Radiation therapy faces multifaceted challenges today, including rising patient demand, complex workflows associated with advanced technology, software integration challenges as well as the need for comprehensive training and technical support to ensure confident delivery of radiotherapy. Additionally, there are accessibility barriers that result in huge gaps in patient care today.
Let’s dive into a closer examination of some of these challenges and delve into their intricacies and explore potential solutions.
Increasing patient demand
Global cancer cases are predicted to continue to rise, with 30.2 million cancer cases expected in 2040, a 56% rise from 20201. Almost half of these patients will require radiation therapy, posing a daunting capacity challenge in some countries2. Meeting demand would necessitate substantive expansion of the current radiotherapy infrastructure and workforce.
Advanced technology
Technology advances such as the introduction of image-guided radiotherapy (IGRT) have enabled smaller treatment volumes, shorter treatment fractionation schedules, improved outcomes, and minimized toxicity2. The use of hypofractionation, which uses fewer fractions of radiotherapy with a higher dose per fraction compared to conventional fractionated regimens has grown more common as delivery techniques have become more accurate, helping to boost efficiency. The most common examples are stereotactic body radiotherapy (SBRT) and stereotactic radiosurgery (SRS), delivering a full treatment over 1-5 sessions. Although these technological advances in planning and treatment delivery have helped to drive new practices in radiotherapy, the need for precise image guidance, patient immobilization, and motion management may contribute to the perception of complex workflows that can be resource-intensive and prohibitive.
Workflow complexities
Radiotherapy treatment is a complex process that requires the entire radiation oncology team working together to ensure safe and effective treatment of patients. There are many guidelines and recommendations for best practices to help standardize workflows, but it is the unpredictable scenarios that can hinder a well-established routine3. For example, changes to internal anatomy, patient weight loss, and difficulty aligning tattoos to get patients in the treatment position, can all equate to a more prolonged workflow. Additionally, as radiotherapy techniques become more advanced, delivering treatment plans that meet stringent dose criteria has become increasingly complex, and can easily exceed the treatment time allocated, causing delays to other patients. Modalities like adaptive radiotherapy enable tighter dose conformality but involve additional imaging, planning, quality assurance, and delivery steps compared to conventional radiation workflows. Streamlining adaptive workflows requires intricate coordination across physics, radiotherapy radiographers, and physician teams. While reducing side effects and improving tumor control, advancing technologies can overwhelm staff bandwidth. Integration of technology is key to helping streamline these complex workflows.
Accessibility barriers
Barriers to widespread adoption of radiotherapy persist due to resource-limited centers. Sadly, the incidence of cancer is expected to be disproportionately higher in low- and middle-income countries (LMIC), compared to high-income countries (HIC)4,5. In addition, many cancers such as head and neck and cervical cancer are diagnosed at a more advanced stage, becoming surgically inoperable. This makes the need for radiotherapy even greater in these areas for both definitive and palliative treatment options. The implementation of modern radiotherapy in these countries not only poses unique challenges but also provides novel opportunities for improving access. Optimizing costs in these countries through the implementation of hypofractionated schedules also holds the potential to enhance radiotherapy access.
Training and support
It is acknowledged globally that there is a chronic shortage of staff in the radiotherapy field that slows progress toward the adoption of advanced technology. Even in countries with an adequate workforce the quality of training and service provided can vary. Training and research remain the mainstay of providing high-quality standardized care. Onsite training remains irreplaceable, but there are clear benefits using distance training programs in contouring, planning, treatment delivery and quality assurance4. The recent COVID-19 pandemic has converted a lot of in-person trainings to remote online activities which is beneficial for remote hospitals.
Technological innovations in radiotherapy are translating into real benefits for cancer patients including improved tumor control, minimized side effects, and excellent safety records6. However, to effectively integrate a rapid pace of change there needs to be increased support to enable hospitals to successfully leverage radiotherapy’s full potential globally.
What can Accuray do to help resolve some of these challenges?
At Accuray we stand on three pillars: “Quality of Care”, “Efficiency in Care” and “Confidence in Care”. These pillars underpin our resolute commitment to enhancing the landscape of radiation therapy.
Quality of care:
We are committed to optimizing every patient’s treatment experience through patient-customizable radiotherapy solutions that balance advanced capabilities with accessibility. Our systems enable clinics to provide high-quality external beam radiation treatment options spanning from SBRT and SRS to more standard conformal radiation techniques. This diversity of precision delivery modes allows clinics to match the optimal technique to each patient’s cancer or lesion type and goals of care. At the heart of our technology is the capability to conform radiation doses from simple to complex tumor shapes while automatically adapting in real-time for movement and anatomy changes. This fusion of sub-millimeter accuracy with adaptive radiotherapy helps clinics target disease precisely while minimizing dose to surrounding tissues. By empowering clinicians with flexible tools to design truly personalized treatments, we aim to make state-of-the-art cancer care achievable for more patients. Our patient-first philosophy guides continual innovation in harnessing established and emerging technologies to advance the quality, capabilities and reach of radiotherapy worldwide.
Efficiency of care:
We aim to maximize patient access to advanced radiotherapy by optimizing treatment workflows for greater efficiency. Our solutions enable streamlined planning, treatment delivery, and quality assurance through automated and integrated processes, without compromising the individualized care experience. At the same time, the system’s accuracy and adaptability safeguards quality by accounting for each patient’s unique anatomy. Our end-to-end workflow focus makes elevating the standard of care viable for more facilities. With greater efficiency across the treatment pathway, adaptive radiotherapy becomes clinically feasible, helping clinics broaden access without adding time burden. Our efficiency drive strives to quicken the translation of technological promise into clinic-wide patient benefits.
Confidence in care:
We empower clinics to deliver advanced radiation therapy with full confidence by providing comprehensive support systems. Recognizing radiotherapy’s quickly advancing complexity, we offer both virtual and on-site staff training tailored to each clinic’s needs and experience level. Our service options maximize treatment system uptime and underscore our commitment to being available at every step. Clinics can embrace innovations with the assurance of a trusted partner. Most importantly, patients deserve to feel secure through their treatment journey – our partnership gives clinics the tools to establish that confidence. We consider it a privilege to work with clinics so that more patients can access advanced care.
Conclusion
At Accuray, our goal is to give healthcare professionals access to highly precise treatment solutions that enable the delivery of exceptional quality treatments with efficiency and confidence to help them face current radiotherapy challenges. Developing radiotherapy solutions that evolve with patients’ needs is critical in a continuously changing environment. We’re here to equip you to build a resilient department in the fight against cancer. Together, we can advance towards a world where cancer is met with unwavering certainty and compassionate care, empowering patients, and driving future advancements
References
- Cancer Tomorrow (iarc.fr) https://gco.iarc.fr/tomorrow/en/dataviz/isotype
- Chandra RA, Keane FK, Voncken FEM, Thomas CR Jr. Contemporary radiotherapy: present and future. Lancet. 2021 Jul 10;398(10295):171-184. doi: 10.1016/S0140-6736(21)00233-6. Epub 2021 Jun 21. PMID: 34166607.
- Halvorsen P, Gupta N, Rong Y. Clinical practice workflow in Radiation Oncology should be highly standardized. J Appl Clin Med Phys. 2019 Apr;20(4):6-9. doi: 10.1002/acm2.12555. Epub 2019 Mar 12. PMID: 30861297; PMCID: PMC6448160.
- Maitre P, Krishnatry R, Chopra S, Gondhowiardjo S, Likonda BM, Hussain QM, Zubizarreta EH, Agarwal JP. Modern Radiotherapy Technology: Obstacles and Opportunities to Access in Low- and Middle-Income Countries. JCO Glob Oncol. 2022 Jul;8:e2100376. doi: 10.1200/GO.21.00376. PMID: 35839434; PMCID: PMC9812473.
- Jaffray DA, Knaul F, Baumann M, Gospodarowicz M. Harnessing progress in radiotherapy for global cancer control. Nat Cancer. 2023 Sep;4(9):1228-1238. doi: 10.1038/s43018-023-00619-7. Epub 2023 Sep 25. PMID: 37749355.
- Quality assurance in radiation | IAEA
