Drivers of Change in Radiotherapy Practice: Lessons From a UK Tertiary Cancer Centre (2013-2023)

There is a dearth of systematic analysis regarding the introduction of changes in radiotherapy practice and how they are evaluated, potentially limiting understanding of how future radiotherapy development could be improved. Using The Christie NHS Foundation Trust (Manchester, UK), a tertiary cancer centre, as a site exemplar, we summarise the types of radiotherapy changes introduced across five cancer sites for which radiotherapy is a crucial component of curative treatment. Along with identifying where and how practice has changed, we also examine the rationale underpinning changes introduced.

Interviews were conducted with key radiotherapy professionals based at The Christie to elicit changes introduced over the period 2013-2023 across the following cancer sites: Upper Gastro-Intestinal, Head and Neck, Breast, Bladder and Prostate, and Brain and Central Nervous System. Analysis involved mapping changes across the radiotherapy pathway, categorising changes according to the evidence base and identifying key factors associated with driving change and evaluation in practice.

Advances across computing and engineering have supported the development of radiotherapy techniques, enabling the refinement of patient set-up, dose fractionation and margin definition. Other drivers for change include alignment with national standards, improving patient experience and clinical trial participation. The pace of change can be further dictated by service culture and readiness, influenced by clinician interest, expertise and consensus. Notably, several changes were introduced into the routine setting without systematic evaluation of their impact, under assumptions of benefit.

Changes in radiotherapy are underpinned by diverse sources of evidence, yet evaluation of impact remains crucial for delivering high quality, evidence-based care. Developing quick, accessible and novel ways to monitor and evaluate modifications in radiotherapy planning or delivery is crucial for fostering more evidence-based and efficient practice, especially with the rapidly developing use of artificial intelligence.