For patients with advanced cancer, radiation therapy (RT) can help relieve pain, improve mobility and enhance quality of life. But for those experiencing severe symptoms, the time and travel required for treatment planning can be daunting.
At BC Cancer – Vancouver, a team of clinicians and researchers is helping to make it easier for these patients to start treatment. Through a successful pilot project, they have shown that some patients with cancer that has spread to their bones can safely receive palliative RT using existing diagnostic imaging, eliminating the need for a separate CT simulation appointment. It's a change that gets patients the care they need sooner and benefits the planet: reducing the number of scans needed lowers the overall environmental footprint of treatment.
People with cancer will often undergo diagnostic CT scans to track how their cancer is progressing or responding to treatment. Patients starting RT will typically get an additional CT scan to help plan their treatment.
“Building on research done internationally, we showed that for select cases, we can use a diagnostic CT scan alone to design safe and effective RT for palliative treatments aimed at improving pain," said Dr. Shilo Lefresne, radiation oncologist at BC Cancer – Vancouver. “For patients, this means getting access to the treatment they need with fewer appointments and shorter waits."
Clinicians found that the treatment plans created with diagnostic imaging alone – known as the diagnostic CT (dCT) pathway – were comparable in quality to those created using standard methods and that they met key safety and treatment parameters. Importantly, the streamlined process did not compromise the patient's comfort or ability to tolerate RT.
“This is about adding flexibility," said Dr. Wei Liu, radiation oncologist, BC Cancer – Vancouver. “We can use the dCT pathway when it's appropriate, while maintaining the same commitment to safe, effective care."
For people receiving palliative radiotherapy, reducing one unnecessary appointment can have a meaningful impact. Many patients will have already been through countless appointments and extensive treatment. Most are managing pain, fatigue, stress and anxiety. Approximately 30 per cent are hospitalized.
“For patients, the benefits are clear: fewer appointments, less time in clinic and faster access to care," says Sheri Grahame, resource radiation therapist, BC Cancer – Vancouver. “By removing the need for a separate CT simulation visit, we're helping patients save their time and effort for what matters most to them."
Patients who participated in the study reported high levels of satisfaction with this approach. They appreciated the convenience of fewer appointments and said they would recommend the approach to others.
Other researchers have demonstrated that eliminating the need for an additional CT scan can reduce the time patients spend in a cancer centre from an average of 4.5 hours to less than 30 minutes.
For patients who are hospitalized, it can also reduce demand on patient transport services and nursing resources. More broadly, reducing demand for CT simulation helps to reduce wait times for other patients.
Beyond improving patient experience, the new approach offers an important environmental advantage.
Health care contributes to greenhouse gas emissions through energy use, travel and disposable materials. Even routine processes like CT simulations require electricity and generate waste from single-use supplies.
By eliminating the simulation step, the dCT pathway reduces both travel-related emissions and resource use.
In the study, the team estimated a median reduction of approximately ten kilograms of carbon dioxide equivalent (CO₂e) per patient. When scaled across eligible patients, this will translate into meaningful reductions over time.
“These changes may seem small individually, but they add up," said Dr. Lefresne, who is also a member of BC Cancer's Planetary Health Unit. “They reflect a broader commitment to delivering care that is patient-centred, improves departmental workflows and is environmentally responsible."
The project team is hoping to expand this initiative to other BC Cancer centres and is exploring how this approach could be offered to more patients with the goal of better meeting patient needs, improving access to care and advancing the sustainability of radiotherapy delivery.
