A Multidisciplinary Rapid Access Clinic - Providing More Than Just Rapid Access

Patients with lung cancer frequently present with metastatic disease and require urgent palliative radiation therapy (RT) for symptom management. In May 2011, the Vancouver Cancer Center (VCC) opened a pilot, multidisciplinary clinic called the Vancouver Rapid Access (VARA) Clinic, which aimed to provide palliative RT to patients with newly diagnosed, incurable lung cancer on an urgent basis. The purpose of this study was to assess the general patient and treatment characteristics of the population served, as well as to compare the efficiency and level of care provided by VARA compared to standard practice. Patients referred to VARA are triaged and assessed by a nurse practitioner (NP), reviewed by a radiation oncologist (RO), and if appropriate, treated with RT on the same day. The NP and advanced practice nurse also address other holistic concerns the patient might have. VARA patient and treatment characteristics were prospectively collected over a 9-month period (May 2011-Jan 2012). Charts for similar patients in the ‘pre-VARA period,’ defined as the same 9 month period one year prior (May 2010-Jan 2011) were retrospectively reviewed. A comparison of the following was made between the VARA period and pre-VARA period: RT wait-times, referrals (BC Palliative benefits, home care, nutrition, pain and symptom management, and patient and family counseling) and number of double bookings for urgent patients. During the first 9 months of VARA, 54 patients were assessed. The mean and median RT wait-times were 3 and 0 days, respectively, with the majority of VARA patients receiving RT on the same day as their consultation (71%). This is compared to only 41% of patients receiving same day RT in the pre-VARA period (p < 0.001). The majority of VARA patients (55%) received at least one referral to a supportive care service compared to only 31% of patients in the pre-VARA period (p = 0.001). The proportion of urgent patients requiring a double booking for assessment decreased from 23% in the pre-VARA period to 13% in the VARA period (p < 0.001). This study suggests that the VARA clinic has shortened the wait time for palliative RT and connects a higher proportion of patients with supportive care services than the previous standard practice. The clinic has also improved RO workload by decreasing double bookings. These results highlight the value of the VARA clinic and suggest that the extension of this model to other tumor sites may be beneficial.