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Research or reality: Within the context of UK radiotherapy and cancer services, where should research and investment be focused to best improve UK treatment outcomes?

Published online by Cambridge University Press:  01 March 2007

O.F.D. O'Connell
O.F.D. O'Connell
Affiliation:
Department of Radiotherapy, Cookridge Hospital, Leeds LS16 6QB, UK
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Abstract

Purpose: It is now six years since the publication of the NHS Cancer Plan. During this time, there has been considerable investment and research within UK cancer services. Some progress has been made towards improving treatment outcomes, but obstacles persist. This article explores some recent advances in cancer treatment and considers whether UK cancer treatment outcomes will best improve through the clinical advances being made in cancer research or whether improvement now needs to be more explicitly driven via a strategic approach. Methodology: The article explores this question from two differing perspectives. First, from a research perspective, it reviews briefly the evidence for a selection of clinical advancements in cancer therapy that have all been cited as providing breakthroughs in treatment outcomes. Second, it considers the investment in cancer research within a more strategic context, focusing on the reality of managing an improvement programme in UK cancer services. Here, some of the practical obstacles to improving treatment outcomes are highlighted. Findings: Significant progress has been made over the past six years towards improving UK treatment outcomes. Much of this is a direct result of international advances in clinical research. Further progress, however, is required. This article argues that progress will best be achieved by focusing resources and research investment on tackling some of the endemic strategic obstacles, highlighted in this article, that are the present reality within UK cancer services.

Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 6 , Issue 1 , March 2007 , pp. 33 - 45
Copyright
Copyright © Cambridge University Press 2007

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References

Department of Health. The NHS Cancer Plan: A plan for investment, a plan for reform. September 2000. London.Google Scholar
Day, M. Cancer research – Let’s get it together. New Sci 2006; 2545:56–59.Google Scholar
National Cancer Research Institute. Report of the radiotherapy and related radiobiology progress review group. August 2003. London.Google Scholar
Littlejohns, P, Barnett, D, Longson, C, UK National Institute for Clinical Excellence. The cancer technology appraisal programme of the UK’s National Institute for Clinical Excellence. Lancet Oncol 2003; 4:242–250.CrossRefGoogle ScholarPubMed
Aird, E, Conway, J. Review Article: CT simulation for radiotherapy treatment planning. Br J Radiol 2002; 75:937–949.CrossRefGoogle ScholarPubMed
Carey, B. Imaging for Prostate Cancer. Clin Oncol 2005; 17:553–559.CrossRefGoogle ScholarPubMed
Kurhanewicz, K, Vigneron, DB, Hricak, H, Narayan, P, Carroll, P, Nelson, SJ. Three-dimensional H-1 MR spectroscopic imaging of the in situ human prostate with high (0.24–0.7 cm3) spatial resolution. Radiology 1996; 198:795–805.CrossRefGoogle ScholarPubMed
Mizowaki, T, Cohen, GN, Fung, AY, Zaider, M. Towards integrating functional imaging in the treatment of prostate cancer with radiation: The registration of the MR spectroscopy imaging to ultrasound/CT images and its implementation in treatment planning. Int J Radiat Oncol Biol Phys 2002; 54:1558–1564.CrossRefGoogle ScholarPubMed
National Cancer Research Institute. Strategic Plan 2005–2008. April 2005. London.Google Scholar
Erdi, YE, Rosenzweig, K, Erdi, AK, et al. . Radiotherapy treatment planning for patients with non-small cell lung cancer using positron emission tomography (PET). Radiother Oncol 2002; 62:51–60.CrossRefGoogle ScholarPubMed
De Ruysscher, D, Wanders, S, Minken, A, et al. . Effects of radiotherapy planning with a dedicated combined PET-CT-simulator of patients with non-small cell lung cancer on dose limiting normal tissues and radiation dose-escalation: A planning study. Radiother Oncol 2005; 77:5–10.CrossRefGoogle ScholarPubMed
NICE. Lung cancer: The diagnosis and treatment of lung cancer – Clinical Guideline 24. National Institute for Clinical Excellence. February 2005. London.Google Scholar
Heron, DE, Gerszten, K, Selvaraj, RN, et al. . Conventional 3D conformal versus intensity-modulated radiotherapy for the adjuvant treatment of gynecologic malignancies: A comparative dosimetric study of dose-volume histograms. Gynecol Oncol 2003; 91:39–45.CrossRefGoogle ScholarPubMed
Metherall, P. Keynote Lecture on Nuclear Medicine. Presented at Sheffield Hallam University, 15th November 2005.Google Scholar
Kumar, R, Jana, S. Positron Emission Tomography: An advanced nuclear medicine imaging technique from research to clinical practice. Methods Enzymol 2004; 385:3–19.CrossRefGoogle ScholarPubMed
Griffiths, P. Nuclear medicine in oncology. J Radiother Pract 2001; 2 (2):59–63.CrossRefGoogle Scholar
Solberg, TD, DeMarco, JJ, Holly, FE, Smathers, JB, DeSalles, AA. Monte Carlo treatment planning for stereotactic radiosurgery. Radiother Oncol 1998; 49:73–84.CrossRefGoogle ScholarPubMed
Budgell, G. Intensity modulated radiotherapy (IMRT)-an introduction. Radiography 2002; 8:241–249.CrossRefGoogle Scholar
Beavis, A. Is tomotherapy the future of IMRT? Br J Radiol 2004; 77:285–295.CrossRefGoogle ScholarPubMed
Kupelian, PA, Ramsey, C, Meeks, SL, Willoughby, TR, Forbes, A, Wagner, TH, Langen, KM. Serial megavoltage CT imaging during external beam radiation for non-small cell lung cancer: Observations on tumour regression during treatment. Int J Radiat Oncol Biol Phys 2005; 63:1024–1028.Google ScholarPubMed
Suit, H. The Gray Lecture 2001:Coming technical advances in radiation oncology. Int J Radiat Oncol Biol Phys 2002; 53:798–809.CrossRefGoogle ScholarPubMed
Hall, E, Wuu, C. Radiation-induced second cancers: The impact of 3D-CRT and IMRT. Int J Radiat Oncol Biol Phys 2003; 56:83–88.CrossRefGoogle ScholarPubMed
Mutic, S, Low, D. Whole-body dose from tomotherapy delivery. Int J Radiat Oncol Biol Phys 1998; 42:229–232.CrossRefGoogle ScholarPubMed
Cromwell Cancer Centre: Development program update. Doctors News Winter 2005/06. Available at www.cromwell-hospital.co.uk (accessed on 18 April 2006).Google Scholar
Orecchia, R. Particle beam therapy (Hadron therapy): Basis for interest and clinical experience. Eur J Cancer 1998; 34:459–468.CrossRefGoogle ScholarPubMed
Jones, B, Burnet, N. Radiotherapy for the future: protons and ions hold much promise. Br Med J 2005; 330:979–980.CrossRefGoogle Scholar
Lennox, A. Accelerators for cancer therapy. Radiat Phys Chem 2001; 61:223–226.CrossRefGoogle Scholar
Goitein, M, Jermann, M. The relative costs of proton and x-ray radiation therapy. Clin Oncol 2003; 15:S37–S50.CrossRefGoogle ScholarPubMed
Beardmore, C. Creating a radiotherapy plan for action. Synergy News. April 2005. The Society of Radiographers. London.Google Scholar
Chua, YJ, Steer, C, Yip, D. Recent advances in management of small-cell lung cancer. Cancer Treat Rev 2004; 30:521–543.CrossRefGoogle ScholarPubMed
NICE. Guidance on cancer services: Improving outcomes in breast cancer: Manual update. National Institute for Clinical Excellence. August 2002. London.Google Scholar
Ginsburg, G, McCarthy, J. Personalized medicine: revolutionizing drug discovery and patient care. Trends Biotechnol 2001; 19:491–499.CrossRefGoogle ScholarPubMed
House of Commons Health Committee. The influence of the pharmaceutical industry. The House of Commons, Fourth report of session 2004–2005 (1). The Stationary Office. London, 22 March 2005.Google Scholar
Piccart-Gebhart, MJ, Procter, M, Leyland-Jones, B, et al. . Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med 2005; 353:1659–1672.CrossRefGoogle ScholarPubMed
Romond, EH, Perez, EA, Bryant, J et al. . Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med 2005; 353:1673–1684.CrossRefGoogle ScholarPubMed
Hortobagyi, G. Trastuzumab in the treatment of breast cancer. N Engl J Med 2005; 353:1734–1736.Google ScholarPubMed
The Lancet. Herceptin and early breast cancer: A moment for caution: Editorial. Lancet 2005; 336 (9498):1673.Google Scholar
Moss, R. Breast Cancer and the hype over herceptin. New Sci 2006; 2541:22.Google Scholar
Bentzen, S. High-tech in radiation oncology: Should there be a ceiling? Int J Radiat Oncol Biol Phys 2004; 58:320–330.Google ScholarPubMed
Department of Health. The NHS Cancer Plan and the new NHS: Providing a patient-centred service. 2004. London.Google Scholar
National Audit Office. Department of Health: The NHS cancer plan: A progress report: Report by the Comptroller and Auditor General. House of Commons HC 343 Session 2004–2005. The Stationary Office. London, 11 March 2005.Google Scholar
Sikora, K, Slevin, M, Bosanquet, N. Cancer care in the NHS. Reform. London. February 2005.Google Scholar
Revill, J. Scores of private cancer treatment centres to be built for NHS patients. The Observer. 8th January 2006. Page 1.Google Scholar
Carvel, J. Time to make the figures add up. The Guardian. 12th April 2006. Page 3.Google Scholar
Kelly, R. Leeds radiographers furious over news of job cuts. Synergy News. November 2004. The Society of Radiographers. London.Google Scholar
Schueren, E, Kesteloot, K, Cleemput, I. Federation of European Cancer Societies. Full report. Economic evaluation in cancer care: Questions and answers on how to alleviate conflicts between rising needs and expectations and tightening budgets. Eur J Cancer 2000; 36:6–36.Google ScholarPubMed
Ash, D, Barrett, A, Hinks, A, Squire, C, Royal College of Radiologists. Re-audit of radiotherapy waiting times 2003. Clin Oncol 2004; 16:387–394.CrossRefGoogle ScholarPubMed
O’Rourke, N, Edwards, R. Lung cancer treatment waiting times and tumour growth. Clin Oncol 2000; 12:141–144.CrossRefGoogle ScholarPubMed
Fortin, A, Bairati, I, Albert, M, Moore, L, Allard, J, Couture, C. Effect of treatment delay on outcome of patients with early-stage head-and-neck carcinoma receiving radical radiotherapy. Int J Radiat Oncol Biol Phys 2002; 52:929–936.CrossRefGoogle ScholarPubMed
Waaijer, A, Terhaard, CH, Dehnad, H, Hordijk, GJ, van Leeuwen, MS, Raaymakers, CP, Lagendijk, JJ. Waiting times for radiotherapy: consequences of volume increase for the TCP in oropharyngeal carcinoma. Radiother Oncol 2003; 66:271–276.CrossRefGoogle ScholarPubMed
Huang, J, Barbera, L, Brouwers, M, Browman, G, Mackillop, WJ. Does delay in starting treatment affect the outcomes of radiotherapy? A systematic review. J Clin Oncol 2003; 21:555–563.Google ScholarPubMed
Dodwell, D, Crellin, A. Waiting for radiotherapy. Br Med J 2006; 332:107–109.CrossRefGoogle ScholarPubMed
Royal College of Radiologists. Equipment, workload and staffing for radiotherapy in the UK 1997–2002. The Royal College of Radiologists. September 2003. Publication Reference Number BFCO(03)3. London.Google Scholar
James, ND, Robertson, G, Squire, CJ, Forbes, H, Jones, K, Cottier, B, RGR, Clinical Oncology Audit Sub-committee. A national audit of radiotherapy in head and neck cancer. Clin Oncol 2003; 15:41–46.CrossRefGoogle Scholar
Woodford, AJ. An investigation of the impact/potential impact of a four-tier profession on the practice of radiography – A literature review’. Radiography 2006; 12:318–326.CrossRefGoogle Scholar
Griffiths, S, Craig, A, Abraham, M. Radiographer roles and risk management in radiotherapy, and a UK survey. J Radiother Pract 2006; 5(3):137–146.CrossRefGoogle Scholar
Kelly, R. Foundation trust votes to ditch Agenda for Change. Synergy News. August 2006. The Society of Radiographers. London.Google Scholar
Society of Radiographers. Radiographic Staffing: Short term guidance 2005 – Benchmark for standard core functions with radiotherapy. The Society of Radiographers. December 2005. London.Google Scholar
Society of Radiographers. Radiotherapy: Positioning therapeutic radiographers within cancer services: Delivering patient-centred care. The Society of Radiographers. March 2005. London.Google Scholar
Delaney, G, Barton, M, Jacob, S, Jalaludin, B. A model for decision making for the use of radiotherapy in lung cancer. Lancet Oncol 2003; 4:120–128.CrossRefGoogle Scholar
Kirkbride, P, Roberts, JT, Craig, A. Radiotherapy in the UK: There are problems – what are the solutions? Clin Oncol 2004; 16:385–386.CrossRefGoogle ScholarPubMed
Winfield, E, Deighton, A, Venables, K, Hoskin, PJ, Aird, EG. Survey of UK breast techniques: Background prior to the introduction of the quality assurance programme for the START (Standardisation of Radiotherapy) trial in breast cancer. Clin Oncol 2002; 14:267–271.CrossRefGoogle Scholar
Probst, H, Griffiths, S. Moving to a high-tech approach to the irradiation of early breast cancer: Is it possible to balance efficacy, morbidity and resource use? Clin Oncol 2006; 18:268–275.CrossRefGoogle Scholar
Schwartz, DL, Ford, E, Rajendran, J, et al. . FDG-PET/CT imaging for pre-radiotherapy staging of head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 2005; 61:129–136.CrossRefGoogle Scholar
van Tinteren, H, Hoekstra, OS, Smit, EF, et al. . Effectiveness of positron emission tomography in the pre-operative assessment of patients with suspected non-small-cell lung cancer. The PLUS multicentre randomised trial. Lancet 2002; 359:1388–1392.CrossRefGoogle Scholar
Holloway, CL, Robinson, D, Murray, B, Amanie, J, Butts, C, Smylie, M, Chu, K, McEwan, AJ, Halperin, R, Roa, WH. Results of a phase I study to dose escalate using intensity modulated radiotherapy guided by combined PET/CT imaging with induction chemotherapy for patients with non-small cell lung cancer. Radiother Oncol 2004; 73:285–287.CrossRefGoogle ScholarPubMed
Grigsby, P, Siegel, B, Dehdashti, F. Lymph node staging by positron emission tomography in patients with carcinoma of the cervix. J Clin Oncol 2001; 19:3745–3749.CrossRefGoogle ScholarPubMed
Cohn, DE, Dehdashti, F, Gibb, RK, Mutch, DG, Rader, JS, Siegel, BA, Herzog, TJ. Prospective evaluation of positron emission tomography for the detection of groin node metastases from vulvar cancer. Gynecol Oncol 2002; 85:179–184.Google ScholarPubMed
van Westreenen, HL, Heeren, PA, van Dullemen, HM, van der Jagt, EJ, Jager, PL, Groen, H, Plukker, JT. Positron emission tomography with F-18-fluorodeoxyglucose in a combine staging strategy of esophageal cancer prevents unnecessary surgical explorations. J Gastrointest Surg 2005; 9:54–61.CrossRefGoogle Scholar
Duong, CP, Hicks, RJ, Weih, L, Thompson, A, Drummond, E, Thomas, RJS. Positive impact of FDG-PET on survival of oesophageal cancer patients. J Clin Oncol 2004; 22(Supplement):4055.CrossRefGoogle Scholar
Popperl, G. Value of O-(2-[18F]fluoroethyl)-L-tyrosine PET for the diagnosis of recurrent glioma. Eur J Nucl Med Mol Imaging 2004; 31:1464–1470.CrossRefGoogle Scholar
Debus, J, Hug, EB, Liebsch, NJ, O’Farrel, D, Finkelstein, D, Efird, J, Munzenrider, JE. Brainstem tolerance to conformal radiotherapy of skull base tumours. Int J Radiat Oncol Biol Phys 1997; 39:967–975.CrossRefGoogle Scholar
Egger, E, Schalenbourg, A, Zografos, L, Bercher, L, Boehringer, T, Chamot, L, Goitein, G. Maximizing local tumour control and survival after proton beam radiotherapy of uveal melanoma. Int J Radiat Oncol Biol Phys 2001; 51:138–147.CrossRefGoogle ScholarPubMed
Thornton, A. Unpublished data, personal communication. In: Suit H. The Gray Lecture 2001: Coming technical advances in radiation oncology. Int J Radiat Oncol Biol Phys 2002; 53:798–809.CrossRefGoogle Scholar
Tokuuye, K. Results of proton therapy for hepatocellular carcinoma at the University of Tsukuba in Proton Therapy Oncology Group XXXV. Tsukuba, Japan: PTCOG, 2001. In: Suit H. The Gray Lecture 2001: Coming technical advances in radiation oncology. Int J Radiat Oncol Biol Phys 2002; 53:798–809.CrossRefGoogle Scholar
Department of Health. Investment in Cancer in 2001/02 – 2003/04. August 2005. London.Google Scholar