Rule of Thumb

[Neoplastic]

Greetings SDNers.

Is there a good rule of thumb for converting the number of consults per week to the number of patients on treatment? And if so, does the rule of thumb take into account that a certain percent of consults will not require radiation?

Thank you in advance.

---

Members don't see this ad.

 

[Damn_Daniel]

There really isn't an overall rule of thumb, but at your individual clinic you'll be able to figure it out, approximately.

For example, I saw about 230 patients, and averaged an ADT of 18. So, for me, about 4.1 patients on treatment per consult/week (you can tweak a bit for vacations, but the fact is patients are getting treated on my vacation because of coverage, so I'm not going to complicate things). And that's steadily gone down a bit, for reasons that will be listed below. But, the reasons my 4.1 ratio may not reflect yours are:

1) Practice type - if you are in a private practice near a big cancer center, like a near suburb of Houston, you potentially may lose patients to the university. We keep almost 90% of the patients we see, while I have friends that keep more like 60-70%. On the other hand, if you are at a big fancy academic center, you are going to see a ton of 2nd opinions that end up going to the community.

2) Hypofractionation - I'm big on hypofractionation, while other people are not. If 25% of both of our practices are breast, and I treat 90% of my patients with 16-20 fractions, while you treat to 30-33 fractions, we are going to have a big difference. Same with if you utilize "one and done" for bone mets vs 30-35 Gy/10-14 fractions.

3) Active surveillance for prostate - if you and the doctors and the patients utilize active surveillance (can range from 20-30% in some practices to almost none, in others), you're talking a spread of 0 fractions vs 44.

4) Brachytherapy for prostate - big brachy practices are going to have way less fractions treated, while urorads or places that don't offer it/don't care for it will have more fractions treated.

5) Omitting RT for low risk breast - same as 3, basically.

I ask you this: "Was it over when the Germans bombed Pearl Harbor???"

 

[seper]

I agree - no good rule. I used to work at a "county" type of a hospital with lotsa trainees/ staff turnover. Something like 35% of my new patient consult did not need XRT.

 

[Mandelin Rain]

It's probably fair to assume an average 4 -5 weeks per patient you sim, depending on your practice style and what you see. This will be longer if you see a ton of prostate. Shorter if you only see mets and hypofractionated breast.

If you treat 80% of the consults you see, and see 5 per week, that's probably about 16-20 patients on treatment at any given time.

That's probably fair-ish math.