Radiation therapy advanced practice – commentary

Radiation therapy advanced practice – commentary Re: Monk CM, Wrightson SJ, Smith TN. An exploration of the feasibility of radiation therapist participation in treatment reviews. It is pleasing to see another piece of research aimed at informing the radiation therapy (RT) advanced practice (AP) debate. 1 The formal introduction of AP in radiography (diagnostic and therapeutic) occurred at least as early as 2000 in the United Kingdom, instigated by the National Health System (NHS) because of a national shortage of medical staff. 2,3 Diagnostic radiography AP was predominantly in the area of image review carried out by experienced and often trained radiographers, ranging from Red Dot processes to formal review of images. 4–6 RT AP was more varied and was tailored to suit the needs of individual departments of radiation oncology. These needs are usually related to a shortage of radiation oncol-ogists (RO) in specific specialty areas, where experienced RTs could step in and help to move the patient more smoothly through the system. Postgraduate education in collaboration with the clinical place was then introduced to formalize the advanced roles. While RT AP in the United Kingdom (UK) was encouraged by the NHS, in Australia and New Zealand it is a 'bottom-up' approach, being led by RTs and supported only in certain supportive departments of radiation oncology. This means that while individual RTs might struggle to convince their supervisors about their advanced attributes, some formalized research projects have been carried out, aimed at assessing RTs' ability to advance their practice and providing validation of the new or proposed roles. This provides an evidence-based approach to the introduction of RT AP roles. The recent article by Monk, Wrightson and Smith 1 presents additional evidence to inform the introduction of RT AP in the area of patient treatment review. The research project contained two arms: an audit of patients on treatment to determine the frequency of side effects detected by the RO and the interventions carried out, and a survey of the local ROs to determine their support (or not) of RT reviewers. Similar to Shi et al. 7 in Singapore, Monk et al. found that radiation oncologist reviews led to medical interventions for fewer than 35% of patients receiving radiotherapy to the prostate, breast, bladder and skin regions. The fact that prostate and breast treatments, with low levels of medical intervention, are a large proportion of the Australian radiotherapy workload provides …