State of the art: How to avoid unnecessary radiotherapy?

Some radiotherapy courses are cancelled or stopped permanently, mostly in palliative situations, due to rapid decline in patient condition, complications, death, or inability to complete the sessions. These occurrences negatively affect patients (increased morbidity and mortality, useless constraints), healthcare professionals (ethical distress), and departmental operations (longer treatment start delays, under-utilization of resources). By reducing the number of non-beneficial ("non-pertinent") irradiations, we have developed an eight-point action plan to implement in radiation department: (1) provide stronger training in palliative radiotherapy (in both initial and continuing medical education, including communication skills and learning to say "no" when appropriate); (2) perform a more rigorous assessment of patients at the initial consultation (evaluating general condition, nutritional status, supportive care needs, and prognosis); (3) create a dedicated forum for team discussions and reinforce the role of the radiotherapy technical meeting when difficulties arise during simulation or treatment planning; (4) better tailor radiotherapy technique (e.g., use of intensity modulation) as well as total dose, fractionation, to each patient's profile - especially for those most at risk or frail; (5) improve management of care timelines and define key objectives to minimize delays, adapting resources and organization to needs (e.g., a "zero delay" project group with specific indicators); (6) establish a process for medical and multidisciplinary reevaluation during the course of treatment that can lead to stopping or modifying the radiotherapy if the indication becomes questionable; (7) integrate palliative radiotherapy into the overall personalized supportive care plan, with early palliative care involvement from the time of incurable disease diagnosis; (8) evaluate professional practices (through defined indicators, satisfaction surveys, and morbidity-mortality meetings) to drive continuous improvement.