Prompt radiotherapy saves lives

Posted on Aug 16, 2011

To the Editor,

Lartigau et al draw attention to the promise of stereotactic body radiotherapy (SBRT). [1] However, other more fundamental strategies that improve radiotherapy should not be forgotten. Delays to radiotherapy allow cancers to progress and outcomes are then worse for both local control and survival. [2] The elimination of any radiotherapy waits longer than 31 days from the decision to treat was set as a government target in England, to be achieved by December 2010. [3] In the past, UK patients have been subjected to waits as long as 12-16 weeks and a national audit in 2003 showed that only 30% of patients were treated within 28 days. [4] The recent report from the Department of Health that radiotherapy waiting times in England are now less than 31 days for 97.8% of patients [5] is of great importance because prompt treatment saves lives. [2, 6]

  • Saif Ahmad, Specialist Registrar in Clinical Oncology
  • Neil Burnet, Reader in Radiation Oncology and Honorary Consultant Clinical Oncologist
The Oncology Centre. Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK.

We have previously modelled the effect of under-provision of radiotherapy, including the effect of delays. [6] Using published values of tumour volume doubling times, we estimated that an overall relative improvement in cancer cures of around 25% could be achieved by providing adequate radiotherapy facilities to alleviate waiting times. [6]

In the light of the new waiting times report [5] we have considered purely the effect of delays to start treatment, after adjusting for the fact that some patients who suffer local recurrence can nevertheless be salvaged. We now estimate that reducing the waiting time for radiotherapy over the last decade, from 12 weeks to 31 days from the decision to treat, should save approximately 2500 lives per year in England. This will make a significant contribution to the government target of saving a further 5000 lives annually. [3]

The advent of newer technologies such as SBRT represents an exciting period in anti-cancer therapy. However it is essential that waiting times to radiotherapy remain as short as reasonably achievable in order for us to realise their true potential. Treatment with the best technology, started promptly, will enable clinicians in the UK to cure thousands more cancer patients of their disease.

Authors Dr Saif Ahmad (1). Specialist registrar in Clinical Oncology

Saif.ahmad@nhs.net

Dr Neil Burnet (1). Reader in Radiation Oncology and Honorary Consultant Clinical Oncologist

Ngb21@cam.ac.uk

1. Box 193, The Oncology Centre. Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK. CB1 8NR

Acknowledgements: Dr Neil Burnet is supported by the National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre.

References

1 Lartigau E. Stereotactic body radiotherapy. BMJ 2011;343:doi:10.1136/bmj.d4286 (published 3 August 2011- accessed online ahead of print)

2 Chen Z, King W, Pearcey R, Kerba M, Mackillop WJ. The relationship between waiting time for radiotherapy and clinical outcomes: A systematic review of the literature. Radiother Oncol 2008;87(1):3-16

3 Department of Health. Improving outcomes: a strategy for cancer. Department of Health, London, 2011.

4 Ash D, Barrett A, Hinks A, Squire C. Re-audit of radiotherapy waiting times. Clin Oncol 2004;16:387-394

5 Department of Health. Cancer waiting times. Last accessed 3.7.11

6 Burnet N, Benson R, Williams MV, Peacock JH. Improving cancer outcomes through radiotherapy. BMJ 2000;320(7229):198-199

Competing interests: None declared


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