Analysis And Comment Cancer care

Waiting for radiotherapy

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7533.107 (Published 12 January 2006) Cite this as: BMJ 2006;332:107
  1. D Dodwell, consultant in clinical oncology (david.dodwell@leedsth.nhs.uk)1,
  2. A Crellin, consultant in clinical oncology1
  1. 1 Cookridge Hospital, Leeds LS16 6QB
  1. Correspondence to: D Dodwell
  • Accepted 2 September 2005

Amid recent improvements in cancer care within the United Kingdom, inadequate radiotherapy capacity compromises care and is an important and underappreciated problem.

A recent BMJ editorial described the exciting potential for heavy particle therapy in the management of relatively uncommon cancers and discussed responses to this development in the United Kingdom. 1 Such progress should not divert attention from a much less comfortable current reality. Many UK radiotherapy departments have inadequate treatment capacity, and the problems experienced by individual patients because of extended waiting times for radiotherapy as a consequence of this are sometimes picked up by the media. After the inevitable outpourings of political concern the spotlight of media attention moves elsewhere, but the basic problem—inadequate radiotherapy capacity—remains. We describe the back-ground to this problem, the evidence that delays in starting radiotherapy may lead to poor outcomes, and some of the issues that need to be considered when managing overstretched radiotherapy services.

Background

Treatment of malignant disease often uses a combination of surgery, radiotherapy, and chemotherapy. After surgery, radiotherapy is the next greatest contributor to cancer cure rates. In the 1970s and 80s it was thought that improved systemic therapy would yield dramatic outcome improvements in common solid cancers and that the need for radiotherapy would diminish. This was fuelled by impressive results with effective cytotoxic agents in paediatric, germ cell, and haematological cancers. Consequently, until recently there was little investment in basic and clinical research in radiotherapy and a reluctance to invest in radiotherapy services.

Demand for radiotherapy has increased because of the rising incidence of cancer, more indications for treatment, greater access to treatment resulting from improved multidisciplinary care, and recognition that chemotherapy does not usually ensure long term loco-regional control of most common solid cancers. In many circumstances radiotherapy offers survival and local control outcomes similar to …

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