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Will radiotherapy always be the poor relation in cancer care?

In case you didn't notice, and many people not directly involved with cancer care might not have, 2011 was the Year of Radiotherapy. This was a national initiative aimed at improving public understanding and raising awareness of the uses of radiotherapy.

The year was studded with events aiming to both educate and allay public fears about the use of radiation in the treatment of cancer. Much of the emphasis was aimed at highlighting the success of radiotherapy in treating, and even curing, many forms of cancer, sometimes where other modalities such as surgery or chemotherapy cannot claim the same levels of success. These ranged from public lectures on radiotherapy to media appearances by oncologists talking about radiotherapy.

It may be too early to assess the effect of these events in improving the public image of radiotherapy but it is certainly the case that many of the myths surrounding radiotherapy for cancer are persistent and hard to shift.

Part of the impetus for the Year of Radiotherapy was the publication of a survey in early 2011 which showed that only 10% of the British public (2000 UK adults surveyed) believed that radiotherapy was a "modern, cutting edge treatment"  as opposed to 40% for cancer drugs. In addition, 40% thought radiotherapy was "frightening" when compared to just 15% for modern targeted drug therapies. No doubt part of the enduring quality of these myths is founded in radiotherapy treatment specifically and radiation more generally.

Radiation is still largely perceived as a dangerous genie that has been let out of the bottle by the nuclear weapons and nuclear power industries. It is very possible that the recent bad publicity linked to the radiation leak in Japan may have perpetuated this notion. I very regularly meet patients and relatives who, before they are informed otherwise, are scared that radiotherapy will make them radioactive in some way and that this might affect others who meet them.

There has also been a tendency for radiotherapy to assimilate all of the negative aspects of other modes of treatment, with many people believing that radiotherapy will make them lose their hair and feel sick; in fact both of these side effects are much more commonly experienced by patients receiving chemotherapy.

So what can be done to improve the perception of radiotherapy as a cancer treatment, outside of special events and promotions such as the Year of Radiotherapy?

The first move in the right direction will be to ensure that radiotherapy has the same kudos in the public imagination as drug treatments. Rarely a month passes without a 'new' drug for cancer lauded in the popular press as heralding a new dawn in treatment, often despite not being 'new' at all and having only moderate success in clinical trials. Efforts should be made to ensure that radiotherapy trials should be given the same high profile coverage. In this way prostate brachytherapy should have already been made more widely available as a treatment with a comparable rate of disease-free survival as surgery with fewer side effects.

Secondly, it should not be difficult to describe radiotherapy as 'technically advanced' with newer treatments, with improved outcomes, such as intensity-modulated radiation therapy (IMRT), being made widely available in the UK.

Thirdly, and most importantly, radiotherapy should be seen as a 'normal' part of cancer care with increased and easier access for patients wherever they live. Already a handful of centres are putting in radiotherapy machines outside of big cancer centres in areas which have had variable access to radiotherapy with long travelling times.

The presence of good quality radiotherapy machines and the staff to deliver good quality treatment, within local communities, will promote radiotherapy as a reliable and 'normal' part of care. In order to make this happen there will have to be continued investment in radiotherapy at a time when money is short and young people willing to train to work in health care are at a premium.