Palliative radiotherapy: Evolving role and policy challenges

International consensus is required on study end-points in palliative radiotherapy research to enable comparison between case series and facilitate randomised controlled trial design. Patient reported outcome measures should be developed that capture the value of radiation treatment for different indications both in achieving symptom control but also improving quality of life. The timing and appropriate use of radiation therapy are generally guided by the clinical assessment of the radiation oncologist, once a referral has been made. An analysis of outcomes from national-level epidemiological studies has the potential to guide appropriate utilisation and identify those patients most likely to derive benefit from radiotherapy in different tumour types. Lastly education and training remain at the heart of reducing inequalities in access to radiotherapy for patients who would benefit. This includes both radiation oncologists for whom many training schemes do not prioritise palliative care and the wider multidisciplinary team who are involved in the management of cancer patients at all stages.