Identifying a Niche: Development of the Orthopedic Radiation Oncology Clinic

The Orthopedic Radiation Oncology Clinic (OROC) was recently developed to identify patients at risk of pathologic fracture of weight bearing long bones, to provide education to patients and staff regarding fracture risk and weight bearing restrictions, to provide rapid access for radiation therapy services, to provide timely access for orthopedic surgical interventions and to provide follow-up services for patients with Metastatic Bone Disease (MBD). At our institution, prior to the development of the OROC clinic, on-call orthopedic evaluation was utilized to determine a patient’s pending fracture risk as identified in the radiographic report. The use of orthotic devices was limited to spinal braces and Radiation Oncology follow-up care and rehabilitation services was minimal and inconsistent. As orthopedic surgical intervention reduces pain, preserves function, minimizes fracture risk and improves quality of life, the OROC clinic was developed as an interdisciplinary assessment for patients with MBD to the appendicular skeleton. It is facilitated by an Orthopedic Oncology Surgeon, a Radiation Oncologist and a Clinical Specialist Radiation Therapist (CSRT) and operates weekly. The CSRT is the liaison and primary contact for referring physicians and specialists. Within the OROC clinic, the responsibilities of the CSRT are to triage referrals, identify diagnostic imaging required for patient fracture risk assessment, coordinate rapid access radiation therapy, patient navigation including assessment and education. From April to July 2018, a retrospective quality assurance chart review from the OROC clinic was completed. Information regarding fracture risk category and interventions including referrals, orthotic devices and patient education material were collected. 29 patient consultations and 9 follow-up visits occurred. 11/29 (38%) patients were identified as high risk of pathologic fracture and received restricted weight bearing instructions. 5/29 (17%) were offered prophylactic orthopedic intervention. 20/29 (69%) received palliative radiation therapy. 4/29 (14%) were referred for prosthetic and orthotic devices and 3/29 (10%) were referred for physiotherapy services. Preliminary data supports the interdisciplinary OROC objective of providing rapid access to centralized coordinated care in an effort to improve patient education, time to treatment, provide follow-up and rehabilitation services. Future partnership with a community based rehabilitation program will ensure consistency of post treatment care for patients with skeletal related events of the appendicular skeleton. Further research is required to measure outcomes in addition to establishing best practices for patients with MBD of the appendicular skeleton.