Clinical Oncologist and NHS Commissioner Perspectives on Reirradiation for Recurrent Cancer

Abstract

AIMS: There is increasing interest in the potential benefits of reirradiation of recurrent or new primary cancer close to or within a previously irradiated region but there is a need for high-quality studies to evaluate this approach. This study aimed to understand clinician and NHS commissioner perspectives, methods for evidence generation, and the potential role of advanced technologies. MATERIALS AND METHODS: Semi-structured interviews were conducted with UK clinical oncologists and commissioners. Analysis was informed by principles of thematic analysis. RESULTS: Interviews were conducted and analysed with 10 clinical oncologists and 2 commissioners. Six themes were developed: 1. Weighing potential benefits against uncertainties; 2. Considering patient preferences in clinical decision-making; 3. A desire for clear guidance on planning and delivering reirradiation; 4. Challenges in the availability of reirradiation; 5. A desire for a stronger evidence-base to guide clinical care; 6. Considerations for clinical trial design. Clinicians and commissioners were supportive of strengthening the evidence base and increasing availability of reirradiation. Some clinicians and both commissioners favoured doing so using clinical trials whereas others considered prospective registries or evaluative commissioning to be more feasible. The potential benefits that could be gained from advanced technologies were highlighted, but also that many patients could benefit from high-quality standard photon reirradiation. CONCLUSION: This study provides important insights into reirradiation practice and how to improve its availability. Perspectives regarding trials and advanced technologies should shape future study design to strengthen the evidence base.