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Radiotherapy report: vast improvements needed to get the best for patients

by Hilary Tovey | Analysis

6 November 2012

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A patient being given radiotherapy

Today’s report shows huge improvements in radiotherapy services are needed

For several years, Cancer Research UK has been calling on the government to invest in improvements to our radiotherapy services across the UK. At the National Cancer Research Institute conference this week, the Department of Health has published a report on radiotherapy services in England.

We’re really pleased – our Voice for Radiotherapy campaign urged the Government to publish an action plan to give an update since the last one was published 5 years ago. The report builds on the Prime Minister’s recent announcements on radiotherapy, and will hopefully help to drive progress across the service. For the very first time, this report allows us to use real-time data to compare services across England to see how well we’re doing.

It’s not a very pretty picture.

Huge improvements are needed if we are to ensure that the right patients are getting the right sort of radiotherapy. Over the next four years, activity must increase by two-thirds if it is to keep pace with the needs of UK patients. And much more of this should be advanced radiotherapy, such as intensity modulated radiotherapy (IMRT) – which targets treatment more closely to the tumour, sparing healthy tissue – and image guided radiotherapy (IGRT) – which tracks the tumour’s movements to ensure the radiation is hitting the right spot.

By 2016, we will need to double the number of linear accelerators (the machines that deliver radiotherapy), both to match increases in demand and to make sure some of the UK’s ageing machines are replaced on schedule.

What does the report show?

The new report draws on detailed information about how the NHS uses radiotherapy information which has been collected for the last three years. The data show how services in England are faring up against the targets set five years ago.

Here are the headlines:

  1. Radiotherapy activity* needs to vastly increase. Between now and 2016 there must be a 67 per cent increase in radiotherapy activity in England. While there has been a 13 per cent increase over the past five years, a growing and ageing population means that unless there is a significant change, demand will continue to outstrip supply.
  2. More people should be getting advanced radiotherapy. Advanced radiotherapy, such as IMRT and IGRT can be more effective and have fewer side effects. But the report shows that only four of 50 radiotherapy centres are providing enough of it. Some centres are delivering no advanced radiotherapy at all.
  3. We need more radiotherapy machines and those we do have need updating. The report says that that by 2016 we need to increase the numbers of linear accelerators, which deliver radiotherapy, from 265 to 412. And if that isn’t challenging enough, all machines should be replaced once they are 10 years old. By this standard, 26 machines need replacing now and a further 92 will need replacing by 2016. That’s 265 new machines. We’ll need to buy at least one a week for the next four years. And at more than £1m a machine – and that’s before we’ve considered the building costs to house them – significant investment is required.
  4. Different doctors are giving different treatments for the same cancers. The report states that for lung cancer and head and neck cancers, patients are being offered shorter treatment programmes than their counterparts in Europe. What’s worrying is that there don’t appear to be good reasons why this is happening.
  5. Patients over 75 are less likely to receive radiotherapy than their younger counterparts. And we urgently need to work out why.

But there is good news too:

  • Waiting times are down, which is saving an estimated 2,500 lives a year.
  • Six new radiotherapy treatment sites opened in the last five years, and four more are in the pipeline. This means that patients don’t have to travel as far to receive treatment – particularly important if you’re going every day for a few weeks to get your radiotherapy.
  • And more patients are getting the opportunity to take part in radiotherapy trials than ever before.

But because of the way that radiotherapy has been prioritised and paid for, change has been difficult and, in some cases, painfully slow.

What else is happening?

At Cancer Research UK, we’re also extremely concerned by the shortfall in advanced radiotherapy. The report says that if patients aren’t being offered techniques like IMRT when this would be the most appropriate treatment for them, they could be experiencing side effects they might have otherwise been spared.

Last month, we welcomed the government’s announcement of a new £15m of a Radiotherapy Innovation Fund to try to jump-start improvements, and the commitment that all patients will have access to cost effective radiotherapy treatments their doctors think they need from April 2013.

The Fund aims to improve access to advanced radiotherapy, by bringing all centres up to the minimum standard for radiotherapy treatments, particularly IMRT.

Cancer Research UK is working with experts from the National Radiotherapy Implementation Group (NRIG) and the Department of Health to help distribute the Fund, to make sure it reaches those centres that need it the most and makes a real difference for patients.

Centres which aren’t doing so well at meeting advanced radiotherapy targets will be visited by teams of experts to discuss what steps they need to take to turn this around. They’ll be given support to have difficult discussions with the people holding the purse strings locally for things that won’t be covered by the fund. Introductory training courses in IMRT, aimed at radiotherapy staff, are also being planned.

As this money comes from under spend in the £200m Cancer Drugs Fund, it will only be available until April. We’re really pleased with the Government’s commitment to ensure patients get the best treatments from then on, but this report shows that a huge amount of work will have to happen before April and thereafter to deliver on the promise.

What more needs to be done?

This report, the £15million fund and the pledge from the Government are all really important. They shine a spotlight on radiotherapy in a way that hasn’t happened before and we think this could be a turning point for the service.

But we must remember that this report only covers England – we’d like to see similar reports from Scotland, Wales and Northern Ireland so that we can assess progress for patients there too.

And of course we need to ensure that world class research into radiotherapy can continue. It’s a priority in our research strategy and The Gray Institute for Radiation Oncology and Biology  – which we fund – is mentioned in the report as a centre of excellence. More centres are upping their game on radiotherapy research and we need to ensure they are supported so that patients benefit.

The fact that we’re now properly collecting data is also an important step forward. Being able to track progress, and identify and help those centres that are struggling to keep up should make a big difference.

As the NHS adjusts to changes coming into force in next April, radiotherapy services must continue to improve, and we want to see annual progress reports so we can celebrate success and focus on the areas that need work. New commissioning arrangements, which will see decisions about where and how to improve the service made in a more co-ordinated way, should mean that radiotherapy will finally get the priority it deserves.

But ultimately, the new NHS Commissioning Board will be responsible for making sure our radiotherapy is up to scratch.

Given the alarming findings in today’s report, it absolutely has to hit the ground running.

Heather Walker and Hilary Tovey, Policy Department

* By ‘activity’ we mean the number of ‘attendances’ at each centre for radiotherapy. Radiotherapy is most commonly given at a set dose (measured in Gray’s – or Gy) in a certain number of ‘fractions’. Fractions are usually given once a day for a set number of days. Each time the patient turns up at a radiotherapy centre to get their fractions, this is recorded as an ‘attendance’.