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Background and Objectives: Standard management of stage II non-small cell lung cancer (NSCLC) is surgery, often followed by adjuvant chemotherapy. However, some patients do not undergo surgery for various reasons. The optimal non-surgical management of stage II NSCLC is undefined. We surveyed Canadian oncologists to understand current practices., Materials and Methods: Canadian oncologists specializing in the management of lung cancer were invited by email to complete an anonymous, online survey developed by the research team. Physician demographics were recorded. Physicians were asked to comment on their practice and make treatment choices in eight clinical scenarios of inoperable stage II NSCLC., Results: Responses were received from 81/194 physicians (42% response rate), 57% medical and 42% radiation oncologists. Most physicians (90%) had a practice with at least 25% lung cancer patients and 85% were based at an academic institution. Across eight clinical patient scenarios, radical therapy was selected 79-98% of the time. Radical radiotherapy alone and concurrent chemoradiotherapy were the preferred options for these patients, while sequential chemoradiation was less favoured. Nodal status (N0 vs N1) did not influence choice of therapy (p 0.31), but the reason for patient inoperability did (p<0.0001). There was no significant difference in choice of therapy when comparing responses between medical vs radiation oncologists, academic vs community physicians, and physicians with high vs low proportion of lung cancer patients., Conclusion: Most lung cancer physicians manage inoperable stage II NSCLC patients with curative intent, but consensus on how to optimally employ radiotherapy and/or chemotherapy is lacking. Future prospective, randomized trials are warranted., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

With the increasing prevalence and complexity of re-irradiation cases, there is a need for comprehensive policies and procedures to ensure optimal patient outcomes and minimize risk. A critical incident involving re-irradiation was reported to Ontario Health-Cancer Care Ontario (OH-CCO) which prompted a review of re-irradiation practices across radiation treatment facilities. The aim of the OH-CCO Re-Irradiation Symposium Webinar was to explore re-irradiation incidents and lessons learned and current re-irradiation practices and processes across the province with the goal of knowledge transfer exchange and best practice sharing. In the context of this webinar, re-irradiation was defined as delivery of a new course of radiation therapy to a previously irradiated volume where there is overlap or potential overlap between the two plans. Prior to the webinar, a pre-meeting survey was circulated to the radiation therapy managers at each of Ontario's radiation treatment facilities. The managers were asked to coordinate one submission per centre in collaboration with the inter-professional team. The survey included questions on re-irradiation policy, gathering radiation treatment history and combining previous and current plans. A 100% response rate (n=15) was achieved. The OH-CCO Re-Irradiation Symposium webinar was held in June 2023. The webinar included an overview of the epidemiology of re-irradiation, a review of the pre-meeting survey results, a summary of the Radiation Incident Safety Committee (RISC) analysis of re-irradiation incidents reported to the National System for Incident Reporting-Radiation Treatment (NSIR-RT), a presentation of a critical incident involving re-irradiation and the resulting quality care review recommendations, and a showcase of re-irradiation processes and learnings from three radiation treatment facilities. The webinar also included four discussion periods where participants could ask questions and share their experiences and challenges with re-irradiation processes. A showing of the recorded webinar was hosted in November 2023 for those unable to attend the live event. The benefits of the webinar included bringing representatives from all radiation treatment facilities to participate in knowledge transfer exchange and best practice sharing, as well as increasing awareness of variation in current re-irradiation processes and challenges with creating or updating these processes. 93% of radiation treatment facilities indicated during the pre-meeting survey that they would be interested in sharing their re-irradiation policy/process with other facilities highlighting an appetite for continued collaboration amongst facilities. The main challenge of the webinar was the size of the group and the virtual setting, which made participation in discussion more difficult and limited the interaction among attendees. Over 180 participants attended the live webinar and/or the showing of the recording. There was representation from each of Ontario's radiation treatment facilities including participants from multiple areas of the multidisciplinary team (i.e. radiation oncologists, medical physicists, clinical specialist radiation therapists, radiation therapists, dosimetrists, clinical educators, radiation nurses, management, students etc.). Opportunities for continued collaboration and best practice sharing have stemmed from this webinar. Suggestions for future symposia topics were raised by the participants; these will be explored by the OH-CCO team. Work is underway to collect re-irradiation policies/processes from each of Ontario's radiation treatment facilities with the goal of developing a recommendation document to support creating or updating these processes to improve their effectiveness. There has also been interest in forming a provincial re-irradiation working group to establish provincial guidelines and promote consensus on re-irradiation practices both clinically and logistically. [ABSTRACT FROM AUTHOR]

Ambulatory cancer centers face a fluctuating patient demand and deploy specialized personnel who have variable availability. This undermines operational stability through the misalignment of resources to patient needs, resulting in overscheduled clinics, budget deficits, and wait times exceeding provincial targets. We describe the deployment of a Learning Health System framework for operational improvements within the entire ambulatory center. Known methods of value stream mapping, operations research and statistical process control were applied to achieve organizational high performance that is data-informed, agile and adaptive. We transitioned from a fixed template model by an individual physician to a caseload management by disease site model that is realigned quarterly. We adapted a block schedule model for the ambulatory oncology clinic to align the regional demand for specialized services with optimized human and physical resources. We demonstrated an improved utilization of clinical space, increased weekly consistency and improved distribution of activity across the workweek. The increased value, represented as the ratio of monthly encounters per nursing worked hours, and the increased percentage of services delivered by full-time nurses were benefits realized in our cancer system. The creation of a data-informed demand capacity model enables the application of predictive analytics and business intelligence tools that will further enhance clinical responsiveness. [ABSTRACT FROM AUTHOR]

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