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Dr Mick Button, Christine Sillman, Nicki Davies, Steve Hill, Rebecca Crawford and Pat Evans


In Wales, over 2000 patients per year have palliative radiotherapy. While it can be very effective to improve cancer symptoms, it also comes with a burden for patients such as short-term side effects and the impact of travel. Radiotherapy involves travelling to one of three main cancer centres which can be some distance for patients. This can take a lot of time, create carbon emissions and incur costs – for the patient, for those close to them, and for ambulance/other NHS transport teams. 

Palliative radiotherapy is also critically dependant on radiographers and clinical oncologists, who are facing increasing demand and growing workforce pressures. We also have new targets, which helps us treat patients more rapidly but further increases staff pressure. Despite the difficulties of implementing innovation when pressures are high, we feel that such new ways of working might be solutions to these problems. New and better ways of working can help improve team work and reduce stress, and new career development opportunities could improve recruitment and retention. Knowing we are delivering the very best care we can is good for everyone – patients and staff! 

Other main drivers for change include new curricula for oncology trainees with a greater focus on palliative radiotherapy in the early years and the importance of understating the value of treatment to a patient – perhaps especially important for patients with advanced cancer symptoms who may struggle with the burden of radiotherapy and who may not always have long to live. 

We wanted to respond to these challenges by improving: 

  1. The quality of our palliative radiotherapy services through a multi-professional approach. 
  2. The quality of training we offer whilst creating new career development opportunities for radiographers across Wales. 


The Three Cancer Centres 


South West Wales Cancer Centre

The South West Wales Cancer Centre team developed a radiographer led clinic where selected patients (3-5 weekly) are seen, consented and treated with minimal medical input. This has sped up the pathway and relieved pressure on a limited number of clinical oncologists. Radiographers and oncology trainees have benefited from practical training experiences, and radiographers have also completed MSc modules to equip them for more advanced and independent practice. 

Velindre Cancer Centre

Velindre Cancer Centre developed a clinic led jointly by a clinical oncologist and radiographer, seeing a wider variety of patients (3-5 weekly) and focussing on training radiographers and junior medical staff. Radiographers at Velindre have also completed MSc modules as they gain the necessary skills for more advanced and independent practice. 

Betsi Cadwaladr University Health Board

The Betsi Cadwaladr UHB team have some difficulties related to staffing which has limited their ability to innovate and change their clinical service. They’ve been a very engaged team in the project and are focussing on upskilling their radiographers through academic modules so, when able, they will have radiographers with more advanced skills, ready to take on new roles. 


Joint Reflections and Emerging Benefits 

All three centres have focused on making sure that their palliative radiotherapy service gives excellent patient experience and high quality staff training. Through the completion of MSc modules, we will have more independently practising radiographers and even consultant radiographers delivering palliative radiotherapy services. 

We’ve raised the profile of palliative radiotherapy and the importance of prioritising this as an area of need. We think that individual patient care, staff working practices/experiences and the wider NHS could benefit from such a focus. The service could benefit both outpatients and those needing emergency radiotherapy as inpatients. There’s also opportunity for wider benefit around:  

  1. Opening up conversations/decisions about future care priorities for patients.
  2. Reducing the impact of travel through ‘one stop’ services or through using the fewest number of radiotherapy visits per patient. 

Making changes can be tough, but by collaborating we can support each other to improve the quality of the work we do. 


Next Steps 

We have more work to do! We will continue to develop palliative radiotherapy services locally and will continue collaborating across all cancer centres in Wales. The exciting, newly funded Advancing Radiotherapy Cymru Academy will give us resource, structure and focus. We’ll work with the Welsh Cancer Network and the Wales-wide Clinical Oncology Sub Committee to influence for high quality palliative radiotherapy services at all cancer centres in Wales. 

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