The pandemic has disrupted not just radiotherapy treatments but radiotherapy professionals’ training and career progression. Investment is needed in workforce development to make the most of their abilities and deliver sustainable, modern services.

With Covid-19 cases still high, restrictions lifting and a predicted backlog of 13 million waiting for cancer treatment across the NHS, one thing is clear – we must act quickly to keep pace, and eventually put an end to the ongoing crisis in cancer care. Cancer services have adapted to the Covid “new normality” while attempting to treat in a timely manner all the cancer cases that have arisen before, during and after the multiple lockdowns.  

Radiation therapy is well placed to help tackle the cancer care backlog, but improvements need to be made to services as they currently stand. With investment and recognition of the capabilities of staff to take on different responsibilities, alongside the use of innovation and technology to create faster workflows, it is possible to significantly increase capacity, improve quality of life and save lives. 

The impact of Covid on cancer care 

Cancellation of surgeries during lockdown is not the sole cause of the current care crisis. The change in primary care to online booking, with video or phone consultations, has led to a reduction in two-week wait cancer referrals. This has resulted in tens of thousands of patients needing urgent investigations and treatments. 

The spectrum of Covid-related harm for cancer patients is wide and varied. It includes halting screening and prevention efforts, delaying timely diagnosis and staging of new patients, delaying initiation of therapy, interrupting ongoing treatment, delivering suboptimal palliative care, and disrupting clinical research. While all cancer treatments (systemic therapies, radiation therapy and surgery) were affected, radiation therapy was best able to step up to the mark, seeing the least reduction in its services (14 per cent fewer treatments compared to 31 per cent in systemic therapies and 29 to 40 per cent in surgery). There was even a rise in the use of radiation therapy as an alternative treatment to surgery. 

At a May 2021 online cancer summit, All Party Parliamentary Group for Radiotherapy Chair Tim Farron MP said that those working in cancer services have the expertise needed to tackle the backlog. But only if ministers are willing to accept there is a crisis, deliver vital investment in cancer services and act quickly. 

A flash survey by charity Action Radiotherapy in May 2021 looked at the impact of Covid on UK radiation therapy one year on. It found that, while 91 per cent of respondents felt that radiotherapy should play a significant or very significant role in reducing the Covid cancer backlog, there were also fears that the service would be unable to cope with the tsunami of cases that would be coming its way.  

Therefore, to future-proof radiotherapy services, we need to create sustainability, which will require appropriate funding and a review of the way we currently work to drastically increase capacity. 

Innovation, technology and upskilling a bridge to better care 

Most radiation therapy departments were able to continue to deliver a reasonable service throughout lockdown. However, figures from Public Health England show that 13,700 fewer patients were treated between April 2020 and January 2021, with some patients presenting with later-stage cancer who were therefore frailer than would normally be expected. 

A European survey in February 2021 reported similar findings, including reduced use of palliative radiation therapy (intended to provide relief from cancer-related symptoms) and less treatment of the elderly. In addition, more treatment courses were interrupted and more curative courses of radiation therapy were given for indications normally treated with surgery. However, during this time of unprecedented conflicts, the need to adapt resulted in a move away from long-engrained radiation therapy protocols to more hypofractionation (and ultra-hypofractionation) aimed at compensating for a reduction in surgery and systemic cancer therapy delivery. 

As well as adapting treatment schedules, it is also vital to recognise the abilities of staff to take on different roles that – if part of careful workforce planning – can significantly help to create capacity and introduce new technology. Focused training and upskilling radiographers to take on extra responsibilities will assist in accelerating implementation of advanced technologies, such as stereotactic ablative radiation therapy (SABR), and off-load certain tasks, including contouring, from radiation oncologists.  

Contouring is the most subjective step in the radiation therapy process and therefore prone to weakness in standardisation. But it also has the potential to significantly improve patient outcomes. It entails drawing accurately around the targets that need to be treated and the anatomy that must be avoided, thereby increasing precision and reducing side effects.  

Radiation therapy technology has come a long way thanks to research and development. It is this constant innovation that is the reason why we now have accurate, fast and increasingly automated workflows for a treatment that is highly effective and very safe. With human supervision, artificial intelligence (AI) can be used to assist a fair proportion of radiation therapy workflows, ensuring greater capacity, improving access, enabling a reduction in the Covid cancer backlog and, more importantly, allowing staff to spend more face-to-face time with the patients. 

However, there is little point in having highly sophisticated radiotherapy technology if the expert cannot use it effectively. This is why developing the users must happen in tandem with innovation. Education and training are therefore key to creating a sustainable and modern service, which sadly has been historically overlooked and underfunded with just five per cent of the NHS cancer budget.  

The pandemic has meant that many radiotherapy professionals, radiographers included, are missing out on training and career progression opportunities. A greater importance and focus needs to be placed on this to ensure an expansion of radiation therapy services, which, with the introduction of innovations, will translate into better patient outcomes within a shorter time frame. 

Elekta is focused on supporting and providing training for radiographers and radiation oncologists. Our cloud-based contouring and planning academies (ECA and EPA) deliver the necessary training to a global workforce dedicated to providing the best cancer care.