Radiotherapy is “undervalued” and requires “greater investment.”

Those are the claims made in a new European report based on assessments around the use, access and availability of radiotherapy services to patients. Titled Radiotherapy: seizing the opportunity in cancer care, the white paper was published this month under a commission by the Marie Curie Legacy Campaign, an initiative of the European Society of Radiotherapy and Oncology (ESTRO) and the ESTRO Cancer Foundation.

"Identifying the barriers contributing to the underuse of radiotherapy and variable access to resources can be complex," Michelle Leech, associate professor of radiation therapy at Trinity College in Dublin, Ireland, told HCB News. "A number of key themes we have identified across Europe include health system budget cuts; absence of investment in new equipment; a mistaken perception that radiation therapy is an expensive treatment; and a limited awareness of the importance of educating radiation oncology professionals. In addition, more than 40% of high-income countries do not address radiotherapy in their national cancer or noncommunicable disease plans, leading to it being left on the sidelines in national health agendas."

Cancer diagnoses are on the rise, with more than 4.2 million cases confirmed in Europe in 2018. Such outcomes have propelled growth projections around the demand for treatments, including a 16 percent hike expected by 2025 for radiotherapy, which cures 40 percent of all cancers either alone or in combination with other forms of treatment.

Its underuse and the lack of understanding around it are due to a number of factors, according to the report, including shortages of high-quality equipment, variations in training, insufficient integration of radiotherapy into treatment plans, lack of investment in research, lack of general understanding of it as a cancer treatment, and misconceptions about its safety.

The paper proposes a five-point plan to overcome these challenges that includes making radiotherapy a central component of cancer care in policies, planning and budgeting; raising recognition of all radiotherapy professions with education and training harmonized across Europe; investing in research and data use for continuous improvement of radiotherapy outcomes for patients with maximized potential for innovation; fully integrated treatment planning and decision-making; and improvement in awareness and understanding of radiotherapy for its full potential to be realized in patient care.

It also encourages governments and policymakers, healthcare professionals, patient and professional societies, and national and international research funds, and all other stakeholders to become so-called “radiotherapy ambassadors” to help in raising awareness of the positive outcomes provided by radiotherapy as a comprehensive, optimal cancer care.

"Multidisciplinary cancer care teams across Europe need to fully integrate radiotherapy into treatment planning. There needs to be greater emphasis on cross-disciplinary training programs throughout the care team – as well as consistent training for all professionals, using the ESTRO core curricula," Yolande Lievens, former ESTRO president and chair of the radiation oncology department at Ghent University Hospital in Belgium, told HCB News. "In the rest of the world, particularly in developing countries, including parts of Africa, basic investment in resources is largely absent – with some countries having no access to radiotherapy at all. We need to ensure that we raise awareness of the benefits of radiotherapy internationally and ensure cancer patients, wherever they live, get the best possible care."