Radiotherapy report lays foundation for improved care

Today's radiotherapy report is a significant achievement

We often talk about radiotherapy as the unsung hero of cancer treatment – it helps cure more people than cancer drugs, yet few people think of it as a modern treatment.

That’s why we’re campaigning to improve radiotherapy services – more needs to be done to ensure that this cornerstone of cancer treatment is being used effectively across the country.

So we were particularly interested to see that the Government has published the first annual report of data about radiotherapy in the NHS.

We’ve written extensively before about the importance of collecting such data in order to improve cancer care.

The reason is simple – you can’t improve something if you don’t know how well it’s working in the first place.

Today’s report from the Department of Health focuses primarily on the not-insignificant achievement of collecting these data in the first place. But it also raises some important questions about variations in radiotherapy services and access to this vital treatment across the country.

What did they measure?

In 2007 a group of radiotherapy experts known as the National Radiotherapy Advisory Group published recommendations on how radiotherapy services could be improved so that all future cancer patients could benefit from a ‘world class’ radiotherapy service.

Among other things, the group called for the better routine collection of information on the types and amount of radiotherapy given to patients in the 49 specialist radiotherapy centres across the country.

The radiotherapy dataset published in today’s report came about as a result of this recommendation. Following publication of the advisory group’s report, a process to collect data from the specialist centres was developed. The types of information captured include data automatically recorded by linear accelerators (the machines used to give radiotherapy) about dose and duration of treatment for each patient, and the types of cancer being treated.

The report shows that after a few initial teething problems, all of the 49 centres required to return data are doing so to a high standard and in a timely manner following recent improvements.

This is great news.

Why is it important?

Collecting accurate information on radiotherapy is vital for improving the service. As the National Cancer Director, Professor Sir Mike Richards, explained at a round table event recently  these data are the crucial piece in the puzzle for how we can improve radiotherapy services. Through the radiotherapy dataset, he said, “we now have information on every single treatment given to every single patient; this will revolutionise what we know is going on in radiotherapy”.

This information is hugely valuable. It allows us to identify variations across the country, and help the government and others to take steps towards a radiotherapy service that is equally available for all.

We know that progress in radiotherapy has been made during the past five years in long-needed increases in the number of people qualified to deliver radiotherapy and huge improvements in waiting times. However, the battle is far from won.

The next big step for UK radiotherapy is getting more new radiotherapy techniques to patients. To choose one example, experts believe that around one-third of all patients getting radiotherapy should be treated with an advanced, more accurate type of treatment called intensity modulated radiotherapy (IMRT). But at the moment only a small proportion are actually treated with IMRT.

Because they require more complicated planning, these new treatments cost more to deliver. For other such services in the NHS, the government has developed a set tariff that underpins payment for the service.

Cancer Research UK published [pdf] a report at the end of last year  which showed that the lack of a tariff for radiotherapy was one of the biggest barriers to service development.

But without good data, no one knows how much we should be paying for it or which specialist centres are already giving the most up-to-date treatments. While the government has promised several times to develop a tariff for radiotherapy, this has been painfully slow in coming. But, as Professor Richards said last week, the development of the radiotherapy dataset should see this change.

By collecting accurate data, we can not only check in with centres to ensure that they are giving the best radiotherapy, but centres can also be assured that where they are doing this, they will be appropriately paid. This in turn will allow them to further develop their service to meet the needs of patients in the future.

What does the annual report show?

The report published today only gives us snapshot of the data that are available through the radiotherapy dataset – the rest of the data have already been given to local centres to help them understand more about their services and where the gaps might be. Despite only reporting the topline stats, it already shows some interesting trends across the country:

1. Access to radiotherapy varies according to where in the country you live.

The report shows variations across the country in both the number of times patients are treated with radiotherapy and the proportion of patients that receive radiotherapy at all. The variation roughly falls into a North/South divide, but there are exceptions to this within those regions.

The largest differences are in the number of times patients are receiving radiotherapy with Northern regions, in particular Yorkshire and the North of England, having the lowest average figures. The variations in the proportion of patients who receive any radiotherapy are smaller, but still show that patients seem to be treated differently depending on where they live, and that the Northern regions are more likely to have lower proportions of patients receiving radiotherapy.

One of the possible explanations for the variations could simply be that the types of cancers that people are most commonly diagnosed with varies across the country, meaning that different demands are placed on the radiotherapy services. However, the report shows that differences are still there when only looking at those patients who received radiotherapy for breast cancer.

The report gives a few clues to why these results might be of concern: if there is a long wait for radiotherapy, or if the service is remote, patients or their doctors might opt for a full mastectomy instead of breast-conserving surgery (‘lumpectomy’) with radiotherapy. So inadequacies in radiotherapy services may be colouring patient choice.

We need to understand more about why these differences are occurring before we can rush to judgement, as there isn’t sufficient information available to know what effects the variations are having on outcomes for patients. And there are several factors that could affect radiotherapy use across the country – such as the average age of the population in a given area and the stage at which cancer is diagnosed.

But already these results are raising important questions that need to be answered to ensure people across the country are receiving the best possible care.

2. The amount of radiotherapy given by each machine varies across the country.

It seems sensible that the same type machine used across the country should be able to deliver similar amounts of radiotherapy over the same amount of time. However, the report shows that this varies, quite significantly in some cases. Given the expense of buying and installing a radiotherapy machine, reducing these variations could mean better value for money for the NHS and, ultimately, better care for patients.

We wouldn’t want all machines across the country to be working flat-out all of the time, in case a back-up is needed when one of them breaks down or needs replacing. But the report also shows that in facilities with fewer staff, there is a drop off in activity in the middle of the day. Armed with this information, centres can now look at how they might re-jig their services, particularly around the lunchtime break, so they can get the most out of the machines they’ve spent millions of pounds installing.

More data are needed

We know that the full radiotherapy dataset contains a wealth of interesting information about services across the country. What we’ve got today is just a little taster of this.

We’d like to see these data linked in to information about how well patients are faring after treatment, so we can learn more about the impact these variations are having on patient outcomes.

And while we’re expecting more of this to be published next year, we think it’s vital that the government makes this information available to patients as soon as possible. This would not only help patients to make informed choices about their treatment, but also that we can keep a close eye on how well services are doing, so that no patient misses out on the best possible cancer treatment simply because of where they live.

Hilary Tovey (Policy Manager) and Matthew Wickenden (Statistical Information Officer)