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Bourgier C, Boisbouvier S, Bayart É, Chamois J, Clavère P, Corbin S, De Oliveira A, Hannoun-Lévi JM, Hasbini A, Geffroy-Hulot C, Le Tallec P, Monpetit É, Santini JJ. [Radiation therapists shortage in France: Organizational consequences and difficulties in deploying new missions and/or tasks delegation]. Cancer Radiother 2023; 27:577-582. [PMID: 37596123 DOI: 10.1016/j.canrad.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 08/20/2023]
Abstract
PURPOSE Radiation therapists shortage has been evaluated at national level in France, specifically in oncology radiotherapy, in terms of: (i) organizational adaptations, (ii) impact on patients care, and (iii) difficulties in deploying new missions and/or tasks delegation. MATERIALS AND METHODS French professional organisations representing radiation therapists - SFRO, SNRO and AFPPE - sent their members a national survey (ten questions on 32 items). RESULTS From 18 November 2022 to 31 December 2022, 55 responses were received (response rate: 31%) from radiotherapy managers or department heads; 51% had a structure comprising three to five treatment rooms (receiving 500 to 1000 patients per year [36%], or 1500 to 2000 patients per year [33%]). Activities performed were intensity-modulated radiotherapy (100%), stereotaxic radiotherapy (85%), brachytherapy (40%), adaptive radiotherapy (34%). These structures described consequences in closing machine time for 25% of them (reduction of the hourly volume greater than 10% in 57%) with the following consequences in the last 6 months: (i) an extension of the period of medical care (78%), a closing of one or more accelerators (50%) and the development of moderate hypofractionation scheme or extreme hypofractionation (50%). In current functioning, linear accelerators can deliver treatments with a team of two radiation therapists per room for a short day (43%) or two to four radiation therapists per room teams for a long day (40%). During the last 6 months, there has been a 10% increase in linear accelerators operating with a single team. (ii) regarding treatment planning: 16.4% reported a decrease in the opening amplitude (less than 20% in 44% of cases, from 20 to 50% in 33 % of cases). The initial scheduling of appointments for radiotherapy sessions was carried out by radiation therapists in 84% of the departments in current functioning (0.1 to 1 FTE dedicated to this activity in 62% of the departments). Over the last 6 months, there has been a clear reduction in the number of dedicated FTEs: [FTE=0.1 to 1]=-8%; [FTE=0]=+7%. (ii) Regarding tasks delegation (excluding the decree on acts and activities carried out by the radiation therapist): organ at risk delineation is partially performed by radiation therapist in 26% of the centres; caregiver support time in 78% (56% totally or 22% partially). This activity has been reduced by 42%. Seventy-five percent of departments want to develop new techniques, patient-centered approaches (44%), implement task delegation (organ at risk delineation: 58%; weekly consultations: 67%; positioning imaging validation: 71%), and 78% of departments are interested in developing advanced radiotherapy practice. However, the number of radiation therapists is considered insufficient in their implementation in 76% of cases (one to two FTE missing for 72% of structures). CONCLUSION This survey shows a significant impact of radiation therapist shortage in radiotherapy oncology care (treatment delays, access to caregiver support time, workload on treatment teams), and represents a major obstacle to the development of radiotherapy structures.
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Affiliation(s)
- C Bourgier
- Fédération universitaire d'oncologie radiothérapie de Méditerranée-Occitanie, institut du cancer de Montpellier (ICM), université de Montpellier, Inserm U1194 IRCM, Montpellier, France.
| | - S Boisbouvier
- Département de radiothérapie, centre Léon-Bérard, rue, Laënnec, 69008 Lyon, France
| | - É Bayart
- Société française de radiothérapie oncologique, centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France
| | - J Chamois
- Département de radiothérapie, centre hospitalier privé de Saint-Grégoire, Saint-Grégoire, France
| | - P Clavère
- Département de radiothérapie, centre hospitalier universitaire de Limoges, Limoges, France
| | - S Corbin
- Département de radiothérapie, institut Gustave-Roussy, Villejuif, France
| | - A De Oliveira
- Département de radiothérapie, institut Curie, Paris, France
| | - J-M Hannoun-Lévi
- Département de radiothérapie, centre Antoine-Lacassagne, Nice, France
| | - A Hasbini
- Département de radiothérapie, clinique Pasteur, Brest, France
| | - C Geffroy-Hulot
- Département de radiothérapie, centre Eugène-Marquis, Rennes, France
| | - P Le Tallec
- Association française du personnel paramédical d'électroradiologie, Montrouge, France
| | - É Monpetit
- Département de radiothérapie, clinique Saint-Yves, Vannes, France
| | - J-J Santini
- Fédération universitaire d'oncologie radiothérapie de Méditerranée-Occitanie, institut du cancer de Montpellier (ICM), université de Montpellier, Inserm U1194 IRCM, Montpellier, France
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Duffton A, Devlin L, Tsang Y, Mast M, Leech M. Advanced practice: An ESTRO RTTC position paper. Tech Innov Patient Support Radiat Oncol 2019; 10:16-19. [PMID: 32095543 PMCID: PMC7033776 DOI: 10.1016/j.tipsro.2019.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Aileen Duffton
- Radiotherapy Department, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Lynsey Devlin
- Radiotherapy Department, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Yatman Tsang
- Radiotherapy Department, Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Mirjam Mast
- Radiation Therapy Department, Haaglanden Medical Center, Burg Banninglaan 1, 2262 BA Leidschendam, the Netherlands
| | - Michelle Leech
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College, Dublin 2, Ireland
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Lee G, Dinniwell R, Liu FF, Fyles A, Han K, Conrad T, Levin W, Marshall A, Purdie TG, Koch CA. Building a New Model of Care for Rapid Breast Radiotherapy Treatment Planning: Evaluation of the Advanced Practice Radiation Therapist in Cavity Delineation. Clin Oncol (R Coll Radiol) 2016; 28:e184-e191. [PMID: 27542573 DOI: 10.1016/j.clon.2016.07.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/22/2016] [Accepted: 06/24/2016] [Indexed: 11/15/2022]
Abstract
AIMS Breast radiotherapy treatment is commonly managed by a multidisciplinary team to ensure optimal delivery of care. We sought a new model of care whereby a clinical specialist radiation therapist (CSRT) delineates the cavity target for whole breast radiotherapy treatment planning and the radiation oncologist validates the contour during final plan review. This study evaluated the radiation oncologist's acceptance of these contours and identified characteristics of cavities suitable for CSRT-directed contouring. MATERIALS AND METHODS Following specialised breast oncology education and training by the radiation oncologist, the CSRT prospectively delineated cavities in 30 tangential breast radiotherapy cases and consulted the radiation oncologist in 'complex' cases but directed 'non-complex' cases for treatment planning. Changes to CSRT contours were evaluated using the conformity index. Breast density, time since surgery and cavity location, size and visualisation score [CVS: range 1 (no visible cavity) to 5 (homogenous cavity)] were captured. RESULTS Of the 30 CSRT delineated cavities contours, the CSRT directed 20 (66.7%) cases for planning without radiation oncology review; 19 were accepted (without changes) by the radiation oncologist upon final plan review and one was changed by the radiation oncologist (conformity index = 0.93) for boost treatment and did not affect the tangential treatment plan. Ten (33.3%) cases, all CVS ≤ 3, were reviewed with the radiation oncologist before planning (conformity index = 0.88 ± 0.12). CVS was inversely correlated with breast density and cavity size (P < 0.01). CONCLUSIONS The CSRT delineated cavities appropriate for clinical radiotherapy treatment planning in women with well-visualised cavities, whereas 'complex' cases with dense breast parenchyma, CVS ≤ 3, and/or cases needing boost radiotherapy treatment required review with the radiation oncologist before planning.
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Affiliation(s)
- G Lee
- Radiation Medicine Program, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - R Dinniwell
- Radiation Medicine Program, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - F F Liu
- Radiation Medicine Program, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - A Fyles
- Radiation Medicine Program, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - K Han
- Radiation Medicine Program, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - T Conrad
- Radiation Medicine Program, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - W Levin
- Radiation Medicine Program, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - A Marshall
- Radiation Medicine Program, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - T G Purdie
- Radiation Medicine Program, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - C A Koch
- Radiation Medicine Program, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
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Lee G, Fyles A, Cho BJ, Easson AM, Fenkell LL, Harnett N, Manchul L, Tran PK, Wang W, Craig T, Czarnota GJ, Dinniwell RE. Evaluation of variability in seroma delineation between clinical specialist radiation therapist and radiation oncologist for adjuvant breast irradiation. Pract Radiat Oncol 2012; 2:114-21. [DOI: 10.1016/j.prro.2011.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 07/05/2011] [Accepted: 07/06/2011] [Indexed: 10/17/2022]
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