This is a republication of the paper “Clearing the radiotherapy backlog: innovation to pave the way”, with the title above, highlighting the message in question.
The Lancet Oncology
September 1, 2022
Executive Summary by:
Joaquim Cardoso MSc.
Health Transformation Institute (HTI)
Cancer Management Unit
September 2, 2022
What is the problem?
- The cancer care backlog caused by the COVID-19 pandemic is no longer a new story.
- Efforts to clear waitlists have been scarce and ineffective, and non-COVID-19 excess deaths are rising rapidly.
- With thousands of patients missing referral targets, it is imperative that this trend is reversed and does not further contribute to the lives lost due to the pandemic.
What are the consequences?
- … every 4 weeks of treatment delay equates to a 10% reduction in survival.
- We welcome the recent UK National Health Service campaign reminding patients to contact their GP if they have symptoms of lung cancer, and we hope the campaign is expanded to other common types of cancer.
Where is this happening?
- Worldwide, there is a pandemic of
(1) missed diagnoses and care, as well as
(2) a shortage of qualified, trained personnel to provide the necessary interventions.
- There is an urgent need to attract new staff to key cancer specialties and to provide adequate training.
- Previous efforts focused on containing the pandemic must now shift to how to deal with its consequences.
What are some innovations implemented during the covid pandemic?
- An example is the rapid expansion of telemedicine, which became a useful tool when visiting a clinic or hospital was not advised during the most serious waves of the pandemic.
- A study done in the USA found high levels of satisfaction with telemedicine consultation for patients undergoing radiotherapy during the pandemic, particularly in avoiding the financial costs and time burden of travel.
- Telemedicine has also been an crucial tool to provide training to physicists, radiation oncologists, and dosimetrists in low-income and middle-income countries.
- However, it has also been reported that doctors are missing crucial cancer signs during video appointments.
- It is now essential therefore to refine the way telemedicine is used in cancer care, to ensure that these issues are overcome, while maintaining the efficiencies and opportunities it offers.
What are the other innovation opportunities?
- Another important aspect of innovation is enabling the delivery of radiotherapy in a shorter period of time, which could allow more patients to be treated per day.
- The FAST-Forward trial in patients with breast cancer showed that a 5-fraction schedule of adjuvant radiotherapy delivered in 1 week was non-inferior to the standard 15-fraction regimen.
- Wider adoption of hypofractionation could significantly reduce the time burden and costs of radiotherapy, while increasing the number of patients treated and tackling the waiting lists faster.
- Another strategy is FLASH, a novel type of radiotherapy currently in clinical trials using a single ultra-high dose-rate (≥40 Gy/s), which reduces treatment times.
What are the recommendations?
- Radiotherapy is a crucial component of cancer treatment.
- Its importance should not be underestimated, and in the shadow of the COVID-19 pandemic it must be seen as an integral component of efforts to restrengthen health-care systems.
- In the short term, funding is needed to
(1) allow patients to access care from all providers and
(2) to incentivise more doctors and researchers to join the radiotherapy workforce.
- In the long term,
(1) not only should investment in radiotherapy workforce and infrastructure continue,
(2) but also must investment in innovation, with the aim to decrease delivery times for radiotherapy, increase patient volumes and accessibility, and reduce costs.
ORIGINAL PUBLICATION (full version)
The cancer care backlog caused by the COVID-19 pandemic is no longer a new story.
Efforts to clear waitlists have been scarce and ineffective, and non-COVID-19 excess deaths are rising rapidly.
Now, Radiotherapy UK has joined the voices of many other cancer charities warning that every 4 weeks of treatment delay equates to a 10% reduction in survival.
With thousands of patients missing referral targets, it is imperative that this trend is reversed and does not further contribute to the lives lost due to the pandemic.
Unfortunately, cancer treatment delays are not confined to the UK.
Worldwide, there is a pandemic of missed diagnoses and care, as well as a shortage of qualified, trained personnel to provide the necessary interventions.
Workforce vacancies in the radiotherapy sector affect all countries alike.
New Zealand, for example, a country praised for its efforts to contain the spread of COVID-19, now has a worryingly low number of radiation oncologists, a situation that has been described as a “point of no return”.
There is an urgent need to attract new staff to key cancer specialties and to provide adequate training.
Previous efforts focused on containing the pandemic must now shift to how to deal with its consequences.
There is an urgent need to attract new staff to key cancer specialties and to provide adequate training.
Previous efforts focused on containing the pandemic must now shift to how to deal with its consequences.
The COVID-19 pandemic has not only damaged health systems, but might also have had negative effects on how patients seek care.
A recent survey by Cancer Research UK and YouGov reported that only about half of those surveyed in the UK who had possible cancer symptoms contacted their GP within 6 months.
Many self-detected symptoms are associated with cancers that require radiotherapy, so the existing radiotherapy backlog might be even worse than has been estimated.
This avoidant behaviour is a complex issue with a myriad of underlying causes:
- not wishing to waste the GP’s time,
- the fear of a cancer diagnosis, and
- poor recognition of potential cancer symptoms.
Therefore, we welcome the recent UK National Health Service campaign reminding patients to contact their GP if they have symptoms of lung cancer, and we hope the campaign is expanded to other common types of cancer.
…we welcome the recent UK National Health Service campaign reminding patients to contact their GP if they have symptoms of lung cancer, and we hope the campaign is expanded to other common types of cancer.
The pandemic has forced health-care professionals to think outside the box for alternative solutions to everyday tasks.
Ultimately, when old paradigms are no longer working as well as they once did, we must look towards new and innovative approaches.
An example is the rapid expansion of telemedicine, which became a useful tool when visiting a clinic or hospital was not advised during the most serious waves of the pandemic.
A study done in the USA found high levels of satisfaction with telemedicine consultation for patients undergoing radiotherapy during the pandemic, particularly in avoiding the financial costs and time burden of travel.
A study done in the USA found high levels of satisfaction with telemedicine consultation for patients undergoing radiotherapy during the pandemic, particularly in avoiding the financial costs and time burden of travel.
Telemedicine has also been an crucial tool to provide training to physicists, radiation oncologists, and dosimetrists in low-income and middle-income countries.
However, it has also been reported that doctors are missing crucial cancer signs during video appointments.
Telemedicine has also been an crucial tool to provide training to physicists, radiation oncologists, and dosimetrists in low-income and middle-income countries.
However, it has also been reported that doctors are missing crucial cancer signs during video appointments.
It is now essential therefore to refine the way telemedicine is used in cancer care, to ensure that these issues are overcome, while maintaining the efficiencies and opportunities it offers.
It is now essential therefore to refine the way telemedicine is used in cancer care, to ensure that these issues are overcome, while maintaining the efficiencies and opportunities it offers.
Another important aspect of innovation is enabling the delivery of radiotherapy in a shorter period of time, which could allow more patients to be treated per day.
The FAST-Forward trial in patients with breast cancer showed that a 5-fraction schedule of adjuvant radiotherapy delivered in 1 week was non-inferior to the standard 15-fraction regimen.
Wider adoption of hypofractionation could significantly reduce the time burden and costs of radiotherapy, while increasing the number of patients treated and tackling the waiting lists faster.
The FAST-Forward trial in patients with breast cancer showed that a 5-fraction schedule of adjuvant radiotherapy delivered in 1 week was non-inferior to the standard 15-fraction regimen.
Another strategy is FLASH, a novel type of radiotherapy currently in clinical trials using a single ultra-high dose-rate (≥40 Gy/s), which reduces treatment times.
Another strategy is FLASH, a novel type of radiotherapy currently in clinical trials using a single ultra-high dose-rate (≥40 Gy/s), which reduces treatment times.
Radiotherapy is a crucial component of cancer treatment.
Its importance should not be underestimated, and in the shadow of the COVID-19 pandemic it must be seen as an integral component of efforts to restrengthen health-care systems.
In the short term, funding is needed to allow patients to access care from all providers and to incentivise more doctors and researchers to join the radiotherapy workforce.
In the long term, not only should investment in radiotherapy workforce and infrastructure continue, but also must investment in innovation, with the aim to decrease delivery times for radiotherapy, increase patient volumes and accessibility, and reduce costs.
Radiotherapy is a crucial component of cancer treatment.
(1) In the short term, funding is needed to allow patients to access care from all providers and to incentivise more doctors and researchers to join the radiotherapy workforce,
(2) In the long term, additional actions are the investment in innovation, with the aim to decrease delivery times for radiotherapy, increase patient volumes and accessibility, and reduce costs.
Only through such efforts can radiotherapy be re-established as a central response to the devastating effects of COVID-19 on cancer care worldwide.
Only through such efforts can radiotherapy be re-established as a central response to the devastating effects of COVID-19 on cancer care worldwide.
Originally published at https://www.thelancet.com.
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