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8. Survey Results with Commentary

8.1 The survey comprised 14 questions.  This section summarises the findings and comments on their significance in the context of the development of site-specialist radiographic roles more generally. A copy of the questionnaire  is at Appendix 1.

8.2 A total of forty-six (46) responses were received, including one by telephone, which is 64% of the total number of 72 cancer centres in the UK. No responses were received from Wales and two from five centres in Scotland. The response from Northern Ireland indicated that there are currently no urology/prostate specialist roles. The response from English centres is comprehensive with only five centres failing to respond.  The response distribution, however impacts negatively on the project aim to be UK-wide. 

8.3 Validity of findings 

Not all respondents answered all questions; the number of respondents to each is indicated next to the question in brackets below. Respondents not answering all of the questions in the survey or giving incomplete answers to questions are the source of the inconsistencies of figures in the report, which is of concern. However, for England, the project findings may be regarded as a valid representation of the current situation with regard to the numbers and scope of practice of the prostate/urology specialist workforce. The participation of 17 specialist practitioners from 14 centres in the workshops reinforces the validity of the findings. 

8.4 Estimated volume of prostate cancer new patient referrals (N = 45) 

Respondents estimated that prostate cancer referrals account for up to 40% of new patients, with a majority estimating <20%. Although only an estimate, the responses indicate that prostate cancer comprises a significant percentage of the total workload of cancer centres. 

8.5 Table 2. Treatments offered for prostate cancer (N = 45)

Treatment

Volume of prostate workload by percentage

Radical External Beam Radiotherapy (EBRT)

Thirty-seven (37) centres said that more than 50% of their prostate work is radical EBRT, with two (2) centres stating that it is 90%.

Brachytherapy

Twenty-one (21) centres offer brachytherapy, representing between 10% - 30% of the prostate workload.

Palliative radiotherapy to primary and secondary sites

Twenty-five (25) centres estimated that between 10% - 30% of the prostate workload was palliative.

8.6 Table 3. Numbers of site-specialist posts including prostate/urology at March 2015 (N = 44)

The survey asked how many tumour site-specific specialist radiographers were in post across 10 different tumour sites. 

 

Tumour site

Number of centres with posts

Total number of posts

Breast

16

28

Colo-rectal

6

6

Gynae-oncology

13

13

Head and neck

10

11

Lung

6

6

Neuro-oncology

6

6

Paediatric

5

5

Palliative care

5

5

Prostate only

7

8

Urology including prostate

13

17

Total

 

105

 

The total number of prostate/urology specialist radiographers in post is 25, but it is not known if these posts are whole time equivalent. This number compares favourably with the number of breast site-specialist posts, reflecting the prevalence of these two disease sites in the radiotherapy workload. The larger numbers of head and neck and gynae-oncology posts also reflect the volume of work in cancer centres associated with these tumour sites. Because of the specialist nature of these posts, these role-holders will often play a key worker role. 

These findings are particularly interesting when we look at numbers of Clinical Nurse Specialists. According to the 2014 Macmillan census of the specialist adult cancer nursing workforce there are 557.8 specialist nurses working in breast cancer compared to 380.1 in prostate/urology.24 Further investigation shows that when provision of nursing is mapped to incidence there are 87 cases per breast cancer specialist nurse as opposed to 159 new cases per urology nurse. This suggests the urology and prostate cancer patients, who make up the bulk of cases, may be in need of key worker support elsewhere. 

8.6.1 Cancer centres with either prostate and/or urology specialist roles (N = 44)

Of the 44 respondents, 18 cancer centres have either prostate or urology (including prostate) specialist radiographers in post (41%), with 2 centres having both rolesOf these;

  • Thirteen (13) centres stated that they employ at least one urology specialist radiographer with two (2) of these centres having two (2) posts and one (1) centre having three (3) posts. 
  • Seven (7) centres stated that they employ a prostate specialist radiographer with one (1) of these having two (2) posts. 
  • Twenty (20) centres reported no prostate/urology specialist roles (45%).
  • Six (6) centres did not answer the question (14%).

The map below shows the geographical site of the 18 cancer centres with either a prostate specialist radiographer or a urology (including prostate) specialist radiographer in post.

 

 

 

 

 

 

 

 

 

 

 

 

 

8.7 Rationale for development of posts (N = 44)

The chief reasons given for implementing site-specialist posts were; to improve service quality (N = 16) and skills mix (N = 14). These were followed by; to provide radiographer development opportunities (N = 11), to provide a more efficient service (N = 9), and to manage the increasing workload (N =8). Only four (4) centres identified cost savings as a reason. No evidence was provided to demonstrate the impact of these roles and whether they met their specified purpose but respondents did not provide with any evidence as to whether these roles have indeed made financial efficiencies as yet.

Funding Source

N o of Posts

New post created out of existing radiographer establishment

11

Additional funding for a new post secured by a business case

2

Charitable funding secured

5

Total

18

The above table illustrates how current posts have been funded. The majority of posts have been created from the existing radiographic establishment, which suggests that service managers are supporting the development of advanced roles where a service need is identified. However, this could place additional pressure on remaining staff when workloads are already very high.  

8.9 Future plans for new site specialist posts within three years (N = 44) 

Respondents were asked how many tumour site-specific radiographers they were planning to introduce in the next three years and these are shown in Table 5 below. The survey did not ask for reasons but it could be assumed that these are similar to those given in 8.7 above.

Table 5. Number of site-specialist posts across tumour types – current and planned 

Tumour site

Current number of centres with posts

Current number of posts

Number of centres planning to introduce posts

Total number of posts planned

Total number of posts, current & planned

Breast

16

28

11

11

39

Colo-rectal

6

6

4

4

10

Gynae-oncology

13

13

5

5

18

Head and neck

10

11

13

14

25

Lung

6

6

4

4

10

Neuro-oncology

6

6

3

3

9

Paediatric

5

5

0

0

5

Palliative care

5

5

15

17

22

Prostate only

7

8

13

13

21

Urology including prostate

13

17

9

10

27

Total

X*

105

X*

81

186

* The number of centres cannot be totalled because cancer centres have multiple numbers of 

   site-specialist radiographers 

Of the planned future prostate/urology workforce;

  • Thirteen (13) centres stated that they planned to introduce a prostate specialist role 
  • Nine (9) centres stated that they planned to introduce a urology specialist role 

8.9.1 Cancer centres with planned prostate and urology (including prostate) roles

The map below shows the geographical site of the cancer centres with stated plans to introduce either a prostate or urology (including prostate) specialist radiographer role in the next three years.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.9.2 Table 6.  This shows the stage at which respondents indicated that plans had been reached for a prostate/urology site specialist post.

Stage of development

Prostate

Urology

Idea under discussion

10

3

Agreed in principle with oncologist

4

3

Agreed in principle with business manager

1

0

Funding sources being considered

3

3

Funding source identified

0

1

 

 

Together, prostate/urology is clearly seen as the greatest area of planned growth. It can be assumed that, for some of those who stated that they had no plans, the reason is that they already have these posts. In terms of other cancer sites, only head and neck and breast are looking to grow significantly over the next three years, with palliative specialists similarly seeing an increase. This raises questions about where both the specialists and the funding will come from and the effect on the radiotherapy workforce as a whole.

8.10 Number of review clinic radiographers where a significant proportion of workload is men with prostate cancer (N = 27)

Fifty-seven (57) posts with a WTE of 31.7 were identified. The proportion of their caseload that was men with prostate cancer ranged from <40% - 70%. Two (2) respondents stated that 100% of the review clinic radiographer’s caseload was men with prostate cancer. This data suggests there is a body of potential prostate specialists who work in review roles. These review radiographers may already have specialist knowledge and expertise or require additional education and training. 

8.11 Number of information radiographers where a significant proportion of workload is men with prostate cancer (N = 14)

Twenty-three (23) posts with a WTE of 17.4 were identified. The proportion of their caseload that was men with prostate cancer ranged from <40% - 50%. One (1) respondent stated that 100% of the information radiographer’s case load was men with prostate cancer. 

8.12 Number of brachytherapy radiographers where a significant proportion of workload is men with prostate cancer (N = 16)

Thirty-eight (38) posts with a WTE of 32.9 were identified. The proportion of their caseload that was men with prostate cancer ranged from 0% - 80%. 

8.12.1 Table 7. This indicates the number of WTE posts where respondents indicated the proportion of their workload that is estimated to be men with prostate cancer. 

Number of WTE posts

Estimated proportion of workload on prostate patients

2

0%

12

Up to 40%

7

50%

3

60%

1

80%

1

100%

26

 

 

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