Who gets radiotherapy?

This study investigated the use of radiotherapy for patients perceived to be unsuitable for curative therapy. Patients were grouped according to whether their cancer was considered curable or incurable and whether they received radical or palliative schedules of radiotherapy. The latter group was further evaluated to clarify current practice, to examine the problems in establishing guidelines for treatment and as a basis for prospective audit. Results confirmed that therapy guidelines within the unit were in line with national practice. Changes in standard therapy were proposed in view of resource limitations and recent results from other surveys. A second audit in 1989, together with a formal costing exercise, showed a reduction in the median number of fractions per course in both patient groups. This study suggests that palliative radiotherapy was used selectively for patients likely to receive significant benefit, and that consensus management was practised, and influenced, by informal internal audit. Results highlighted decision-making problems in the management of advanced non-metastasised cancer; confirmed doubts about the advisability of establishing rigid guidelines in palliative therapy; and clarified some of the difficulties in conducting meaningful cost-benefit analyses in this area.