Cancer expert calls for governments and health systems to embrace ‘undervalued’ radiotherapy

A leading cancer expert is challenging widespread misconceptions about radiotherapy which she says is marginalised by healthcare systems despite contributing to 40 per cent of cancer cures.

Professor Pat Price, visiting professor at Imperial College London and chair of both Radiotherapy UK and the Global Coalition for Radiotherapy (GCR), has authored a comprehensive report highlighting the problem.

The report, Precision Targeting, Global Impact: Cancer Radiotherapy in the 21st Century, was released at the American Society for Radiation Oncology’s (ASTRO) 67th Annual Meeting on September 29.

The report, supported by Elekta, explores the multi-faceted ways in which the evolving technology can treat a range of cancers, alone and in combination with other therapies.

One of the most damaging ‘myths’ out there, according to ProfPrice, is around the cost. However, she argues that radiotherapy is actually many degrees cheaper than the alternatives.

The cost for immunotherapy, for example, is almost five times greater per patient than radiotherapy.

Prof Price says: “A radiotherapy machine may cost £1 million, but it could treat 700 patients annually over a decade, working out to roughly £400 per patient.

“That’s cheap as chips, so I think we’ve got to tackle the myth that radiotherapy is expensive.”

It’s also relatively inexpensive to train practitioners to use new technology in this connected, post-Covid era, Prof Price adds.

The expert explains that the global radiotherapy community has fully embraced digital collaboration, with practitioners sharing their expertise with international colleagues virtually.

Prof Price argues that the main barrier to access in lower income countries is not training costs but infrastructure and internet access.

She adds: “You don’t have to fly people to expensive training courses.

“You can actually sit there on a screen in front of them telling them what to do.”

The professor highlights several reasons why radiotherapy is often left out of the conversation despite its effectiveness.

Firstly, there’s a perception problem.

Radiotherapy is not a ‘new, sexy treatment.’ While this may be the case, there have been significant technological advances over the years, Professor Price says.

And perhaps more importantly, radiotherapy lacks the marketing power of new Big Pharma drugs.

Professor Price says: “If you were a drug, you would have a marketing budget for one drug that is bigger than the entire UK budget for radiotherapy.”

Modern radiotherapy if fact bears little resemblance to the treatments of eras past, Professor Price argues.

The Precision Targeting report highlights today’s adaptive and image-guided radiotherapy which can achieve millimetre precision, minimising damage to surrounding tissue.

Radiotherapy has also fully embraced the AI revolution, with Prof Price arguing that it is at the very forefront of AI application in medicine, particularly with planning and delivery.

She explains: “If I were planning treatment for your lung cancer, I’d need to review your CT scan and outline the lung, identify where your liver is, and mark all the other structures I want to avoid. That process used to take me two and a half hours.

“Now I can press a button and AI does it in two minutes, then I check it. The checking part is crucial.

“When it’s accurate, we get better quality results in far less time. This has been proven to speed up patient care significantly.

“Instead of getting through three patients in my weekly planning session, I can now get through nine.

“A strong study from Oxford showed that using AI for breast cancer cuts six days off the waiting list, and for prostate cancer, nine days. I also believe it’s more accurate. So it’s better all around.”

As chair of the GCR, Professor Price is working with the Union for International Cancer Control (UICC) to ensure that radiotherapy is front and centre of national cancer plans.

It’s not enough to ensure that countries have the machines to deliver radiotherapy, Prof Price adds: they need to have the resources to use and maintain them.

“There’s plenty of countries who’ve bought a machine but don’t know what to do with it,” the researcher explains.

“So you’ve got to think about things like how you’re going to get them serviced. But the community globally is really happy to help.”

Prof Price launched the Global Coalition for Radiotherapy during the early stages of the pandemic.

She recalls phone calls to Wuhan in April, then shortly after, Italy, the UK and the US as the virus spread.

“We were disseminating this information really quickly among the global community, sharing what we learned along the way. So we’re actually really good at this. So I think we can do this.

“The challenge is, how do we explain the value of radiotherapy to the people making the policy decisions?

“Ultimately, if you want to have value-based cancer care, radiotherapy needs to be front and centre.

“That’s not saying that we don’t also need fantastic surgery, pathology, drugs and so on. We need all of that too.

“But they are all speaking quite well for themselves already. For some reason, perhaps because it is so technical, radiotherapy is getting lost.”