Specific Trends in Radiation Oncology
Continuing improvements in techniques and technologies are increasing the precision and accuracy of radiotherapy, allowing treatments that minimise the impact on healthy tissue and reduce treatment related morbidity. These advances are mediated through increased complexity of treatments and consequently are relatively more resource-intensive in the short term, but lead to long term savings. The following trends are expected to endure across the radiation oncology sector.
The rate of evolution in radiotherapy techniques and improvements in the delivery technologies will accelerate.
Recent radiotherapy innovations have led to increases in the precision of treatments, which allows improved outcomes and reduced treatment-related side effects. Notable developments to date are in the areas of intensity modulated radiotherapy (IMRT), stereotactic body radiation therapy (SBRT), 4D imaging, particle therapy and nanotechnology. Advances in imaging technology are further enhancing the targeting of radiotherapy treatments. An important development is the introduction of adaptive treatments that can be adjusted as tumour and patient characteristics change throughout the course of radiotherapy. Adaptive treatments improve patient outcomes (for example, the reduction of radiotherapy related side effects for bladder cancer) but can often require significant investment of time by the radiation oncology team3, 4.
Radiation oncology is increasingly personalised.
Radiotherapy is by its nature a personalised treatment: every patient’s plan is unique and tailored to their particular clinical circumstances and anatomy. It is anticipated that the introduction of tumour marker testing and molecular and biological imaging techniques will enable the already personalised radiotherapy treatments to be even more targeted. With the introduction of tumour marker testing, radiotherapy treatments and doses can be tailored to the specific tumour biology of each patient, for example, radiotherapy dose modification based on Positron Emission Tomography (PET) findings in prostate cancer5 and radiotherapy volume modifications based on PET findings in head and neck cancer6. Molecular and biological imaging will allow improved patient selection for treatment (for example, select patients suitable for surgery in lung cancer, melanoma and oesophageal cancer) 7 and will reduce futile treatment in instances where cancer has already spread 8,10.
Models of care are evolving.
Service delivery and models of care are changing, with the focus shifting from the delivery of isolated treatments towards a multidisciplinary, coordinated approach to cancer care. This multidisciplinary patient management involves radiation, surgical and medical oncology as well as allied health services. The team considers relevant treatment options and agrees on treatment planning and supportive care for individual patients. Increasingly, radiation oncology centres are developing expertise in specific techniques and the treatment of specific malignancies. As a result, provision of radiation oncology services will increasingly rely on networks for collaboration and referral of patients to specific centres. Referrals to these specialist facilities will increase for certain diagnoses and complex treatments.
The use of technology to enable better communication and information transfer will intensify.
Radiation oncology uses some of the most advanced information technology infrastructure in the healthcare system to support its data and imaging needs. The need to use tele- medicine in patient management across Australia will increase dramatically as the number of cancer centres, particularly in regional areas, increases. With a mobile patient population, increasing numbers will present following initial treatment to a different radiotherapy centre and require re-treatment with radiotherapy or develop a second malignancy (requiring treatment with radiotherapy). Technological solutions to expedite the transfer the relevant imaging and previous radiotherapy treatment details to the treating radiotherapy centre will be important. This technology is already in use in Australia, although our use is significantly below that of other countries such as Canada. The utilization of telemedicine in radiation oncology is well below that of other medical specialists in Australia; however it is expected to intensify due to the changes in service provision and models of care.
The inflexible nature of funding arrangements for radiation oncology will increasingly be a rate-limiting step for services.
Radiation oncology professionals raised significant concerns during the stakeholder consultation about the current funding levels being inadequate to meet service needs and that the funding structures do not appropriately support the complexity of current treatments and are likely to be even more restrictive as new treatments emerge. This is anticipated to remain a challenge in the future.
Consumer awareness of radiotherapy and new techniques will continue to expand.
Consumer awareness of radiation oncology has historically been low. Increased access to information via the Internet is changing this. The current lack of a centralised patient information resource for radiation oncology means that sometimes the information accessed by consumers is inappropriate or not relevant in their clinical circumstances. In some instances, the information may relate to treatment techniques that are not available in Australia (such as proton therapy or heavy ion therapy). It is anticipated that awareness of radiotherapy treatments will continue to increase in the coming years as a result of the increasing availability of information via the Internet and the increased awareness through multidisciplinary care teams.