Radiotherapy 2034 Vision: Preview Document
Radiotherapy is an essential part of cancer treatment for about half of all patients and is involved in 40% of cancer cures[1]. It is cost-effective[2] , and has undergone a recent technological revolution that can lead to better patient outcomes in the countries that embrace it.
Cancer survival outcomes in the UK remains near the bottom of the cancer league tables of comparable high income countries[3]. This of grave concern for two reasons. Firstly, cancer incidence is increasing yearly, with CRUK estimating an increase in cancer cases in the UK by a third to 500,000 by 2040[4]. And secondly, the UK’s radiotherapy service is already unable to cope with current numbers, with nearly 1 in 4 cancer patients waiting longer than NHS targets to start their cancer treatment[5]. This is deeply concerning because international research shows that every 4 weeks of delay in starting cancer treatment can increase the risk of death from cancer by about 10%[6].
Improved access to advanced radiotherapy has the potential to provide a better, earlier start to high-quality treatment and cure more patients. However years of under-investment and under-resourcing means the small and vital workforce is depleted, access to radiotherapy is significantly lower than international consensus estimated using NHS England data as 34% in 2022 [7] compared to over 50% recommended[8]), equipment is out-dated[9], and technology advances in treatment may not be equally available to all patients[10]. There is an urgent need for clarity in direction for radiotherapy services in the UK that is focused on how we develop the multi-disciplinary skilled workforce and embed systems and processes that improve access to high quality treatment equitably. We need to harness innovation to create a world-class radiotherapy service that improves outcomes for cancer patients.
In collaboration with the radiotherapy community and stakeholders, and to address this urgent need, Radiotherapy UK are developing a 10-year vision for radiotherapy in the UK to map out a world-class service for all. Engagement is ongoing with an expected date for publication of February 2024. Key themes emerging from the engagement process are;
- Equitable Access
Treatment in the UK with radiotherapy is much lower than the internationally recognized metric of 50% access for primary radiotherapy with the percentage of patients receiving radiotherapy estimated using NHS England data as 34% in 2022 [7] . There is also wide variation in timely access to high-quality radiotherapy treatments as evidenced by data from NHS England5. The capacity and capability in the radiotherapy landscape needs to be understood. A national plan should have actionable standards for access and quality that are delivered on a local and regional level, driving improvements to national standards.
- Workforce
Radiotherapy treatment in the UK is delivered by a small, multi-disciplinary and highly skilled workforce of over 6,500 people[11]. Staff shortages driven by poor retention and recruitment across all disciplines is critically low and is a main driver of inequity of access to timely radiotherapy treatment. A joint workforce plan for radiotherapy including clinical oncologists, radiographers and medical physicists is required in parallel with considering new ways of working.
- Health information technology
The current IT system is insufficient and the digital agenda needs urgent investment. Digital transformation is essential to improving information sharing of digital records to not only improve clinical care but to facilitate monitoring and improving access to radiotherapy treatment.
- Using Data Effectively
Radiotherapy is a data-rich treatment, which could be utilised much more effectively to quickly interpret and determine impacts of changes and advances to patient care. The radiotherapy data source held by the NHS has shown its value most recently during the COVID-19 pandemic. A nation-wide plan should be implemented that improves access to translatable data at a service level, to drive a productive efficient system and allows inequalities to be addressed. Transparently and monitoring or quality metrics is essential at a local and national level.
- Health Services Research
Investment should be prioritised for the implementation of economics and health system radiotherapy research. Currently funding is not proportional to the utilisation of radiotherapy. It is essential that available resources are used to implement radiotherapy treatments to achieve better outcomes and experiences for every person and halt low-value practices being introduced in to the NHS.
- Innovation
The UK must stay ahead of the curve for radiotherapy innovation. Centres of innovation should be created to investigate new technology and generate evidence, including cost effectiveness and health system, to assess the appropriateness and feasibility of new innovations including, magnetic resonance imaging linear accelerators, adaptive radiotherapy, automation and artificial intelligence, and proton beam therapy. Innovations that meet agreed standards should then be rolled out nationally to ensure equity of access for all patients.
- Leadership
Leadership is urgently needed to oversee a National radiotherapy plan to achieve sustainable improvements to access to high quality radiotherapy. To move away from crisis management and form a 10-year world class plan. It is essential that plans for resilience and contingency for cyber-attacks is included.
[1] Borras JM, Barton M, Grau C, et al. The impact of cancer incidence and stage on optimal utilization of radiotherapy: Methodology of a population based analysis by the ESTRO-HERO project. Radiotherapy and Oncol, 2015, 116: 45-50
[2] Spencer K, Defourny N, Tunstall D, et al. Variable and fixed costs in NHS radiotherapy; consequences for increasing hypo fractionation, Radiotherapy and Oncol, 2022, 166: 180-188.
[3] Allemani C, Matsuda T, Di Carlo, V et al. Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet, 2018, 391: 1023-1075
[4] Cancer in the UK, Overview 2023, accessed 9th Nov 2023.
cancer_in_the_uk_report-overview-03.pdf (cancerresearchuk.org)
[5] Cancer waiting times, NHS England, August 2022. Accessed 9th November 2023.
https://www.england.nhs.uk/statistics/statistical-work-areas/cancer-waiting-times/
Cancer-Waiting-Times-Statistical-Release-August-2022-Provider-based-Provisional.pdf (england.nhs.uk)
6 Hanna TP, King WD, Thibodeau S ect al. Mortality due to cancer treatment delay: systematic review and meta-analysis. BMJ 2020; 371 :m4087
[7] COVID-19 rapid cancer registration and treatment data. Accessed 14th November 2023
www.cancerdata.nhs.uk/covid-19/rcrd
[8] Borras JM, Lievens Y, Barton M, et al. How many new cancer patients in Europe will require radiotherapy by 2025? An ESTRO-HERO analysis. Radiotherapy Oncol 2016; 119: 5–11.
[9] International Advances in Radiotherapy -Industry Summit, July 2023. Accessed 9th November 2023 https://www.appgrt.co.uk/_files/ugd/6a3b84_51d5be2eeeff411c8d18118a9185aa62.pdf
[10] National Cancer Taskforce Dashboard for access to IMRT. Accessed 9th November 2023. https://www.cancerdata.nhs.uk/dashboard#?tab=Overview
[11] rcr_clinical_oncology_workforce_census_2022_v2.pdf; 2021_CoR_radiotherapy_radiographic_workforce_uk_census_report_v3.pdf (sor.org); 2021-radiotherapy-workforce-census-summary-report.pdf (ipem.ac.uk) (write out properly, date being accessed)
