Examining Radiation Treatment Appointment Times at a Canadian Cancer Centre: A Timing Study

Abstract

Introduction: Technological advancements in radiation therapy have led to more complex treatment techniques such as volumetric modulated arc therapy, and in turn, more daily image verification. As treatment complexity increases, it is important to consider what effect this may have on treatment time. Additional factors that may influence treatment times are patient-centered care and mobility status. The aim of this study is to determine optimal radiation treatment appointment times based on site, technique, imaging requirements, and patient needs.

Methods: Data from 535 fractions of radiation treatments were collected and analyzed between June 2016 and July 2017 by a team of eight radiation therapists at BC Cancer Vancouver Centre. Data collectors documented a number of data points, including treatment unit, scheduled appointment time, scheduled appointment duration (booked in 12 minute increments), treatment site, treatment technique, imaging modality, pre-treatment-related and post-treatment-related activity time, patient mobility status, etc. Student's t-test was performed for each site/technique to determine if the mean total treatment time was significantly different from the standard appointment time for that site. A two-sample unpaired t-test assuming unequal variance was used to compare average treatment times of the same site with different imaging modalities. Student's t-test was also used to compare average treatment times for ambulatory patients versus patients requiring some form of mobility assistance.

Results: Average treatment times for 6 of the 10 sites used for data analysis were longer than standard booked times and showed statistical significance (prostate/prostate bed: n = 82, P < .001; chest: n = 32, P < .001, palliative 1 treatment site: n = 28, P < .05, gyne pelvis only treatment: n = 25, P < .001, head & neck: n = 56, P < .001, and rectum: n = 28, P < 0.05). The breast/chest wall + nodes site had a significantly shorter treatment time than the standard booked appointment time (n = 87, P < .001). Analysis of the prostate/prostate bed imaging showed a significant difference between daily cone beam computed tomography and daily kilovoltage treatment time, with cone beam computed tomography imaging taking 3.83 ± 1.36 (P < .001) minutes longer on average than kilovoltage imaging. Average treatment time for patients requiring mobility assistance was 20% longer than for patients requiring no assistance (P = .02).

Conclusion: The majority of the most common sites and techniques treated at our centre were inappropriately booked. Radiation therapy appointment durations are influenced by several factors, including site, technique complexity, imaging, and patient care. It is recommended that radiation treatment centres evaluate appointment times regularly as technology, treatment delivery, and professional practice standards evolve to ensure high-quality patient care.

Keywords: appointment times; booking; radiation therapy; radiotherapy; time increments.