OnCo
ideasIdea

Make one-week radiotherapy the default in overloaded systems

Giving radiotherapy in five larger doses over one week instead of 15-25 smaller doses is proven safe for breast and prostate cancer and could treat three times as many patients on the same machines.

Randomised trials (FAST-Forward in breast, several in prostate) show that ultra-hypofractionated schedules are non-inferior for cancer control and late toxicity. In systems where the queue for a machine is the limiting factor, adopting these schedules as the national default protocol is the fastest capacity gain available, without any new hardware. The barrier is guideline inertia and fee-for-fraction payment.

Hypothesis
National adoption of five-fraction breast and prostate protocols in a country with fewer than one machine per million people will increase the number of patients starting radiotherapy within 30 days of referral by at least 50% within 18 months.
Rationale
Machine throughput scales inversely with fraction number; the evidence base is Level 1 and the schedules are simpler for patients who travel long distances. Fee-for-fraction reimbursement is the main disincentive and can be changed by decree.
What would test it
A stepped-wedge national rollout with per-centre audit of fraction numbers, waiting times, and two-year local-control and toxicity outcomes against the pre-rollout cohort.
Maturity
being tested at scale
Who has to act
clinic
Cost to try
Small (under $1M)
Years to first evidence
2
Bottlenecks it attacks

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