Cancer patients put at risk by shortage of radiotherapy staff

Cancer care: Waiting for radiotherapy, BMJ Volume 332, pp 107-9

Many radiotherapy departments in UK hospitals are heavily overstretched, resulting in long waits for cancer patients which may be jeopardising treatment, says a paper in this week's BMJ.

Radiotherapy treatment can be as successful at tackling some cancers as radical surgery, and often has the advantage of organ preservation. But waiting lists are severe in many radiotherapy departments, and although radiotherapy services in the UK offer high quality treatment, say the authors, they are often less able to cope with the volume of patients needing radiotherapy than other developed countries, and indeed many poorer countries.

For patients with a realistic chance of beating cancer, studies show that delaying treatment hampers doctors' ability to tackle the disease, report the authors.

With cervical cancer, for instance, a longer waiting time for radiotherapy reduces the chance of the patient's survival. And for head and neck cancer, patients waiting more than six weeks for post-operative radiotherapy are three times as likely to have the cancer recur. For breast cancer, patients are at a 60% increased risk of the disease returning if the delay between surgery and radiotherapy goes beyond eight weeks.

Despite considerable investment in radiotherapy equipment in recent years, a shortage of specialist staff - radiographers, physicists, and dosimetrists (specialists in radiation dosage) - means that hospitals cannot cope with the rising demand for radiotherapy treatment. More training places are being created, but that does nothing to remedy current staff shortages.

Many hospitals have already done all they can - including adapting staff rotas and skills mix - to optimize staff cover. Where possible patients are also transferred to other hospitals with more capacity to treat them. But removing them from the care of their local team of doctors can bring other problems for patients.

Doctors and radiotherapy managers are faced with the difficult decision to prioritise patients, say the authors, with no clear national guidance or precedent for the unpleasant choices that have to be made.

The time has come to agree a national policy to tackle these issues, say the authors, a strategy not subject to political timetables or funding waves. Avoidance of such a discussion is no longer an option, they conclude.

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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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