Raising the profile of radiotherapy: Advocacy efforts around the world

Cancer is a global disease with incidence rising. Radiotherapy is a precise, safe and cost-effective treatment needed by 1 in 2 cancer patients¹ and responsible for 40% of cancer cures². However, less than 30% of cancer patients globally actually receive radiotherapy³. Even in high income countries, with robust health systems, knowledge of and access to radiotherapy is not universal⁴. In England for example, access ranges from 25% to 49% depending on the region, with the average around 38%⁴.

Despite radiotherapy being a highly effective cancer treatment that presents good value for money, it is consistently the last modality to be considered in planning and building treatment capacity for cancer⁵.

For those of us working in radiation oncology how many times have we had to explain what we do, debunk myths about being radioactive or even let other health professionals know we exist?! Too many to mention! Public perception of radiotherapy is a major barrier to overcome in the drive for universal, equitable access and recognition. Thankfully, there is a growing global network of radiation oncology professionals and organisations advocating for increased awareness about the role and benefits of radiotherapy.

In this MedRadJClub blog we explore advocacy efforts for our favourite cancer-curing underdog; radiation therapy.

Australia/New Zealand

The Radiation Oncology Targeting Cancer Campaign is an initiative of the Faculty of Radiation Oncology of the Royal Australian and New Zealand College of Radiologists (RANZCR) with a website and Twitter profile. Commencing in 2013, the Targeting Cancer campaign was initiated to raise awareness among the cancer community and health professionals, particularly among General Practitioners (GP), that radiotherapy is an effective, safe and sophisticated treatment for cancer which is often overlooked and poorly understood.

One of the flagship activities is GP oncology information evenings hosted by radiotherapy departments across both countries⁶. These events highlight the importance of GP involvement for cancer patients and provide information on a range of topics including debunking some of the outdated side effect profiles of radiation treatment and when GP’s should refer to radiation oncology. Case studies are presented with a focus on the benefits of radiotherapy in the palliative setting and for improving access for prostate cancer patients who often aren’t referred to a radiation oncologist to discuss treatment options.

Friend of MedRadJClub and previous guest blogger, Julie McCrossin, is a Targeting Cancer ambassador following her treatment for oropharynx cancer in 2013. The use of ambassadors, often those who have experienced radiotherapy themselves, add value and depth to the conversation ensuring radiotherapy’s profile within Australia and New Zealand remains a priority.

Radiotherapy UK (formerly Action Radiotherapy), launched in 2010 and is the only UK charity dedicated to improving radiotherapy. When the charity launched, funding for radiotherapy research was at a critical low point despite advancements like IMRT and IGRT. Chemotherapy and big pharma were receiving all the attention (and investment).

“If radiotherapy improvements were a drug and we could package it, large profits could be generated and our funding problems would be over.”
Price, 2011, p. 3

The original aims of the grass-roots charity were to inform government of the importance of radiotherapy and support the delivery of cancer care and research in the UK. It sought to do this through mobilising the radiotherapy community and lobbying government through the All-Party Parliamentary Group for Radiotherapy for which the charity is the secretariat, providing advice and data on key issues to MPs.

Radiotherapy UK have campaigned on a number of inequities affecting radiotherapy, such as universal access to SABR, abolishment of the antiquated tariff system, and highlighting the unequal access to treatment across the country and the important role of satellite centres. Since the start of the pandemic, Radiotherapy UK has focussed on highlighting the impact of Covid-19 on cancer services through the Catch Up With Cancer campaign urging for policy makers to prioritise radiotherapy and put an effective plan in place to tackle the cancer backlog.

Last summer, Radiotherapy UK organised the #Miles4Radiotherapy challenge to raise awareness of radiotherapy and some funds to help sustain the charity. Over 50 teams took part contributing distances by running, walking, cycling and even caving to cover over 370,000 miles!

Rad Chat Podcast went live in 2019 and has been gathering pace ever since. It is the first therapeutic radiographer-led oncology podcast, aimed at bringing the experiences of cancer patients, healthcare professionals and academics together. Jo McNamara and Naman Julka-Anderson are passionate about using podcasting as a platform for radiotherapy advocacy, to improve patient experience, cancer awareness and promote the role of therapeutic radiographers.

Europe

The Marie Curie Legacy campaign pioneered in 2017 by the ESTRO Cancer Foundation (ECF) centred on extoling the benefits of radiotherapy and optimizing provision with the motto “seizing the opportunity in cancer care”. This campaign leveraged the 150^th anniversary of Marie Curies birth and drew attention with its adorable and informative infographics featuring Marie herself. You can find their White Paper here. Sadly the campaign is not currently active.

North America

The American Society for Radiation Oncology (ASTRO) has created a website with a twitter profile called “RT Answers” to explain to the public how radiation therapy is used to treat cancer and signpost to relevant support resources.

[Authors: we had a surprisingly hard time finding advocacy efforts in North America, if you know of any, please let us know and we can update the blog!]

Global Advocacy

The Union for International Cancer Control (UICC) supports the cancer community to reduce the global cancer burden and has in recent years added its voice to the role radiotherapy has in improving cancer outcomes in low- and middle-income countries (LMIC). Together with its partners, UICC, advocates for increased global access to radiotherapy as a cost-effective cancer treatment option. Through education platforms, partnerships and alliances, barriers and challenges are addressed to help raise the profile of radiotherapy within LMIC. UICC support collaboration, leadership and advocacy from the global radiation oncology community to ensure those in policy and decision-making roles understand the need for and benefit of radiation therapy to those with cancer⁸. Examples of UICCs radiotherapy advocacy work can be found here, here and here.

The Global Coalition for Radiotherapy (GCR) established in 2020 to understand the challenges and opportunities facing radiotherapy delivery around the world during the Covid-19 pandemic. GCR is a multidisciplinary collaborative holding monthly webinars and round-tables to bring advocates and industry together on a range of global radiotherapy issues⁹. The GCR are currently working to gather data to support cancer patients whose treatments are being disrupted because of the war in Ukraine. Find out more about their important work and how you can get involved here.

There’s no doubt that the radiotherapy advocacy movement is gaining momentum across the globe, however, public perception and universal access to high quality treatment remain key challenges to overcome. How can we accelerate progress? No doubt our strength lies in our community, so we’re rounding off this blog with a call to action!

Follow | join | promote at least one radiotherapy advocacy organization
Get familiar with the facts about radiotherapy inequities nationally and globally
Pledge to take part in #Miles4Radiotherapy 2022
Join the #MedRadJClub chat on March 24th / 25th and share your advocacy ideas!

References:

Barton MB, Jacob S, Shafiq J, Wong K, Thompson SR, Hanna TP, Delaney GP. Estimating the demand for radiotherapy from the evidence: a review of changes from 2003 to 2012. Radiother Oncol. 2014 Jul;112(1):140-4. doi: 10.1016/j.radonc.2014.03.024. Epub 2014 May 12. PMID: 24833561.
Ringborg U, Bergqvist D, Brorsson B, et al. The Swedish Council on Technology Assessment in Health Care (SBU) Systematic Overview of Radiotherapy for Cancer including a Prospective Survey of Radiotherapy Practice in Sweden 2001–Summary and Conclusions, Acta Oncologica, 2003: 42:5-6, 357-365, DOI: 10.1080/02841860310010826
Barton M., Jacob S., Shafig J., Wong K., Thompson S., Hanna T., Delaney G. National & International Benchmarks set following study of delivery of Radiotherapy Services: ‘Review of Radiotherapy Optimal Utilisation Rates’. Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Liverpool Hospital, Sydney, Australia, 2013: p6.
Cullen J. Drabble D, Castellanos Serrano C, Brissett, L (2014). Recommendations for achieving a world-class radiotherapy service in the UK. Final report prepared for Cancer Research UK.
Atun R, Jaffray DA, Barton MB, Bray F, Baumann M, Vikram B, Hanna TP, Knaul FM, Lievens Y, Lui TY, Milosevic M, O’Sullivan B, Rodin DL, Rosenblatt E, Van Dyk J, Yap ML, Zubizarreta E, Gospodarowicz M. Expanding global access to radiotherapy. Lancet Oncol. 2015: Sep;16(10):1153-86. doi: 10.1016/S1470-2045(15)00222-3. PMID: 26419354.
Morris, L., Gorayski, P. and Turner, S. Targeting general practitioners: Prospective outcomes of a national education program in radiation oncology. J Med Imaging Radiat Oncol, 2018: 62: 270-275. https://doi.org/10.1111/1754-9485.12685
Price, P. The launch of the first UK charity devoted to radiotherapy: ACORRN — Action Radiotherapy. The British Journal of Radiology, 2011: 84;2–4
Abel-Wahab M, Gondhowiardjo SS, Rosa AA, et al. Global radiotherapy: Current status and future direction –White paper. JCO Global Oncology 2021: 7:827-842
Price P, Fleurent B, Barney SE. The Role of the Global Coalition for Radiotherapy in Political Advocacy for Radiation Therapy as a Cost-Effective and Underfunded Modality Around the World. Int J Radiat Oncol Biol Phys. 2021 Sep 1;111(1):23-26. doi: 10.1016/j.ijrobp.2021.04.010. PMID: 34348109.