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BMJ. 2007 May 5; 334(7600): 915.
PMCID: PMC1865396
Candour on Unfunded Treatments

Ignorance is a public health issue

Michael V Williams, dean, Faculty of Clinical Oncology

Marcus indicates the importance of candour in outlining the choices available to individuals.1 However, there is also the effect on wider issues of public health and the availability of treatment options from which patients can choose.

Unacceptable radiotherapy waiting times have been highlighted by the Royal College of Radiologists for over a decade.2 They have now started to improve, but the last audit in September 2005 still showed that over half our patients wait longer than one month for curative treatment. What is probably not made clear to patients is the impact that this can have on their prognosis. A systematic review has shown that for breast cancer a wait of longer than eight weeks carries a 60% increase in the risk of local recurrence over five years.3 For postoperative radiotherapy of head and neck cancer, a delay of six weeks increases the risk of local recurrence 2.6-fold.3

Worse than this, delay may render patients untreatable. An audit of waiting times in lung cancer patients showed that 20% progressed so that they were unsuitable for radical radiotherapy while on a waiting list.4 An update in 2007 showed no change.5

These are serious risks to patients. Our failure to communicate them or to bring them into the public arena has contributed to the current lamentable state of our radiotherapy services. The report of the National Radiotherapy Advisory Group, which is currently with ministers, proposes a plan to tackle these issues.


Competing interests: MVW holds a joint lymphoma clinic with Dr Marcus.


1. Marcus R. Should you tell patients about beneficial treatments that they cannot have? Yes. BMJ 2007;334:826 (21 April.) [PMC free article] [PubMed]
2. Dodwell D, Crellin A. Waiting for radiotherapy. BMJ 2006;332:107-9. [PMC free article] [PubMed]
3. Huang J, Barbera L, Brouwers M, Browman G, Mackillop WJ. Does delay in starting treatment affect the outcomes of radiotherapy? A systematic review. J Clin Oncol 2003;21:555-63.
4. O'Rourke N, Edwards R. Lung cancer treatment waiting times and tumour growth. Clin Oncol 2000;12:141-4.
5. Muirhead R, O'Rourke N. Waiting times for radical radiotherapy in NSCLC. Clin Oncol 2007;19: S41.

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