Abstract Book

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ESTRO 37

county range, 21.8%–36.6%). Female gender, advanced age at death, certain cancer sites, short survival time, and previous receipt of curative radiotherapy were all associated with decreased odds of receiving PRT. Patients with low education, those living in certain counties, or with travel distances 100–499 km, were also less likely to receive PRT. Patients with high household income (adjusted odds ratio (OR) 1.58; 95% confidence interval (CI) 1.39–1.78) and those diagnosed in hospitals with radiotherapy facility (OR 1.42; 95% CI 1.30–1.55) had higher likelihood of receiving PRT. Conclusion Despite free and universal healthcare coverage in a highly egalitarian country such as Norway, the use of PRT seems to be influenced by factors unrelated to patients’ needs. Even after adjustments for relevant factors, unexplained geographic variations exist. OC-0067 Radiotherapy in small countries M. Barton 1 , E. Zubizarreta 2 , J. Polo Rubio 2 1 Ingham Institute for Applied Medical Research, Collaboration for Cancer Outcomes Research and Evaluation CCORE, Liverpool BC- NSW, Australia 2 International Atomic Energy Agency, Applied Radiation Biology and Radiotherapy Section- Division of Human Health e Department of Nuclear Sciences and Applications, Vienna, Austria Purpose or Objective Radiotherapy is an essential part of the treatment of cancer and is indicated at least once in about half of all cancer patients. However access to the therapy is often limited or not available at all in many countries. Countries with smaller populations and lower economic status face additional challenges to justify the investment in the treatment. This study aims to examine the availability of radiotherapy in small countries and the factors influencing the establishment of radiotherapy. Material and Methods A small country was defined as a country with a population less than one million persons. The economic status of each country was defined using the World Bank Classification. The number of cancers in each country was obtained from GLOBOCAN 2012. The number of cancer cases with an indication for radiotherapy was calculated using the CCORE model. The available radiotherapy equipment in the country was obtain through the DIRAC database and complemented with information obtained directly from certain countries Results There were 41 countries with a population of under 1 million; 15 were classified as High Income Countries (HIC), 15 Upper Middle Income Countries (UMIC), 10 Lower Middle Income Countries (LMIC) and one Low Income Country (LIC). 28 countries were islands. Populations ranged from 799 (Holy See) to 886450 (Fiji) and the total number of cancer cases occurring in small countries was 21,043 (range by country from 4 to 2476). Overall the total number of radiotherapy cases in small countries was 10982 (range by country from 2 to 1239). Radiotherapy was available in all HIC islands with 80 or more new cases of cancer in 2012 but was not available in any LMIC island. Fiji was the only LMIC island with a large radiotherapy caseload. Similar caseloads in non- island LMIC all had radiotherapy services. Where radiotherapy was available, the number of megavoltage (MV) machines (Cobalt and Linear accelerator) ranged from 0.9 to 11.5 MV Machines per 1000 new cases of cancer. Conclusion Geographical location, economic status, and cancer burden were significant factors small countries establishing local radiotherapy facilities. This is reflected in our findings that no LMIC islands offer radiotherapy services. Radiotherapy was available in all HIC islands but

was not available in any LMIC island. Most small non- island HIC did not have radiotherapy services presumably because of the easy access to radiotherapy in neighbouring countries. OC-0068 Can Advanced Practice Radiation Therapists improve access to radiotherapy? N. Harnett 1 1 Harnett Nicole, Academic Radiotherapy, Toronto, Canada Background From 2004 to 2016, Ontario Canada evaluated the development and impact of advanced practice radiation therapists (APRT) in radiation treatment (RT) programs across the province. As part of that project, a competency profile was developed the described the expanded scope of practice assigned to the APRT. In general, the expanded scope included activities that were traditionally performed by radiation oncologists (RO). The acquisition of the various competencies by those engaged in the pilot study was assessed such that when suitable competence was acquired, those activities could be shared or delegated to the APRT to improve efficiency or effectiveness of the RT program. It is hypothesized that this advanced practitioner could be deployed to areas where radiation therapy knowledge is lacking in order to close that gap and work with the local medical teams to enable the delivery of safe, quality radiation therapy. Method During development, APRTs were paired with a RO supervisor to identify and work towards learning goals. APRTs used a variety of methods to develop competence including self directed learning, formal courses, one-on- one instruction from members of the RT team. Once it was felt the APRT had achieved competence, concordance studies were employed to compare APRT performance with gold standard performance. Metrics for the studies were drawn from literature where possible (ie. DICE co-efficient, conformity index, centre of mass calculations, etc.) and developed de novo when no validated tool existed (3-point Likert scale for RO to assess concordance and impact of APRT decisions). Activities assessed included, for example, ontreatment review, new patient assessment and decision to treat, obtaining consent, disclosing results of diagnostic tests, serving as expert technical consultants, patient physical exam, medication consultation, prescribing treatment, contouring high risk volumes, delineating treatment field, etc. Results Over the course of the project, 25 APRTs completed a range of concordance studies. A “pass score” of 90% concordance was set to denote “competence”. APRTs were able to achieve a concordance of 90% or higher in 100% of the assessments. This led to the approval of 32 medical directives (5 pending approval) and innumerable delegated acts at the local facilities. Conclusions : APRTs demonstrated that with appropriate education and training, they were able to perform to an acceptable standard on a variety of activities traditionally performed by a RO. Future work includes characterizing the knowledge gap in underserviced regions and describe the competencies that APRTs could offer to bolster the existing team’s capabilities and improve access to quality radiation treatment. OC-0069 Process Mining in Oncology to assess adherence to clinical guidelines from existing data log C. Casà 1 , F. Cellini 2 , J. Lenkowicz 3 , A. Damiani 3 , V. Lanzotti 3 , N. Dinapoli 4 , C. Masciocchi 3 , R. Gatta 3 , V. Valentini 4 1 Gemelli ART- Department of Radiation Oncology- Fondazione Policlinico A. Gemelli- Università Cattolica