3rd June 2020: We have now sent the letter to the Secretary of State for Health
10th September 2020: We received the following response from Jo Churchill MP, Parliamentary Under-Secretary of State for Health
"We welcome all members of the oncology and radiotherapy community (e.g. clinicians, physicists, radiographers, dosimetrists, nurses and technicians) to sign up to our open letter to the Secretary of State for Health and NHS England, which is calling for Stereotactic Ablative Radiotherapy (SABR) services to be opened up across the NHS in England. We believe that it is crucial to maximise radiotherapy capacity to manage a predicted surge in cancer diagnosis and a backlog of cases due to the COVID-19 pandemic. Delays in cancer treatment costs lives, and is vital that we try to achieve supra-normal levels of capacity and activity to minimise and reduce waiting lists"
Dr Clive Peedell
Consultant Clinical Oncologist
James Cook University Hospital, Middlesbrough
Open letter to the Secretary of State for Health, Matt Hancock, and NHS England
“NHS England must stop rationing Stereotactic Ablative Radiotherapy (SABR). The use of SABR is essential to increase UK radiotherapy capacity, in order to deal with the cancer backlog during the COVID-19 pandemic”
Dear Secretary of State,
The COVID-19 pandemic is having profound effects on the delivery of cancer services, as the unprecedented demand on the NHS has understandably forced a shift of focus away from non-emergency clinical services. At the same time, the necessary public health measures to lockdown the population to reduce viral transmission rates, has had a dramatic impact on the referral of patients with cancer symptoms from the community into secondary care. Cancer is generally a disease of older age and associated with risk factors such as smoking, alcohol and obesity, which result in additional co-morbidities. This is clearly a higher risk demographic who are being advised to self-isolate, causing anxiety about seeking help for cancer-related symptoms. Hence, there is a “perfect storm” for delayed diagnosis and reduced access to services. This is predicted to cause a large backlog of cases and later presentations of cancer, which are more difficult and complex to treat. NHS cancer services could become overwhelmed creating an additional public health crisis with a significant increase in cancer mortality and morbidity. A recent analysis from University College London has estimated an additional 6270 additional cancer deaths over the next 12 months in England, a 20% increase over the expected numbers.
Developing supra-normal capacity in diagnostic and treatment services will be required to address the anticipated cancer backlog. However, this is unlikely to be achievable in key areas of cancer treatment like cancer surgery, where prioritisation of surgical cases may be required for many months at least, with capacity varying geographically and temporally. Moreover, although surgical activity is increasing again as the lockdown eases, COVID-19 is now endemic within society and surgical risk is inevitably higher in such an environment. Even “clean” surgical hubs cannot remain risk free. Recent surgical studies have shown mortality rates of 20-30% in patients who develop COVID-19 infection in the post-operative period. In addition, possible further lockdowns in response to further waves of infection could close down surgical capacity again in future. Since delays in surgery have been shown to increase cancer mortality exponentially with time, it is imperative and urgent that we reduce the burden on our surgical services by increasing the capacity of alternative options such as radiotherapy, which is already a key treatment modality in 50% of all cancer patients, contributing to 40% of cancer cures.
Much progress has already been made by the UK radiotherapy community by shortening radiotherapy treatment schedules, which frees up radiotherapy capacity and reduces COVID-19 exposure risks to both patients and staff by reducing the number of hospital visits. Unfortunately, one of the most important modern and innovative radiotherapy techniques that can further help tackle this crisis is being rationed by NHS England. Stereotactic ablative radiotherapy (SABR) is a method of radiation delivery that can accurately deliver very high doses of radiation to localised cancers, typically in 1-5 outpatient visits, compared to conventional radiotherapy which usually requires 20-30 visits over 4-6 weeks. It is used to treat many types of cancers and can also be an excellent alternative to surgery in selected cases of lung, prostate, kidney, liver and pancreas cancer. However, although every UK cancer centre has the ability to deliver SABR, NHS England has rationed the service so that only 25 out of England’s 52 radiotherapy centres are currently permitted to offer it (Written Parliamentary Question 230710 March 2019). Although Specialist commissioners have recently allocated £12M to open up more SABR centres (Written Parliamentary Question 46037 20 May 2020), the NHS England timetable to introduce this is by 2022. This is not acceptable under the current circumstances and goes against the current NICE COVID19 guideline on the delivery of radiotherapy, which states that the NHS should make the best use of its resources to reduce patient exposure to COVID-19, including alternative dose-fractionation schedules. Failure to act now will be detrimental to our goal of achieving the levels of supra-normal activity required to deal with the cancer backlog. This will inevitably result in more delays to cancer treatment and increasing morbidity and mortality. It will be a tragic lost opportunity.
We therefore call upon NHS England to unshackle SABR services in order to increase UK radiotherapy capacity to help tackle this national emergency.
Yours sincerely,
Dr Clive Peedell
Consultant Clinical Oncologist
James Cook University Hospital, Middlesbrough
Professor Pat Price
Chair, Action Radiotherapy
Professor Matthew Hatton
Consultant in Clinical Oncology
Weston Park Hospital, Sheffield
Professor Corrine Faivre-Finn
Honorary Consultant Oncologist and Professor of Thoracic Radiation Oncology
The Christie and the University of Manchester
Dr Crispin Hiley
Associate Professor UCL
Hon Consultant Clinical Oncologist UCLH
Visiting Scientist The Francis Crick Institute
Dr Andrew Bates
Consultant Clinical Oncologist
University Hospital of Southampton
Dr Xue-Yan Jiang
Consultant Clinical Oncologist
Freeman Hospital, Newcastle
Professor Anthony Chalmers
Consultant Clinical Oncologist
University of Glasgow
Dr Tony Pope
Consultant Clinical Oncologist, SABR lead The Clatterbridge Cancer Centre Liverpool
Mr Jim Daniel
Radiotherapy physicist
James Cook University Hospital
Middlesbrough
Mrs Claire Huntley
Superintendent radiographer, radiographer SABR lead James Cook University Hospital Middlesbrough
Dr Eleanor Aynsley
Consultant Clinical Oncologist
James Cook University Hospital
Middlesbrough
Dr Nick Wadd
Consultant Clinical Oncologist
James Cook University Hospital
Dr Guarav Kumar
Consultant Clinical Oncologist
James Cook University Hospital
Dr Dan Johnson
Department of radiotherapy physics
James Cook University Hospital
Middlesbrough
Dr Hannah Bainbridge MBChB, MRCP, PhD, FRCR
Consultant Clinical Oncologist (Lung)
Queen Alexandra Hospital
Susan Helen Campbell
Research Partner
Tony Murphy
Linda Rose Gordon
Radiotherapy Services Manager
Jo Strickland
Therapeutic Radiographer
Anne Anderson
Senior Planning Radiographer
Shrinivas Kuthpady
Therapy Radiographer
Erica Chivers
Senior Lecturer, Radiotherapy
Lizzie Tait
Radiotherapy Physicist
Elizabeth Cooper
Radiographer
Philip Reynolds
Consultant Therapuetic radiographer
Professor Glyn Shentall
Head of Radiotherapy Physics
Rosemere Cancer Centre - Preston
Elizabeth Southgate
Therapy Radiographer
Rosie Cooke
Therapeutic Radiographer
Susan Chadwick
Therapeutic Radiographer
Joanne Thomas
Therapy Radiographer
Naman Julka-Anderson
Therapeutic Radiographer
Katie Jayne Bircumshaw
Therapeutic Radiographer
Lauren Mercer
Alex Stewart
Oncologist
Joanne Little
Radiotherapy Radiographer
Tania Simnor
Radiotherapy physicist
Penny Kechagioglou
Consultant Oncologist
Claire Bode
Radiotherapy Service Manager
Caroline Knight
Ananya Choudhury
Chair and Honorary Consultant in Clinical Oncology
Karen Walker
Therapy Radiographer
Hazel Newcombe
Senior Radiotherapist
Jen Cannon
Clinical Scientist
David Maskell
Clinical Oncologist
Alice Maguire
Kamalram Thippu Jayaprakash
Consultant Clinical Oncologist
Lucy Darby
Therapy Radiographer
Rosie Hales
Carmel Facer
Lung Cancer Nurse Specialist
Dr Anthea Cree
Clinical Research Fellow
Carole Solazzo
Jennifer Lamming
Senior Radiotherapist
Miguel Panades
Consultant Clinical Oncologist
Joe Whitbourn
Medical Physicist
Teresa Howe
Therapeutic Radiographer
Chris O’Sullivan
Therapeutic Radiographer
Terri Land
Dosimetry Team Leader
Kieran James Bosson
Therapeutic Radiographer
Rachel Ball
Advanced Practitioner Therapy Radiographer
Kate Lynch
Therapy Radiographer
Clare Caine
Therapy Radiographer
Emma Mcclune
Radiographer
Mary Spensley
Retired Lecturer
Seema Rughani
Radiotherapy Radiographer
Joseph Rimmer
Physician Associate Student
Elizabeth Christine Sharman
Therapy Radiographer
Indie Hayes
Therapy Radiographer
Katie Ross
Senior Therapy Radiographer
Nicole Jessop
Medical Physicist
Helen Chamberlain
Radiotherapy Physics, The Christie, Manchester
Dr Mohammed Mubashir Kagzi
Consultant Clinical Oncologist, The James Cook University Hospital, Middlesbrough
Jacqueline Walters
Therapy Radiographer
Kim Meeking
Therapeutic Radiographer
Andrew Gaya
Consultant Clinical Oncologist
Jaymisha Davda
Radiographer
Ahmed Bedair
Consultant in Clinical Oncology
Rosaleen Crouch
Superintendent Radiographer- Advanced Practitioner for Technique Development
Catherine Soul-Williams
Therapy Radiographer
Christine Ball
Retired therapeutic radiographer
Joanne Findlay
Radiographer
Joanne Cook
Therapeutic Radiographer
Nicola Calvert
Radiographer
Marta Hidalgo
Therapeutic radiographer
Eleanor Derrick
Diagnostic Radiographer
Anna Lydon
Consultant Clinical Oncologist
Clare Hartill
Head of Radiotherapy, Royal Free Hospital
Pamela Bowen
Medical Physicist
Lynne Davies
Lung cancer CNS
David Pilborough
Radiographer
Lisa-Jane Conway
Radiographer
Catherine Mercer
Tunbridge Wells
Darragh O Donovan
Radiotherapist
Susan Harden
Consultant clinical oncologist
Kate Garas
Research Radiographer
Professor Jon Wadsley
Consultant Clinical Oncologist
Patricia Oliver
Medical Secretary
Paula Robson
Radiotherapy Research Radiographer
Kimberley Quinn
Senior Clinical Scientist
Emma Thompson
Radiographer
Emma Cowan
Radiotherapy nurse
Elise Arnett
Radiotherapist
James Barber
Radiographer
Kevin Burke
Medical Physicist
Andrew Greenhalgh
Clinical Scientist
Edward Beaumont
Therapy Radiographer
Gareth Thomas
Lecturer
Helen Curtis
Radiotherapy Physicist
James Cook University Hospital
Jayne Matthews
Therapy Radiographer
Deborah East
Therapeutic Radiographer
Addenbrookes
Christopher Jackson
Dosimetrist
Neil Livingstone
Radiotherapy Services Manager
The London Clinic
Karen Tipples
Consultant Clinical Oncologist
Barts Health
Daniel Love
Medical Physicist
Dr Narayanan Nair Srihari
Consultant Clinical Oncologist
Michelle Proudfoot
Therapeutic Radiographer
Mariam Kalsoom
Therapy Radiographer
Bernadette Mortiboy
Therapeutic Radiographer
Ben Dixon
Medical Physicist
Joanna Thompson
Diane Lister
Catherine Mercer
Asia Sarwar
Geraldine Seed
Melanie Brown
John Derrick
Caroline Hailstone
Lauren Mercer
Rosie Hales
Keeley Rosbottom
Simon Goldsworthy
Keith Harland
Kathy Shearer
Jonathan McMillan
Talal Mansy
Consultant Medical Oncologist
Joanna Reynolds
Superintendent Radiographer
Radiotherapy and Oncology James Cook University Hospital
Elizabeth Jenkins
Radiographer
Dr Albert Edwards
Consultant Clinical Oncologist
Maidstone and Tunbridge Wells NHS Trust
David Bradbrook
Radiotherapy Radiographer
Jakub Thornley
Therapeutic Radiographer
Leeds Teaching Hospital
Wendy Goldshaker
Therapeutic radiographer
GSTT
Ruqayyah Sarang
Radiotherapy Practitoner
Sarah Pritchard
Macmillan Dietitian
Curtis Parker-Milnes
Senior Therapeutic Radiographer
Leeds Teaching Hospitals NHS Trust
Sophie Terry
Therapeutic Radiographer
Portsmouth NHS Trust
Ceri Nichola Jamieson
Therapeutic Radiographer
Lucinda Melcher
Consultant Clinical Oncologist
North Middlesex Hospital
Emma Crozier
Therapeutic Radiographer
Royal Cornwall Hospital Trust
Ravi Desai
Therapeutic Radiographer
Sue Thompson
Teacher
Jen Anthony
Radiographer
Susan Shaw
Therapeutic Radiographer
UHS
Steve Blake
Clinical Scientist
Helen Cullimore
Radiotherapy Radiographer
UHBW
Jenny Poole
Radiographer
Southampton Hospital
Jeanette Collings
Macmillan Support Radiographer
Natasha Wallbank
Radiotherapist
Shrewsbury and Telford NHS Trust
Emma Jade Bennett
Therapy Radiographer
North Wales Cancer Treatment Centre
Alys Catherine Williams
Therapeutic Radiographer
Hannah Brown
Therapeutic Radiographer
Shrewsbury and Telford NHS Trust
Carolyn O'Donovan
Radiotherapy Service Manager
University Hospitals of North Midlands
Kathryn Morrison
Therapeutic Radiographer
NHS
Gaynor Wardle
Royal Shrewsbury Hospital, Lingen Davies Cancer Centre
Emma Scully
Therapeutic Radiographer
Liz Crees
Physicist
Debbie Holmes
Clinical Scientist
Lily Brereton
Therapeutic Radiographer
JCUH
Wendy Roberts
Retired Radiotherapy Radiographer
Helen Bayles
Therapy Radiographer
Stuart Tomlinson
Radiotherapy Physicist
Northampton General Hospital
Paul Andrew Evans
Head of Radiotherapy Physics
Shrewsbury and Telford Hospital NHS Trust
Paula Powell
Treatment Lead Therapeutic Radiographer
Neil Dancer
Head of Radiotherapy Physics
Lauren Brown
Radiotherapy Radiographer
Gita Bhanvra
Therapeutic Radiographer
Hywel Rogers
Lecturer
Christopher Quinn
Radiotherapist
Darren Thompson
Clinical Scientist
South Tees Hospitals NHS Foundation Trust
Styliani Savva
Clinical Scientist
Dr Richard Simcock
Consultant Clinical Oncologist
Brighton and Sussex Medical Schools
Melissa Lovegrove
Advanced Planning Radiographer
Royal Free Hospital
Peter Goldie
Radiotherapy Physicist
Janice Merryfield
Senior Therapy Radiographer
Elaine Dancer
Therapeutic Radiographer
Louise Killey
Therapeutic Radiographer
Janette Rawlinson
Lung cancer patient advocate NHSE CEG, BTOG SC, WMCA LC EAG patient rep, NCRI lung subgroup consumer member, CCG Cancer steering group member and lay member
Kobika Sritharan
Clinical Oncology Registrar
Jean Tremlett
Radiographer
Brighton and Sussex University hospitals NHS trust
Jannath S Kottakunnan
Therapeutic Radiographer
Francesca Eden
Radiotherapy Radiographer
Ollie Minton
Consultant
BSUH
Andrew Jepson
Senior Radiographer
Dr Rema Jyothirmayi
Consultant Oncologist
Kent Oncology Centre, Maidstone Hospital
Anna Britten
Consultant Radiation Oncologist
Brighton & Sussex University Hospitals NHS Trust
Ellie Mills
Therapy Radiographer
Paul Bartley
Superintendent Radiographer
James Cook University Hospital
Hannah Tharmalingam
Consultant Clinical Oncologist
Mount Vernon Cancer Centre
Joanne Hope
Registered Nurse
Suzanne Hill
Radiographer
Torbay and South Devon Foundation Trust
Bojidar Goranov
Consultant Clinical Oncologist
University Hospitals of Plymouth NHS Trust
Alice Brain
Senior Clinical Scientist
Kayleigh Lett-Logue
Therapeutic Radiographer
Kathy Kylilis Therapy
Radiographer
Christie
Steven Floyd
Radiographer
Helen Elizabeth Davey
Therapy Radiographer
BCHUB
Jenny Callender
Therapeutic radiographer
University of Liverpool
Sangeeta Mannion
Therapeutic Radiographer
Guys and St Thomas
Rosie Clark
Nurse in Radiotherapy
Leeds Teaching Hospitals
Helen Louise Wem
Therapeutic Radiographer
University of Bradford
Kate McBurney
Radiographer
Brighton and Sussex University Hospital
Elizabeth Toy
Consultant Clinical Oncologist
Natalie Ing
Therapy Radiographer
Clair York
Dosimetrist Radiographer
Northampton General Hospital
Fiona Fisher
Diagnostic radiographer
Portsmouth Hospitals Trust
Paula Mulvenna
Consultant clinical oncology
Kelly Hobbs
Therapeutic Radiographer
Keisha Robinson
Radiographer
Steph King
Angela Lane
Sanal Jose
Therapeutic Radiographer
Carolyn Morris
Cancer patient advocate, past lay member national and local radiotherapy groups
Andrew James Williams
Radiotherapy lecturer
Dr Jackie Sham
Consultant Clinical Oncologist
Victoria Harris
Consultant Clinical Oncologist
Alison Blower
SABR Lead Superintendent Radiographer
South Tees NHS
Sarah Robinson
Dosimetrist
Shadab Ahmad
Radiationtherapist
Shri Ram Murti Smarak Institute of Medical Sciences
Renay Joss
Therapy Radiographer
Amy Dodd
Therapeutic Radiographer
Krupesh Haria
Therapeutic Radiographer and Policy Advisor
NEL CSU
Erin McMonnies
Therapeutic Radiographer
Dr Juliet Brock
Consultant Clinical Oncologist
BSUH
Emma Charman
Therapy Radiographer
GHNHSFT
Amy Ah-Moye
Clinical Oncology Registrar
Cherie Mary Sycamore
Superintendent - Pre-Treatment - Retired
Addenbrooke's - Cambridge University Hospital
Carley Rowe
Lung Cancer MSW
Margaret Mclean
Principal Therapy Radiographer
James Cook University Hospital
Rebecca Murray
Radiographer
Dr Kate Lankester
Consultant in Clinical Oncology
Colin John Brewer
Clinical Technologist Radiotherapy
Janice Reid
Radiographer
RSH Shrewsbury
Adrian Christopher Moss
Consultant Medical Oncologist
Brighton and Sussex University Hospitals
Professor Karol Sikora
Consultant Oncologist and Chief Medical officer
Timothy Sevitt
Consultant Clinical Oncologist
Maidstone & Tunbridge Wells NHS Trust
Dr Pippa Lewis
National Radiotherapy Clinical Fellow
Siobhan Graham
Head of Radiotherapy
Queens Hospital Romford
Eileen Pearson
Therapy Radiographer
Guys & St Thomas
Maryanne Okubanjo
Clinical Research Radiographer
United Lincolnshire Hospitals NHS trust