L to R: Kevin LeNeve, Sajida Moledina, Lian Velasco, Mary Stewart
Radiation therapists, (L to R), Kevin LeNeve, Sajida Moledina, Lian Velasco and Mary Stewart are part of the RMP Case Expert Model, and are pictured here in the CT Simulator Scanner Suite at Princess Margaret Cancer Centre. (Photo: UHN)

The cancer journey is often scary, confusing and disjointed for a patient and their family.

Gaps in care can exist and rob people of comfort and confidence after diagnosis. It's an issue that is top of mind for people across UHN's Cancer Program and the Princess Margaret Cancer Centre.

These patient experiences also speak to the urgency of World Cancer Day 2022's theme – "Close the Care Gap." This year the annual campaign recognizes inequities in cancer care around the globe with the goal of moving towards equitable access to cancer treatment and care for all.

The team in PM's Radiation Medicine Program (RMP) spoke to UHN News ahead of World Cancer Day, held on Feb. 4, to highlight their award-winning Case Expert Model. This homegrown initiative is designed to close the care gap and deliver comfort and confidence to patients.

The model, launched in 2017, is a person-centred approach to radiation therapy. A patient is partnered with an individual radiation therapist (RT) who provides support and guides the patient through the radiation therapy journey, serving as the primary point of patient contact.

"The cancer program does a great job in providing a lot of material, pamphlets, videos and all sorts of information to an individual," says Jerry Roussos, Practice Lead in RMP. "But really, what's going on in a patient's mind after diagnosis is 'I just heard the words that I have cancer' and they're afraid. They don't know what's coming next."

The Case Expert Model, which was honoured recently with a UHN Local Impact Award, aims to ease those concerns by providing a familiar face at every visit. The model aims to decrease transitions among different RTs as happens in standard practice, says Christine Hill, Acting Director of PM Radiation Therapy.

"The vision behind this was to ensure a therapist could focus on the patient, instead of focusing on treatment tasks," she says. "They can really become an expert in that patient's care needs and help them transition throughout the full journey and understand what's important to that patient."

Christine says ensuring patients have a dependable point-of-contact has been invaluable and help eased anxiety around many aspects of treatment.

"One of the main things that patients have asked for throughout their care is having the same person to speak to and feel comfortable with," she says. "They don't want to have to explain themselves five times over at every appointment."

Christine says that this approach to care is not only helpful for patients, it allows the RTs to adapt and personalize treatment.

"Every day that the patient is treated, we take images to make sure we're delivering the radiation correctly," she says. "But sometimes on those images, you'll see that there's changes to the disease. You might actually want to change the treatment plan based on that. Some of our new technologies actually allow us to make that change every single day."

The Case Expert Model has grown over the past five years as the program gradually refreshed training for RTs and brought more patients into the program.

Clinical Educator Angela Cashell says her colleagues already have all of the skills to conduct the full range of radiation therapy tasks themselves, but because of operational needs often end up​​ specializing in one area.

"You get into a profession and you tend to get pigeonholed very quickly," Angela says. "And you may have trained with a broad scope, but then you'll end up losing some of your scope because you're not using it. This model allows that full scope of practice to be used."

Jerry says RTs are highly-skilled individuals and this model taps into all of their abilities and potential.

"This is a group of individuals that is so well-balanced in every aspect of the profession," he says. "The experience they get through this model wouldn't likely happen to its full entirety at any other place than PM. So it's a win-win situation any way you look at it."

Currently, a clinical trial is underway to measure the effectiveness of the model. Angela says she has interviewed a number of patients and their feedback has been invaluable. It will help to further refine the program in the coming months, she adds.

"Overwhelmingly, the majority say they love it," she says. "It was nice to know that one person knew everything about them and was integral to their care."

Dr. Michael Velec, radiation therapist and clinician-scientist at PM, is conducting the clinical trial which is based on data from more than 100 patients. The trial is focused on measuring a number of inputs including its impact on patient anxiety levels. The results of the clinical trial will help make the model more responsive to patient needs, he adds.

"We know that this is a big investment and if it's going to be adopted by other centres, which we think it can, we're going to need to demonstrate evidence that it improves things," he says.

The program also aims to bolster the comfort and confidence of patients by empowering them, Dr. Velec says.

"We want to get people from a state of being a passenger, where the healthcare team is kind of pushing them along, to being more proactive and more engaged in their own care because we know that outcomes are better," he says.

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