component of timely care for veterans to optimize outcomes of cancer treatment.
Timely Delivery of Radiotherapy for Oncologic Emergencies
There are a few scenarios in which emergent radiation treatment, within 24 hours, is indicated. These include malignant spinal cord compression, uncal herniation from brain metastasis, superior vena cava syndrome, and tumor hemorrhage.9 Studies on management of metastatic spinal cord compression demonstrate that delays in treatment are associated with reduced ambulation10 as well as loss of sphincter function and incontinence.11
Our study demonstrates that VHA medical centers with onsite radiotherapy more frequently deliver radiotherapy within 24 hours for patients with metastatic spinal cord compression. This timely delivery of treatment is critical to optimizing functional status and quality of life in patients requiring treatment for oncologic emergencies. Revisiting treatment pathways for such situations at regular intervals is crucial given that residents and staff may rotate and be unfamiliar with emergency protocols.
Communication With Radiation Oncologists
Several studies have demonstrated that the inability to contact a radiation oncologist and poor communication result in decreased referrals for palliative radiotherapy.12,13 Our study demonstrates that onsite radiation oncology is associated with improved ability to contact a radiation oncologist. About 20% of clinicians at facilities without onsite radiation oncology reported difficulty contacting a radiation oncologist, compared with 0% at facilities with onsite radiation departments (P = .006).
It is possible that increased radiation oncology presence at VHA medical centers, through attenuation of barriers related to contacting a radiation oncologist and improved communication, would lead to increased use of radiotherapy. Increased communication between referring clinicians and radiation oncologists also can help with education of those clinicians making the referral. Since knowledge gaps have been identified in multiple studies as a barrier to referral for radiotherapy, such communication and increased education on the role of radiotherapy could increase use.12-14
Patient Travel
Patient ability to travel was the most commonly reported barrier (81%) to referral for palliative radiotherapy in our study. Travel time and transportation difficulties have been established in multiple studies as barriers to radiotherapy for both definitive and palliative management.15-18 Travel for radiotherapy was much less frequently reported as a barrier among respondents with onsite radiation oncology departments compared with those without onsite radiation departments (28% vs 71%, respectively; P < .001).
It is therefore possible that expansion of VHA radiation oncology services, allowing for provision of onsite radiotherapy at more VHA facilities, would reduce travel burden. Increasing travel accommodations for patients and provision of patient lodging on hospital campuses, which is already offered at some VHA medical centers (ie, Fisher House Foundation), could also help attenuate this barrier.
Multidisciplinary Tumor Boards
Our study demonstrates that centers with onsite radiation departments more frequently hold multidisciplinary tumor boards compared with centers without radiation departments (31% vs 3%, respectively; P = .01). Multidisciplinary tumor boards allow subspecialties to meet regularly to communicate about patient care and can help mitigate barriers related to communication and education of the referring health care practitioners.
As cases are discussed in multidisciplinary tumor boards, health care practitioners have the opportunity to make recommendations and provide education on potential benefits and/or downsides of treatments offered by their respective specialties. Several studies have demonstrated that cases discussed at multidisciplinary tumor boards are more likely to be referred for radiation therapy.19-21 Furthermore, multidisciplinary tumor boards have been associated with improved treatment outcomes.22
Conclusions
In this consensus statement the VHA Palliative Radiotherapy Taskforce recommends the optimization of use of radiotherapy within the VHA. Radiation oncology services should be maintained where present in the VHA, with consideration for expansion of services to additional facilities. Telehealth should be used to expedite consults and treatment. Hypofractionation should be used, when appropriate, to ease travel burden. Options for transportation services and onsite housing, or hospitalization, should be understood by practitioners and offered to patients to mitigate barriers related to travel.
Radiation therapy, along with surgery and systemic therapy, is a primary therapeutic modality for cancer management. At least half of cancer patients receive radiation as part of their treatment regimen.1 Multiple studies demonstrate that radiotherapy is underutilized worldwide.2 One reason for underutilization of radiotherapy globally is poor access to this treatment modality. Factors that contribute to poor access include long wait times for consultation, delays in treatment initiation, distance to a treatment facility, and poor coordination of care.
Taskforce Findings
The presence of onsite radiation oncology and its impact on utilization of radiotherapy is poorly studied. The Veterans Health Administration (VHA) Palliative Radiotherapy Taskforce recently conducted a survey to determine the barriers to referral and timeliness of treatment for palliative radiotherapy within the VHA.3 Key findings of this study comparing centers with onsite radiation departments with centers without onsite radiation departments include:
a. Radiation consults are more likely to be completed within 1 week of consult request at centers with onsite radiation therapy (68% vs 31%, respectively; P = .01).
b. Centers with onsite radiation therapy more frequently deliver emergent treatment within 24 hours for patients with spinal cord compression, an emergency condition in which prompt radiation can prevent or minimize long-term neurologic disability (94% vs 70%, respectively; P = .01).
c. Referring practitioners with onsite radiation departments are less likely to report difficulty contacting a radiation oncologist as a barrier to referral for palliative radiotherapy (0% vs 20%, respectively; P = .006).
d. Referring practitioners with onsite radiotherapy report patient travel as a barrier to referral for palliative radiotherapy less frequently (28% vs 71%, respectively; P < .001).
e. Practitioners with onsite radiation oncology departments are more likely to have multidisciplinary tumor boards (31% vs 3%, respectively; P = .01) and are more likely to be influenced by radiation oncology recommendations at tumor boards (69% vs 44%, respectively; P = .02).
Based on the findings of this study, the VHA Palliative Radiotherapy Taskforce has prepared this consensus statement regarding the importance of onsite radiation oncology departments at VHA medical centers. More information regarding our 5 key findings and their implications for patient care are as follows:
Timeliness of Radiation Oncology Consultation
Delays in radiation oncology consultation, which can also delay treatment initiation, are associated with poor satisfaction among both patients and referring clinicians.4 Wait times have been identified as a barrier to utilization of radiotherapy by both patients and clinicians.5,6 Furthermore, delays in initiation of definitive therapy have been associated with worse outcomes, including worse overall survival.7,8 Our survey study demonstrates that consults for palliative radiotherapy are occurring in a more timely manner at centers with onsite radiation departments. Radiation oncology consults are more frequently completed within 1 week at centers with onsite radiation oncology departments compared with centers without onsite radiation oncology departments (68% vs 31%, P = .01). This trend would likely be seen for nonpalliative, definitive cases as well. The presence of radiation oncology departments onsite at VHA medical centers is an important component of timely care for veterans to optimize outcomes of cancer treatment.
Timely Delivery of Radiotherapy for Oncologic Emergencies
There are a few scenarios in which emergent radiation treatment, within 24 hours, is indicated. These include malignant spinal cord compression, uncal herniation from brain metastasis, superior vena cava syndrome, and tumor hemorrhage.9 Studies on management of metastatic spinal cord compression demonstrate that delays in treatment are associated with reduced ambulation10 as well as loss of sphincter function and incontinence.11
Our study demonstrates that VHA medical centers with onsite radiotherapy more frequently deliver radiotherapy within 24 hours for patients with metastatic spinal cord compression. This timely delivery of treatment is critical to optimizing functional status and quality of life in patients requiring treatment for oncologic emergencies. Revisiting treatment pathways for such situations at regular intervals is crucial given that residents and staff may rotate and be unfamiliar with emergency protocols.
Communication With Radiation Oncologists
Several studies have demonstrated that the inability to contact a radiation oncologist and poor communication result in decreased referrals for palliative radiotherapy.12,13 Our study demonstrates that onsite radiation oncology is associated with improved ability to contact a radiation oncologist. About 20% of clinicians at facilities without onsite radiation oncology reported difficulty contacting a radiation oncologist, compared with 0% at facilities with onsite radiation departments (P = .006).
It is possible that increased radiation oncology presence at VHA medical centers, through attenuation of barriers related to contacting a radiation oncologist and improved communication, would lead to increased use of radiotherapy. Increased communication between referring clinicians and radiation oncologists also can help with education of those clinicians making the referral. Since knowledge gaps have been identified in multiple studies as a barrier to referral for radiotherapy, such communication and increased education on the role of radiotherapy could increase use.12-14
Patient Travel
Patient ability to travel was the most commonly reported barrier (81%) to referral for palliative radiotherapy in our study. Travel time and transportation difficulties have been established in multiple studies as barriers to radiotherapy for both definitive and palliative management.15-18 Travel for radiotherapy was much less frequently reported as a barrier among respondents with onsite radiation oncology departments compared with those without onsite radiation departments (28% vs 71%, respectively; P < .001).
It is therefore possible that expansion of VHA radiation oncology services, allowing for provision of onsite radiotherapy at more VHA facilities, would reduce travel burden. Increasing travel accommodations for patients and provision of patient lodging on hospital campuses, which is already offered at some VHA medical centers (ie, Fisher House Foundation), could also help attenuate this barrier.
Multidisciplinary Tumor Boards
Our study demonstrates that centers with onsite radiation departments more frequently hold multidisciplinary tumor boards compared with centers without radiation departments (31% vs 3%, respectively; P = .01). Multidisciplinary tumor boards allow subspecialties to meet regularly to communicate about patient care and can help mitigate barriers related to communication and education of the referring health care practitioners.
As cases are discussed in multidisciplinary tumor boards, health care practitioners have the opportunity to make recommendations and provide education on potential benefits and/or downsides of treatments offered by their respective specialties. Several studies have demonstrated that cases discussed at multidisciplinary tumor boards are more likely to be referred for radiation therapy.19-21 Furthermore, multidisciplinary tumor boards have been associated with improved treatment outcomes.22
Conclusions
In this consensus statement the VHA Palliative Radiotherapy Taskforce recommends the optimization of use of radiotherapy within the VHA. Radiation oncology services should be maintained where present in the VHA, with consideration for expansion of services to additional facilities. Telehealth should be used to expedite consults and treatment. Hypofractionation should be used, when appropriate, to ease travel burden. Options for transportation services and onsite housing, or hospitalization, should be understood by practitioners and offered to patients to mitigate barriers related to travel.
1. Barton MB, Jacob S, Shafiq J, et al. Estimating the demand for radiotherapy from the evidence: a review of changes from 2003 to 2012. Radiother Oncol. 2014;112(1):140-144. doi:10.1016/j.radonc.2014.03.024
2. Atun R, Jaffray DA, Barton MB, et al. Expanding global access to radiotherapy. Lancet Oncol. 2015;16(10):1153-1186. doi:10.1016/S1470-2045(15)00222-3
3. Gutt R, Malhotra S, Hagan MP, et al. Palliative radiotherapy within the Veterans Health Administration: barriers to referral and timeliness of treatment. JCO Oncol Pract. 2021;17(12):e1913-e1922. doi:10.1200/OP.20.00981
4. Agazaryan N, Chow P, Lamb J, et al. The timeliness initiative: continuous process improvement for prompt initiation of radiation therapy treatment. Adv Radiat Oncol. 2020;5(5):1014-1021. Published 2020 Mar 10. doi:10.1016/j.adro.2020.01.007
5. Gillan C, Briggs K, Goytisolo Pazos A, et al. Barriers to accessing radiation therapy in Canada: a systematic review. Radiat Oncol. 2012;7:167. Published 2012 Oct 12. doi:10.1186/1748-717X-7-167
6. Hanna TP, Richardson H, Peng Y, Kong W, Zhang-Salomons J, Mackillop WJ. A population-based study of factors affecting the use of radiotherapy for endometrial cancer. Clin Oncol (R Coll Radiol). 2012;24(8):e113-e124. doi:10.1016/j.clon.2012.01.007
7. Ho AS, Kim S, Tighiouart M, et al. Quantitative survival impact of composite treatment delays in head and neck cancer. Cancer. 2018;124(15):3154-3162. doi:10.1002/cncr.31533
8. Cone EB, Marchese M, Paciotti M, et al. Assessment of time-to-treatment initiation and survival in a cohort of patients with common cancers. JAMA Netw Open. 2020;3(12):e2030072. Published 2020 Dec 1. doi:10.1001/jamanetworkopen.2020.30072
9. Mitera G, Swaminath A, Wong S, et al. Radiotherapy for oncologic emergencies on weekends: examining reasons for treatment and patterns of practice at a Canadian cancer centre. Curr Oncol. 2009;16(4):55-60. doi:10.3747/co.v16i4.352
10. Laufer I, Zuckerman SL, Bird JE, et al. Predicting neurologic recovery after surgery in patients with deficits secondary to MESCC: systematic review. Spine (Phila Pa 1976). 2016;41 (Suppl 20):S224-S230. doi:10.1097/BRS.0000000000001827
11. Husband DJ. Malignant spinal cord compression: prospective study of delays in referral and treatment. BMJ. 1998;317(7150):18-21. doi:10.1136/bmj.317.7150.18
12. Samant RS, Fitzgibbon E, Meng J, Graham ID. Family physicians’ perspectives regarding palliative radiotherapy. Radiother Oncol. 2006;78(1):101-106. doi:10.1016/j.radonc.2005.11.008
13. McCloskey SA, Tao ML, Rose CM, Fink A, Amadeo AM. National survey of perspectives of palliative radiation therapy: role, barriers, and needs. Cancer J. 2007;13(2):130-137. doi:10.1097/PPO.0b013e31804675d4
14. Chierchini S, Ingrosso G, Saldi S, Stracci F, Aristei C. Physician and patient barriers to radiotherapy service access: treatment referral implications. Cancer Manag Res. 2019;11:8829-8833. Published 2019 Oct 7. doi:10.2147/CMAR.S168941
15. Longacre CF, Neprash HT, Shippee ND, Tuttle TM, Virnig BA. Travel, treatment choice, and survival among breast cancer patients: a population-based analysis. Womens Health Rep (New Rochelle). 2021;2(1):1-10. Published 2021 Jan 11. doi:10.1089/whr.2020.0094
16. Yang DD, Muralidhar V, Mahal BA, et al. Travel distance as a barrier to receipt of adjuvant radiation therapy after radical Prostatectomy. Am J Clin Oncol. 2018;41(10):953-959. doi:10.1097/COC.0000000000000410
17. Sundaresan P, King M, Stockler M, Costa D, Milross C. Barriers to radiotherapy utilization: Consumer perceptions of issues influencing radiotherapy-related decisions. Asia Pac J Clin Oncol. 2017;13(5):e489-e496. doi:10.1111/ajco.12579
18. Ambroggi M, Biasini C, Del Giovane C, Fornari F, Cavanna L. Distance as a barrier to cancer diagnosis and treatment: review of the literature. Oncologist. 2015;20(12):1378-1385. doi:10.1634/theoncologist.2015-0110
19. Bydder S, Nowak A, Marion K, Phillips M, Atun R. The impact of case discussion at a multidisciplinary team meeting on the treatment and survival of patients with inoperable non-small cell lung cancer. Intern Med J. 2009;39(12):838-841. doi:10.1111/j.1445-5994.2009.02019.x
20. Brännström F, Bjerregaard JK, Winbladh A, et al. Multidisciplinary team conferences promote treatment according to guidelines in rectal cancer. Acta Oncol. 2015;54(4):447-453. doi:10.3109/0284186X.2014.952387
21. Pillay B, Wootten AC, Crowe H, et al. The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: A systematic review of the literature. Cancer Treat Rev. 2016;42:56-72. doi:10.1016/j.ctrv.2015.11.007
22. Freytag M, Herrlinger U, Hauser S, et al. Higher number of multidisciplinary tumor board meetings per case leads to improved clinical outcome. BMC Cancer. 2020;20(1):355. Published 2020 Apr 28. doi:10.1186/s12885-020-06809-1
1. Barton MB, Jacob S, Shafiq J, et al. Estimating the demand for radiotherapy from the evidence: a review of changes from 2003 to 2012. Radiother Oncol. 2014;112(1):140-144. doi:10.1016/j.radonc.2014.03.024
2. Atun R, Jaffray DA, Barton MB, et al. Expanding global access to radiotherapy. Lancet Oncol. 2015;16(10):1153-1186. doi:10.1016/S1470-2045(15)00222-3
3. Gutt R, Malhotra S, Hagan MP, et al. Palliative radiotherapy within the Veterans Health Administration: barriers to referral and timeliness of treatment. JCO Oncol Pract. 2021;17(12):e1913-e1922. doi:10.1200/OP.20.00981
4. Agazaryan N, Chow P, Lamb J, et al. The timeliness initiative: continuous process improvement for prompt initiation of radiation therapy treatment. Adv Radiat Oncol. 2020;5(5):1014-1021. Published 2020 Mar 10. doi:10.1016/j.adro.2020.01.007
5. Gillan C, Briggs K, Goytisolo Pazos A, et al. Barriers to accessing radiation therapy in Canada: a systematic review. Radiat Oncol. 2012;7:167. Published 2012 Oct 12. doi:10.1186/1748-717X-7-167
6. Hanna TP, Richardson H, Peng Y, Kong W, Zhang-Salomons J, Mackillop WJ. A population-based study of factors affecting the use of radiotherapy for endometrial cancer. Clin Oncol (R Coll Radiol). 2012;24(8):e113-e124. doi:10.1016/j.clon.2012.01.007
7. Ho AS, Kim S, Tighiouart M, et al. Quantitative survival impact of composite treatment delays in head and neck cancer. Cancer. 2018;124(15):3154-3162. doi:10.1002/cncr.31533
8. Cone EB, Marchese M, Paciotti M, et al. Assessment of time-to-treatment initiation and survival in a cohort of patients with common cancers. JAMA Netw Open. 2020;3(12):e2030072. Published 2020 Dec 1. doi:10.1001/jamanetworkopen.2020.30072
9. Mitera G, Swaminath A, Wong S, et al. Radiotherapy for oncologic emergencies on weekends: examining reasons for treatment and patterns of practice at a Canadian cancer centre. Curr Oncol. 2009;16(4):55-60. doi:10.3747/co.v16i4.352
10. Laufer I, Zuckerman SL, Bird JE, et al. Predicting neurologic recovery after surgery in patients with deficits secondary to MESCC: systematic review. Spine (Phila Pa 1976). 2016;41 (Suppl 20):S224-S230. doi:10.1097/BRS.0000000000001827
11. Husband DJ. Malignant spinal cord compression: prospective study of delays in referral and treatment. BMJ. 1998;317(7150):18-21. doi:10.1136/bmj.317.7150.18
12. Samant RS, Fitzgibbon E, Meng J, Graham ID. Family physicians’ perspectives regarding palliative radiotherapy. Radiother Oncol. 2006;78(1):101-106. doi:10.1016/j.radonc.2005.11.008
13. McCloskey SA, Tao ML, Rose CM, Fink A, Amadeo AM. National survey of perspectives of palliative radiation therapy: role, barriers, and needs. Cancer J. 2007;13(2):130-137. doi:10.1097/PPO.0b013e31804675d4
14. Chierchini S, Ingrosso G, Saldi S, Stracci F, Aristei C. Physician and patient barriers to radiotherapy service access: treatment referral implications. Cancer Manag Res. 2019;11:8829-8833. Published 2019 Oct 7. doi:10.2147/CMAR.S168941
15. Longacre CF, Neprash HT, Shippee ND, Tuttle TM, Virnig BA. Travel, treatment choice, and survival among breast cancer patients: a population-based analysis. Womens Health Rep (New Rochelle). 2021;2(1):1-10. Published 2021 Jan 11. doi:10.1089/whr.2020.0094
16. Yang DD, Muralidhar V, Mahal BA, et al. Travel distance as a barrier to receipt of adjuvant radiation therapy after radical Prostatectomy. Am J Clin Oncol. 2018;41(10):953-959. doi:10.1097/COC.0000000000000410
17. Sundaresan P, King M, Stockler M, Costa D, Milross C. Barriers to radiotherapy utilization: Consumer perceptions of issues influencing radiotherapy-related decisions. Asia Pac J Clin Oncol. 2017;13(5):e489-e496. doi:10.1111/ajco.12579
18. Ambroggi M, Biasini C, Del Giovane C, Fornari F, Cavanna L. Distance as a barrier to cancer diagnosis and treatment: review of the literature. Oncologist. 2015;20(12):1378-1385. doi:10.1634/theoncologist.2015-0110
19. Bydder S, Nowak A, Marion K, Phillips M, Atun R. The impact of case discussion at a multidisciplinary team meeting on the treatment and survival of patients with inoperable non-small cell lung cancer. Intern Med J. 2009;39(12):838-841. doi:10.1111/j.1445-5994.2009.02019.x
20. Brännström F, Bjerregaard JK, Winbladh A, et al. Multidisciplinary team conferences promote treatment according to guidelines in rectal cancer. Acta Oncol. 2015;54(4):447-453. doi:10.3109/0284186X.2014.952387
21. Pillay B, Wootten AC, Crowe H, et al. The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: A systematic review of the literature. Cancer Treat Rev. 2016;42:56-72. doi:10.1016/j.ctrv.2015.11.007
22. Freytag M, Herrlinger U, Hauser S, et al. Higher number of multidisciplinary tumor board meetings per case leads to improved clinical outcome. BMC Cancer. 2020;20(1):355. Published 2020 Apr 28. doi:10.1186/s12885-020-06809-1