Waiting for radiotherapy: Financing increased capacity is a must

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7535.235-a (Published 26 January 2006) Cite this as: BMJ 2006;332:235
  1. S Michael Crawford, consultant medical oncologist (michael.crawford{at}anhst.nhs.uk)
  1. Airedale General Hospital, Keighley, West Yorkshire BD20 6TD

    Editor—Dodwell and Crellin's points about the issues facing radiotherapy services are starting to apply to the services that administer chemotherapy and other parenteral drug treatments for cancer.1

    The number of patients requiring such treatments for cancer is rising, as the baby boom generation ages and as technology changes; the recently reported evidence that treatment with Herceptin (trastuzumab) every three weeks for at least 12 months markedly reduces the recurrence rate for breast cancer is a topical case in point.2 These treatments require specialist nurses operating from appropriate premises, with a pharmacy service able to supply medicines prepared to the required standards. The processes by which increased demand with inadequate capacity in these resources results in a service that is degraded by delay are similar to those described by Dodwell and Crellin.

    The only patients with cancer to benefit in the competition for these resources by virtue of a national target are those for whom this treatment is the first modality to be applied; their treatment must start within 62 days of diagnosis. This group is not necessarily the one with the highest clinical priority; palliative treatment for recurrent disease needs to start promptly to relieve symptoms and post-surgical adjuvant treatment needs to start promptly to minimise recurrence.

    The only way to deal with this is to finance increased capacity. The present state of commissioning finances in the NHS seems absolutely to preclude these developments.


    • Competing interests SMC leads a district general hospital oncology service, in which the initiation of treatment is increasingly subject to delay because of capacity issues.


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