Skip to main content

Advertisement

SpringerLink
Log in

Evaluation of time, attendance of medical staff, and resources during radiotherapy for breast cancer patients

The DEGRO-QUIRO trial

Zeiterhebung, Personalaufwand und Ressourcen bei der Strahlentherapie des Mammakarzinoms

Die DEGRO-QUIRO-Studie

  • Original article
  • Published:
Strahlentherapie und Onkologie Aims and scope Submit manuscript

Abstract

Background and purpose

To conform to recommendations regarding the treatment of breast cancer, an estimation of costs and personnel to assure treatment is required. To date no recommendations based on real time measurements are available. The DEGRO (German Society of Radiation Oncology), therefore, initiated a prospective multicenter evaluation of core procedures of radiotherapy. In this analysis, the results regarding human resources and room occupation during the treatment of breast cancer are presented.

Patients and methods

Three academic radiation oncology centers (Erlangen, Münster, Mannheim) prospectively documented their workflow and working time for all breast cancer patients from July–October 2008. Subsequently, a statistical analysis was performed.

Results

The longest working time of physicians was the definition of the target volume and organs at risk (mean 33 min). Furthermore, physicians needed much time for general tasks, which included conversations. Physicists needed the most time for treatment planning and authorization (64 min), whereas technicians were mostly needed in day-to-day radiotherapy treatment (15 min, 31 min including verification). Despite significant differences in specific steps between centers, overall working times and room occupation were comparable and representative. Special procedures (intraoperative radiotherapy/multicatheter brachytherapy) required considerable amounts of additional working time of physicians and physicists.

Conclusion

In this prospective analysis, data of human resources and room occupation during treatment of breast cancer are presented for the first time. Each patient consumes about 12 h of human resources for treatment and 3.75 h for general tasks (physicians 4.7 h, physicists 1.8 h, and technicians 9.2 h).

Zusammenfassung

Einleitung

Um Therapieempfehlungen zur Behandlung des Mammakarzinoms nachzukommen, ist es notwendig, die Kosten und das benötigte Personal abzuschätzen, um die geforderten Leistungen zu erbringen. Aktuell gibt es keine Empfehlungen, die auf tatsächlichen Messungen in der Radioonkologie bzw. Strahlentherapie beruhen. Die DEGRO (Deutsche Gesellschaft für Radioonkologie e.V.) hat deshalb eine prospektive und multizentrische Studie zur Evaluation der Kernarbeitsschritte in der Strahlentherapie durchgeführt. In dieser Analyse werden die Ergebnisse sowohl bezüglich des eingesetzten Personals als auch der Raumbelegungszeiten während der Strahlentherapie beim Mammakarzinom dargestellt.

Patienten und Methodik

Drei universitäre radioonkologische Zentren (Erlangen, Münster, Mannheim) dokumentierten prospektiv ihren Arbeitsablauf und die dafür benötigte Arbeitszeit für alle Mammakarzinompatientinnen zwischen Juli und Oktober 2008. Anschließend erfolgte eine statistische Analyse.

Ergebnisse

Die längste Einsatzzeit für Ärzte ergab sich durch die Zielvolumendefinition und das Einzeichnen der Risikoorgane (im Mittel 33 min). Zusätzlich hatten Ärzte einen beachtlichen Zeitaufwand für allgemeine Tätigkeiten, wie z. B. Arzt-Patienten-Gespräche und Anfertigung der Arztbriefe. Physiker wurden am längsten bei der physikalischen Therapieplanung und Autorisierung (64 min) und MTRAs bei der täglichen Routinebestrahlung (15 min, 31 min inklusive Verifikation) eingesetzt. Trotz signifikanter Unterschiede in einzelnen Arbeitsschritten zwischen den drei Zentren sind die Personalbindungs- und Raumbelegungszeiten insgesamt vergleichbar und repräsentativ. Spezielle Anwendungen (intraoperative Bestrahlungen/Multikatheter-Brachytherapie) erfordern vor allem zusätzliches ärztliches Personal und Physiker.

Schlussfolgerung

In dieser prospektiven Analyse wurden die Arbeitszeit und der Personalaufwand zur Durchführung einer Strahlentherapie bei Mammakarzinompatientinnen erstmals dargestellt. Für eine Patientin werden etwa 12 h Arbeitszeit für die Therapie und 3,75 h für allgemeine Tätigkeiten benötigt (Ärzte 4,7 h, Physiker 1,8 h und MTRAs 9,2 h).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Refereces

  1. Anderson BO, Distelhorst SR (2008) Guidelines for international breast health and cancer control-iImplementation. Introduction. Cancer 113:2215–2216

    Article  PubMed  Google Scholar 

  2. Bentzen SM, Heeren G, Cottier B et al (2005) Towards evidence-based guidelines for radiotherapy infrastructure and staffing needs in Europe: the ESTRO QUARTS project. Radiother Oncol 75:355–365

    Article  PubMed  Google Scholar 

  3. Boyle P, d’Onofrio A, Maisonneuve P et al (2003) Measuring progress against cancer in Europe: has the 15% decline targeted for 2000 come about? Ann Oncol 14:1312–1325

    Article  PubMed  CAS  Google Scholar 

  4. Brucker SY, Wallwiener M, Kreienberg R et al (2011) Optimizing the quality of breast cancer care at certified german breast centers: a benchmarking analysis for 2003–2009 with a particular focus on the interdisciplinary specialty of radiation oncology. Strahlenther Onkol 187(2):89–99

    Article  PubMed  Google Scholar 

  5. Budach W, Bölke E, Fietkau R et al (2011) Evaluation of time, attendance of medical staff and resources during radiotherapy for head and neck cancer patients – The DEGRO-QUIRO trial. Strahlenther Onkol 187(8):449–460

    Article  PubMed  Google Scholar 

  6. Dunst J, Popp W, Willich N et al (in preparation) Quality assurance and innovation in radiation oncology: the QUIRO study – basics of methodology. Strahlenther Onkol

  7. Fietkau R, Budach W, Zamboglou N et al (2012) Time management in radiation oncology: development and evaluation of a modular system based on the example of rectal cancer treatment: the DEGRO-QUIRO Trial. Strahlenther Onkol 188(1):5–11

    Article  PubMed  CAS  Google Scholar 

  8. Gerlach A, Wiedemann R (2010) Breast care nurses – nursing experts for breast cancer care. A path to “advanced nursing practice” in Germany? Pflege 23:393–402

    Article  PubMed  Google Scholar 

  9. Boda-Heggemann J, Lohr F, Wenz F et al (2011) KV cone-beam CT-based IGRT: a clinical review. Strahlenther Onkol 187(5):284–291

    Article  PubMed  Google Scholar 

  10. Norlund A (2003) Costs of radiotherapy. Acta Oncol 42:411–145

    Article  PubMed  Google Scholar 

  11. Ploquin NP, Dunscombe PB (2008) The cost of radiation therapy. Radiother Oncol 86:217–223

    Article  PubMed  Google Scholar 

  12. Sautter-Bihl ML, Sedlmayer F, Budach W et al (2010) Intraoperative radiotherapy as accelerated partial breast irradiation for early breast cancer: beware of one-stop shops? Strahlenther Onkol 186:651–657

    Article  PubMed  Google Scholar 

  13. Slotman BJ, Cottier B, Bentzen SM et al (2005) Overview of national guidelines for infrastructure and staffing of radiotherapy. ESTRO-QUARTS: work package 1. Radiother Oncol 75:349–354

    Article  PubMed  Google Scholar 

  14. Steil V, Schneider F, Kupper B et al (2009) Patient-centered image and data management in radiation oncology. Strahlenther Onkol 185:1–7

    Article  PubMed  Google Scholar 

  15. Vaidya JS, Joseph DJ, Tobias JS et al (2010) Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet 376:91–102

    Article  PubMed  Google Scholar 

  16. Varga D, Wischnewsky M, Atassi Z et al (2010) Does guideline-adherent therapy improve the outcome for early-onset breast cancer patients? Oncology 78:189–195

    Article  PubMed  Google Scholar 

  17. Verdecchia A, Santaquilani M, Sant M (2009) Survival for cancer patients in Europe. Ann Ist Super Sanita 45:315–324

    PubMed  Google Scholar 

Download references

Acknowledgment

The authors wish to thank Beate Küpper, Anke Keller, and Volker Steil and their teams in Mannheim and all the teams in Erlangen and Münster for their support during organization and procedure and Prime Networks for the statistics.

Conflict of interest

The radiobiological research by Frederik Wenz was supported by Carl Zeiss Surgical.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Germany

    E. Blank & F. Wenz

  2. Department of Radiation Oncology, University Hospital Münster, University of Münster, Münster, Germany

    N. Willich

  3. Department of Radiation Oncology, University Cancer Center Erlangen, University of Erlangen, Erlangen, Germany

    R. Fietkau

  4. Prime Networks AG, Basel, Switzerland

    W. Popp & J. Schaller-Steiner

  5. Department of Radiation Oncology, University of Essen, Essen, Germany

    H. Sack

Authors
  1. E. Blank
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. Willich
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Fietkau
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. W. Popp
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Schaller-Steiner
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H. Sack
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. F. Wenz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. Blank.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Blank, E., Willich, N., Fietkau, R. et al. Evaluation of time, attendance of medical staff, and resources during radiotherapy for breast cancer patients. Strahlenther Onkol 188, 113–119 (2012). https://doi.org/10.1007/s00066-011-0020-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00066-011-0020-0

Keywords

Schlüsselwörter

Search

Navigation