Introduction made about when technologies are ready to be adopted.
Radiotherapy in the United Kingdom (UK) is lagging behind the rest of the world. The current
A recent article entitled ‘Cancer patients missing out on best treatment because The conventional measure of risk has been to assume that the randomised controlled
of cost’ stated that only seven per cent of UK patients were getting care that trial (RCT) is the gold standard against which decisions about likely effectiveness of system is very
was commonplace in the United States and Europe
1
; the reason given was that interventions should be assessed. In radiotherapy, full evidence of effectiveness is
“the NHS is struggling to invest in staff and technology”. In this particular report not gained for many years post intervention; and the overall risk to the population of ‘safe’ but it is
the technology in question was intensity modulated radiotherapy (IMRT) but withholding a potentially beneficial intervention is not factored in. Is a new measure
the same statement could be made about many others, including image guided needed, therefore; one by which the risk/benefit balance can be determined for too slow
radiotherapy
2
(IGRT) and proton therapy. The primary cause given for this gap emerging technologies? And if so, what measure could be used?
in access to advanced care is the lack of investment in, and slow adoption of, This problem isn’t unique to radiotherapy. Rather, it is common in other technology
emerging technologies in the UK compared to North America and Western Europe. based practices and radiotherapy may have something to learn from some of these.

Delays in developments are not a new phenomenon. Historically, the UK has been What does radiotherapy really want?
a slow adopter of new technologies in radiotherapy as shown by the take up of Initial consideration of the question ‘what does radiotherapy really want?’ leads
technologies such as electronic portal imagers and multi-leaf collimators – years to another – what are the fundamental purposes of radiotherapy provision and
behind the US. Why is this? Why is the UK particularly slow at implementing services? While that may appear a big question at first blush, it helps to clarify
emerging technologies? And are there strategies that would improve the rate of and focus on the end points. This is important given that the effort and resources
implementation and uptake? deployed in radiotherapy, including new technologies, are paid for by taxpayers
who, without necessarily having detailed understandings of how the end points
Safety first? may be achieved, certainly expect to obtain some benefit from their contributions.
The UK radiotherapy community has a reputation for providing good quality
evidence for new procedures, and is amongst the world leaders in the production This somewhat unfocussed taxpayer expectation of ‘some benefit’ is crystallised by
of evidence. The community thinks and checks first, and there is a culture of various standing committees
7
that are tasked with setting out clear objectives for
playing safe and waiting for proof of effectiveness. This risk aversion translates into radiotherapy services
8
– in other words, to turn a rather generalised expectation on
poor investment in technology; with competition for National Health Service (NHS) the part of the taxpayer into a set of specific objectives and strategies for delivery.
funds, purchasers prefer to have evidence of cost-effectiveness or value for money
before committing to new technologies. But this practice may well be contributing Review of the various policy documents that have been issued shows clearly
to the gap in provision of advanced practice. that the prime expectation of taxpayers is a service that addresses their cancer
problems quickly and effectively. Both of these terms are, of course, relative:
Whilst the UK spends time waiting for ‘best evidence’, those that risk the quickly implies faster than previously, and effectively means with improved
uncertainty of early adoption of new technologies are able to offer advanced, if success/survival rates.
not totally proven, treatments to their patients. This is not necessarily bad as, for
certain technologies, the concept behind the technology is so robust that the risk Acceptable success rates are nearly always under ever-upward pressure; society
of using it is minimal. Indeed, the greater risk may be to withhold the intervention. seems to expect both a better job in terms of delivering on the existing list of
The question, therefore, is about whether the UK is right to wait for technologies cancer treatments, and the continual addition of new treatments to that list. These
to be validated, or could more patients benefit by increasing the speed at which dual pressures inevitably force the radiotherapy community to constantly seek
developments are taken up? new ways to deliver yet more from within existing resources, whether measured
in human terms or in strictly financial ones. Inevitably, in this quest, there is an
Risk/benefit balance expectation that new technologies can play a part in satisfying ever-increasing
Recent reviews of cancer services
3,4
have deemed that the balance needs demand in a resource limited environment.
addressing; that the UK should, perhaps, implement emerging technologies
more quickly. Currently, there are many initiatives aimed at increasing speed of Radiotherapy is not alone in facing pressures for ever-improving results from a
technological adoption
5,6
but there appear to be difficulties in the way decisions are fixed (or even contracting) resource base. Historically, technology development
2009
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IMAGING & ONCOLOGY
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