Service improvements and workload increases; Royal College of Radiologists (RCR) re-audit of curative intent radiotherapy for non-small cell lung cancer (NSCLC)

Aims and Background The Royal College of Radiologists (RCR) audit of radical radiotherapy (RR) for patients with non-small cell lung cancer (NSCLC) in 2013 concluded that there was under-treatment compared to international comparators and marked variability between cancer networks. Elderly patients were less likely to receive guideline recommended treatments. Access to technological developments was low. Various national and local interventions have since taken place. This study aims to re-assess national practice. Methods Radiotherapy departments completed one questionnaire for each patient started on RR for 4 weeks in January 2023. Results 93% of centres returned data on 295 patients. RR has increased 70% since 2013 but patients on average wait 20% longer to start treatment (p=0.02). Staging investigations were often outside a desirable timeframe (79% of PET/CT scans). Advanced planning techniques are used more frequently: 4-dimensional planning increased from 33% to 90% (P<0.001), cone beam imaging from 67% to 97% (p<0.001) and colleague led peer review increased from 41% to 73% (P<0.001). Conclusions There have been significant improvements in care. There has been a considerable increase in clinical oncology workload with evidence of stress on the system that requires additional resourcing.