Why don’t we have radiotherapy at the weekend?

Today’s thought of the day: why don’t we have radiotherapy at the weekend?

If each radiotherapy plan takes so long to plan, each fraction carefully calculated and patients told to clear their calendars for weeks and cancel their prior commitments, why don’t they continue their treatments at the weekends or over Christmas?

It’s so much more complicated than I could have imagined! Historic, economic and social factors play a role.  Historically, treatments have only been delivered on weekdays. Hence all research completed on fractions and doses have most likely been calculated in a sort of 5 days on, 2 days off structure, so we have to ask if we have the scientific backing to change to radiotherapy 7 days a week for everyone? Do all places in the world have this concept of weekends however?*

There are also major logistic challenges associated with putting on radiotherapy treatments at the weekend. Patients travel for long distances to get to a radiotherapy centre and transport is different at the weekend. Canteen services in hospitals are limited, porters are limited, you’d need to employ 40% more radiotherapists and your service contract costs would increase by at least 40%.

Finally and perhaps most importantly- something it’s no doubt easy to forget when bogged down in Quality Assurance and calculations in the basement, is that we do all of this for the patient. And it’s the patient experience that is most important. Researchers at St Thomas’ found that patients don’t want to have radiotherapy delivered in the middle of the night. But perhaps we could carefully explain to patients the logic behind currently keeping radiotherapy to the weekdays so they don’t get disheartened?

*Turns out that mostly yes although not necessarily the Saturday/Sunday weekend we have depending on the predominant religion of the country. However Iran, Somalia, Dijibouti and Nepal are amongst a handful who have a 1 day weekend, how does their radiotherapy treatment compare? As of 2013, Somalia and Dijibouti did not have radiotherapy services available (Global Access to Radiotherapy Services: Have We Made Progress During the Past Decade? Mei Ling Yap, Eduardo Zubizarreta, Freddie Bray, Jacques Ferlay, and Michael Barton, Journal of Global Oncology 2016 2:4, 207-215).