Quality Improvement Initiative for Screening Radiation-Induced Late Effects in Hodgkin Lymphoma Patients

A quality improvement initiative looking at a standardised clinic template for screening radiation- induced late-effects in Hodgkin lymphoma (HL) patients. Dr Sinead Horan Radiation Oncology Registrar St Luke s Radiation Oncology Network, Beaumont Hospital Consultant lead : Dr Orla McArdle 3rdAnnual RCSI Hospital Group Quality & Patient Safety Conference 24th March 2022

Background Hodgkin Lymphoma (HL) has become a highly curable cancer with a 5-year survival rate > 80% modern-day radiotherapy and combination chemotherapy (1) Long-term survivors screening to prevent treatment-related complications Aim to introduce a screening protocol for HL patients on follow-up Pre-intervention audit inadequate screening Ensure adherence to international guidelines (3, 4) Assess if template applicable to different patient cohorts Change initiative Clinic template incorporating the NCCN and COG guidelines for HL patients on follow-up User-friendly Applicable to busy clinic setting Clinic letter (2)

Results: a. Pre intervention audit: Patient cohort: 30 HL patients, disease-free and stable on follow-up post completion of RT Electronic patient records (Aria) + clinic letters assessed for screening Annual follow-ups: TFTs missed at 40%, FBC, U+E, fasting lipids missed at 36% b. Post intervention audit: Patient cohort: 19 HL patients, disease-free and stable on follow-up post completion of RT Template piloted in Dr McArdle s clinic in Beaumont from August 3rd 2021 100% of patients had full screening completed in compliance with NCCN and COG guidelines Key outcomes: 1. A successful quality improvement initiative, confirmed on pre and post intervention audits 2. Achieves full compliance with international guidelines

What worked well: User-friendly & comprehensive Sustainment phase 3 months later: we re-audited patient records 100% compliance with screening maintained Education session at each changeover for rotating NCHDs Value to patients Comprehensive, standardised assessment in clinic Screening adequately completed Encourages patient ownership in the survivorship paradigm Spread The success of this simple initiative could be expanded to other patient cohorts on follow up References 1. van Leeuwen, FE, Ng, AK. Late sequelae in Hodgkin lymphoma survivors. Hematological Oncology. 2017; 35( S1): 60 66. https://doi.org/10.1002/hon.2402 2. Ng, A. K. (2014). Current survivorship recommendations for patients with Hodgkin lymphoma: focus on late effects. Blood, 124(23), 3373-3379. doi:10.1182/blood-2014-05-579193 3. Group., C. s. O. (2014). Children s Oncology Group. Long-Term Follow- Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers. Retrieved from http://www.survivorshipguidelines.org/pdf/ ltfuguidelines.pdf 4. Richard, T. H., Ranjana, H. A., Weiyun, Z. A., Richard, F. A., Patricia, A., Celeste, M. B., . . . Hema, S. (2017). Hodgkin Lymphoma Version 1.2017, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network J Natl Compr Canc Netw, 15(5), 608-638. doi:10.6004/jnccn.2017.0064