Cancer statistics for the UK make sobering reading: one in two people born after 1960 will be diagnosed with some form of cancer during their lifetime and there are currently approximately 330,000 new diagnoses every year. Despite significant improvements that have been made in treating cancer over the last 40 years, the UK survival rate continues to lag behind that in countries of similar wealth.
The UK has a deserved reputation for creativity and excellence in designing and developing new interventions with the potential to deliver significant improvements in outcomes. However, apart from a few leading centres, we are slower than other countries to adopt new innovations, even where they are clearly cost-effective and/ or were developed within our own health system. One of the critical enablers for rapid and widespread adoption of new innovations is ensuring that their performance, safety and effectiveness can be measured and optimised in what is necessarily a conservative community.
NPL has played a key role in supporting the UK medical physics community from the beginning of the twentieth century. In more recent times, ground-breaking measurement research has been undertaken to support innovative treatments which require novel approaches to measurement to ensure continued consistency of the dose delivered to the patient.
In 2012, the UK government invested £23 million with the aim of significantly increasing the number of patients benefitting from access to intensity modulated radiotherapy (IMRT), a more advanced and targeted form of treatment. In order for this to be achieved, it was necessary for the treatment to be delivered using a faster and more complex rotational delivery system (RIMRT). As a much more targeted and advanced form of radiotherapy, it was essential to audit delivery systems with differing capabilities across the UK, and assess whether each had been optimised uniformly before implementing the technique. Around two thirds of all UK radiotherapy centres were included, demonstrating an impressive 97% pass rate with a comparative exercise conducted in the USA achieving a 90% pass rate.
NHS England funding has since enabled NPL, in partnership with the national radiotherapy trials group, to play a key role in ensuring the safe and optimised uptake of new radiotherapy techniques such as stereotactic ablative body radiotherapy (SABR) for non-small cell lung cancer and stereotactic cranial radiosurgery (SRS) – a specialist form of radiotherapy that can be used to treat patients with conditions such as benign and malignant brain tumours. Both of these national audits have highlighted and resolved issues with inconsistencies in implementation that have resulted in significantly reduced variation in the dose delivered to the patient.
With our well-established expertise in underpinning and improving the accuracy of cancer therapy delivery, NPL plays a unique role in helping provide confidence that regardless of where a patient received treatment, it is of the same standard of excellence. We help to ensure that new innovations in treatment provide the better patient outcomes that they promise, in order to help realise the NHS's target to deliver consistent, world-class cancer care by 2020.
NPL continues to offer verification services to centres within the UK and abroad, with several countries now basing their audit techniques and protocols on those developed by NPL and its collaborators. We are currently leading an 'audit of auditors' project, which will allow centres from multiple countries to be included in international clinical trials, which is of particular importance for more rare cancers and new techniques such as proton beam therapy (PBT).