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Policy Implications

Radiation oncology is distinguished from other areas of healthcare by several important characteristics.

Radiation oncology relies on a team of experts. This team management approach starts at the level of integration between radiation oncology, surgery, palliative care and medical oncology and extends to the core radiotherapy team, including Radiation Oncologists, Radiation Oncology Medical Physicists and Radiation Therapists. The radiation oncology team also includes engineers, cancer nurses and other allied health practitioners. Radiation oncology practice is strongly underpinned by a detailed knowledge of the biological effects and physics of radiation, the application of sophisticated imaging and treatment technologies, and extensive understanding of the diverse clinical behaviours, pathology and management of cancer.

Radiation oncology requires custom-built facilities and specialised equipment. Establishing a radiation oncology facility requires an up-front investment for the building of radiation-proof bunkers and the purchase of the necessary equipment (such as a linear accelerator and a CT scanner). Radiation oncology is a specialty dealing with rapidly changing technological advances largely directed at improving the accuracy and effectiveness of radiotherapy outcomes, including better control and cure of tumours, as well as reduction of side effects. Increasing use of high quality imaging to direct radiotherapy, newer types of radiation (such as heavy ions) and modern treatment techniques, such as Intensity Modulated Radiotherapy (IMRT), are changing the standard treatment methods. Radiation oncology facilities must include appropriate technological and information technology infrastructure to ensure quality service provision.

Radiation oncology is largely an out-patient service, but it cannot be delivered remotely. Research in radiobiology substantiates the benefits of fractionated radiotherapy for many patients. This is one of the main reasons why radiotherapy is usually delivered to patients in daily doses repeated over a number of weeks – it gives normal cells time to recover between treatments and allows a higher dose of radiation to be given to the cancer while the harm to normal tissue is minimized. This delivery method means that the patients have to be close to a radiotherapy facility for several weeks for their treatment.

Policy approaches to ensure that the national demand for radiation oncology services is met should be:

Prospectively planned and coordinated nationally to effectively use resources and provide access for all patients;
Differentiated to distinguish the different radiotherapy techniques and tumour streams, providing targeted approaches;
Integrated across service providers, jurisdictions and medical disciplines to address silos in the system;
Innovative to take advantage of technological and organisational developments internationally and between disciplines;
Focused on quality across all domains including patient access, health outcomes, data, service provision and survivorship and
Patient centred with consumer involvement at all levels of decision-making.

Action at the policy, service and professional levels aimed at meeting the rising incidence of cancer must be an ongoing effort. The needs of Australian patients are quantifiable and the contribution of radiation oncology to cancer care is well defined and evidence-based. There is a strong and urgent need to refocus the action agenda on closing the current radiotherapy service gaps, as well as identifying and acting on future needs.

Short-term fiscal considerations can hamper effective policy approaches in health care. The well-established cost effectiveness of radiation oncology is a strong incentive for policy action.

Radiation oncology is not only an effective but also a cost-effective cancer treatment: the cost per year of life gained from radiotherapy treatment in Australian dollars (1993 dollars) was reported to be A$7,186¹⁴. The addition of radiation therapy to breast conserving surgery has been shown to improve quality of adjusted life years (QALYs) at a cost of $28, 000/QALY¹⁵ and the use of short-term, pre-operative radiation therapy for operable rectal cancer has been shown to increase QALYs by 39% at a cost of $25,100/QALY¹⁶. These costs are less than the threshold of $50,000/QALY commonly cited for cost-effective care¹⁵.

Radiotherapy can be cheaper than other treatment modalities; the curative treatment of non-small cell lung cancer in Canada in 1995 was shown to be cheaper using radiation therapy (C$12,474) than with surgery¹⁷.

Radiation therapy can be delivered to most patients as an outpatient service with resulting cost savings and improvements in patient convenience.

Active engagement of the professions and consumers is necessary for effective implementation of all initiatives and policies.

Experiences across multiple sectors, including health care and community development, demonstrate that successful implementation of policies and initiatives are reliant upon active engagement of key stakeholders.

The radiation oncology sector must build on its successes to-date in fostering collaboration between the professions, planners, funders and consumers to create ongoing conditions and forums for collective planning and decision-making.

Australia must act now to maintain existing gains in the provision of quality radiation oncology services and to meet current and future demand among cancer patients.

To guide action, the Tripartite National Strategic Plan for Radiation Oncology (Australia) 2012-2022 articulates important strategic directions and a series of recommendations to improve, expand and safeguard the provision of quality radiation oncology services across Australia.

To assist stakeholders in understanding the radiation oncology sector and its challenges, the Plan details key elements of providing a quality radiation oncology service across Australia, including: