Radiotherapy Treatment and Beyond - Mapping Radiotherapy Late Effects Service Provision in England

Radiotherapy provides an effective radical treatment approach for a range of cancers. Despite technical advancements improving survival rates, many patients experience acute and late radiotherapy toxicities. Radiotherapy late effects (RLEs) present months or years following treatment, and present a significant physical, psychosocial and emotional burden. The radiotherapy service specification calls for RLEs to be managed locally; however, provision of specialist support for RLEs across England is lacking. Encouragingly, RLE-specific services have been introduced to diagnose and manage RLEs and provide holistic support. Few studies have explored how RLE services are configured, funded and staffed. This study sought to evaluate the current provision of RLE services across England and barriers to further service development.

An online survey was developed using Microsoft Forms and disseminated to all 52 radiotherapy service providers across England. Descriptive statistics were used to analyse quantitative data, whilst inductive thematic analysis was conducted to identify key themes within qualitative responses.

31 responses were received, providing a response rate of 60%. 55% (n = 17) had an established RLE service and were mostly led by Therapeutic Radiographers. Most services managed pelvic RLEs, whilst few provided support for other disease sites. All RLE services accepted referrals from secondary care; however, primary care and patient self-referrals were less common. Most services were NHS-funded (71%, n = 12), whilst 24% (n = 4) relied on charitable funding. Qualitative comments highlighted challenges associated with staffing and insufficient funding.

These findings provide an initial insight into RLE services across England, revealing significant regional variation. To achieve equitable access and support for all patients, a revised approach to workforce modelling and commissioning of RLE services is urgently required. Here, we provide recommendations to support future development and sustainability of RLE services. Addressing the barriers identified within this study is imperative to improve survivorship outcomes nationwide.