Breaking Barriers National Collaborative Highlights How Access to RT Can Be Improved Through QI Process

Purpose: Review national collaborative in barriers to care for radiation therapy as a surrogate for compliance in cancer care

Methodology: Programs voluntarily participated in the Commission on Cancer national QI Study, Breaking Barriers, with baseline data established in 2022 and 2023. Patients missing 3 or more treatments during curative therapy (numbering 15-45 fractions) were counted as “no-shows”, with each program scoring rates and reasons for “no-shows” by specific sites, or collectively by program. Each program was encouraged to create QI projects to improve outcomes specific to their geographic needs. Data was collected quarterly using REDCAPS questionnaires, and analyzed centrally.

Results: Over 300 programs participated in this national collaborative with the Commission on Cancer (COC), including COC and/or NAPBC (breast) programs. Barriers were identified by program type, with our top barriers to timely RT completion in care being: 1) toxicity from therapy, 2) transportation barriers, 3) other social determinants of health (financial, housing, etc.) and 4)conflicting appointments. Like other participating programs, we were unaware of our no-show rates in comparison to other programs, and we worked collaboratively to improve compliance as a group by mapping community resources to identified needs. Our rural no-show rates of 15% were higher than national averages (by a factor of 2) based on rural geography and limited resources. We have implemented several strategies to help improve our outcomes in 2024, including more use of hypofractionation, better screening tools, and better care pathways for complex sites such as head and neck.

Conclusions: Rural providers of radiation therapy have more barriers to care as we found in this national collaborative. We propose strategies to improve compliance with RT, with plans to review this in 2024 as continued participants in this national study.

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