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1. Introduction and Rationale

1.1 Therapeutic radiographers plan and deliver radiotherapy and care for patients with cancer before, during and after their treatment. They provide specialist expertise, advice and continuity of support for patients across the radiotherapy treatment pathway. National work to raise radiotherapy standards has been ongoing since the publication of the National Health Service (NHS) Cancer Plan1 and subsequent formation of the National Radiotherapy Advisory Group in 2005, culminating in the recently published Vision for Radiotherapy 2014 – 2024.2 The vision paper highlights the importance of skills-mix and new roles at advanced and consultant levels of practice in order to enable delivery of innovative and advanced radiotherapy to patients.

1.2 An independent task force was set up in early 2015 to formulate an action plan to radically improve the outcomes that the NHS delivers for people with cancer. The resultant strategy3 proposes six strategic priorities many of which are particularly relevant to this project. Recommendations include; increasing access to radiotherapy, investment in a radiotherapy equipment replacement programme, addressing critical workforce deficits, a strategic review of future workforce needs and access to a clinical nurse specialist (CNS) or other key worker for all people with cancer.

1.3 The focus of this project is the care and treatment of men with prostate cancer. As the number of men diagnosed with this disease increases4,5,6,7,8 and technological developments and medical advances continue, the availability of complex radiotherapy is expanding and needs to be aligned with prostate-specific knowledge and expertise in both external beam radiotherapy and brachytherapy. In cancer centres across the United Kingdom (UK), there are prostate/urology specialist radiographer roles, with post holders being responsible for streamlining and focussing care and support across radiotherapy pathways. 

1.4 Figures obtained from the National Clinical Analysis and Specialist Applications Team (NATCANSAT)9 show that the number of prostate episodes for radiotherapy providers in England has increased from 18778 in 2009/10 to 23879 in 2014/15, a rise of 21%. These figures are included in the urology tumour group, which demonstrates that, of the 28,684 teletherapy urology episodes in 2014/15, 17,506 were of radical intent and 11,151 were of palliative intent.  Eighty-five (85%) of NHS Radiotherapy Data Set (RTDS)9 prescriptions with palliative intent for urology patients are treating metastases, leaving 15% of urology patients having palliative symptom control to the primary tumour and /or pelvic nodes.  

Table 1. The split of modalities for all urology episodes in 2014/15

Modalities

External Beam

Kilovoltage

Brachytherapy

Total

Urology Episodes

27181

203

4662*

32046

 

*This increase in 2014/15 is in part due to the scope of the Radiotherapy Dataset (RTDS) expanding to include sealed sources not from brachytherapy machines ie prostate seeds.

1.5 The exact number of site-specialist posts and their nature and scope has not been quantified or evaluated. A recent unpublished survey about therapeutic radiographer roles, undertaken by the Society and College of Radiographers (SCoR) in March 2014, identified 15 prostate and bladder site specialist roles in 13 centres from a sample of 43 centres nationwide.10 This compared to 13 breast cancer site specialists, 9 head and neck cancer site specialists and smaller numbers of palliative care, gynaecological, lung, skin and gastro-intestinal tract site specialists. 

1.6 It is known that some centres employ urology specialist radiographers whose work includes caring for men with prostate cancer, whilst others employ prostate cancer site specialists. A decision has therefore been taken by the project team to describe the workforce as prostate/urology specialist radiographers. 

1.7 It is also known that review clinic and information and support radiographers (ISRs) are in post in many centres and these individuals often also play an important role in providing care and support to prostate patients. 

Rationale

1.8 Prostate Cancer UK recognises that therapeutic radiographers have a very focused role with intense patient contact, which makes them critical in the prostate cancer patient pathway. Their knowledge, expertise, care and support are essential to ensuring that the outcomes and experiences of men are as successful and as positive as possible. It has been demonstrated that cancer patients see the benefits of having access to a specialist nurse,11 but recent research suggests that urology/uro-oncology specialist nurses are time poor, often with vast caseloads and complex and varied responsibilities.12

1.9 The charity already works closely with the Society and College of Radiographers (SCoR) on a number of joint initiatives in order to advance treatment, knowledge and skills in prostate cancer, including through the provision of clinical research training fellowships, education and training courses and funding. Prostate Cancer UK also funded a site-specialist radiographer to pilot a service improvement project in a major cancer centre in England. 

1.10 The shared view of Prostate Cancer UK and SCoR is that prostate/urology specialist radiographers potentially have a vital role in co-ordinating and ensuring their centres are providing the best care possible to these patients, deploying the appropriate planning and treatment techniques. These post-holders have the potential to:

  • act as local champions driving change to ensure their cancer centre is implementing evidence-based practice in all aspects of patient care;
  • provide continuity of care for all patients by being a point of contact and support (key worker) to patients during their prostate cancer treatment journey;
  • educate and train the radiotherapy workforce to ensure consistency of standards in planning and treatment delivery;
  • maintain quality through undertaking  audit and radiographer-led research  to monitor local service activity, be able to compare to national standards and drive local improvements to the radiotherapy service;
  • develop radiotherapy workforce capacity, through development of advanced level skills, enabling skills mix and supporting radiographers in the delivery of the more routine elements of the pathway previously delivered by clinical oncologists.

1.11 Prostate Cancer UK therefore wished to commission this service mapping and development project in order to understand and strengthen this growing, specialist workforce. This includes information about how and where the roles have developed, what the support and development needs of post-holders are, and what evidence there is to show their impact on patient experience and outcomes. Prostate Cancer UK wishes to put the findings to immediate use, making them available to those in these roles, those in the process of creating them or those considering developing them in the future.

1.12 Although it is known that there is some informal cooperation between existing site specialists, there is no regular, facilitated meeting space or discussion forum. As well as co-hosting a national conference to share the research and practice to date, Prostate Cancer UK is committed to help share learning and build opportunities for networking, collaboration and peer support. An important output of the project is an online forum where interested radiographers can not only speak to their peers about their work in prostate treatment and care but also access the tools, resources, and information they need to lead and deliver excellence in their hospitals. 

1.13 This joint report was a principal output of the project and will be shared with key stakeholders, including NHS radiotherapy service providers, radiographers, education institutions, NHS England, Health Education England and equivalent bodies in the devolved countries.

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