Roundtable: Understanding challenges in nuclear medicine delivery

Nuclear medicine, using targeted radiopharmaceuticals to image and treat diseases, is an evolving speciality of medicine that leads to both earlier diagnoses and more effective treatment options for patients with cancer.^[1] However existing nuclear medicine services – mostly set up in the last century – are already nearing or exceeding capacity.^[2]

In February, Wilmington Healthcare facilitated a roundtable meeting on behalf of Advanced Accelerate Applications, a Novartis company, bringing together a group of experts to understand the current challenges, develop solutions for the NHS and other stakeholders, supporting a future which is prepared for a greater role for nuclear medicine, and particularly molecular radiotherapy, in cancer services of the future. The event, sponsored by Advanced Accelerator Applications, a Novartis company, involved key experts from across the clinical and regulatory cancer ecosystem.

MRT is a form of nuclear medicine that is currently used as a treatment option for patients whose cancer has become resistant or unresponsive to other forms of treatment. Unlike traditional radiotherapy, MRT delivers radiation to cancer cells in a targeted way, reducing damage to healthy cells. The radioligands commonly used are made of two parts: a target ligand, which binds selectively to specific markers on target cells, and a radioisotope, which emits therapeutic radiation that can damage cells, leading to cell death. Different isotopes and ligands can be combined to potentially treat a variety of cancers, giving MRT the potential to be used in many different types of cancers in the future.

Currently, MRT is licensed in the UK for use in a small number of rare cancers – which have a relatively small patient population. Multiple MRT clinical trials are underway into other solid tumour cancers and increasing numbers of patients eligible for MRT will be a huge challenge for services, which are already struggling to meet demand.^[2] Some centres are already nearing maximum capacity and greater NHS readiness will be required in terms of physical infrastructure, workforce training, and recruitment, to meet expected demand. Alongside this, centres offering MRT in England are non-uniformly distributed across the country – with some patients having to drive 200 miles for treatment, creating a postcode lottery in access to care.^[3]

All participants at the Advanced Accelerator Applications-led roundtable agreed that the service capacity for MRT must be expanded and that urgent action was needed to ensure UK cancer patients were not left behind. The experts made recommendations intended to support the NHS. These include:

• The need for a clear strategic plan for the NHS to deliver MRT services, setting out short, medium and long-term objectives;
• Using population mapping to determine the likely eligible patient population;
• Instigating clinical networking to support training;
• Making the most efficient use of existing services; and
• Ensuring equity of access.

Workforce and infrastructure were the main challenges identified:

• The infrastructure for current radiotherapy cancer services was developed 30 years ago and isn’t set up to meet the different and sometimes complex demands of emerging forms of cancer care – the specialised facilities and equipment needed to treat patients safely and consistently with radiotherapies like MRT are currently not in place across the country.
• There is also a shortage of specially trained technologist staff and oncologists. The UK needs to invest in more of these specially trained professionals to meet the complex needs of nuclear medicine services to ensure the necessary levels of quality are maintained to deliver accurate diagnostic and therapeutic outcomes.

Problems in accessing the radioisotopes essential for MRT and other therapies must also be addressed. Sustained efforts are required from the UK government to improve the reliability of medical radioisotope supply, ideally for the UK to have its own manufacturing site.

Moreover, the inequitable distribution of resources could, to an extent, be ameliorated by radiotherapy Operational Delivery Networks leading to the organisation of regional service delivery across the country. Capacity for treatments and diagnostic scanning could then be shared across a region, improving access and reducing waiting times for patients.

It will also be vital to raise awareness of the potential of therapies like MRT and to communicate the potential these therapies offer to policymakers and NHS decision-makers, to encourage them to design the services needed to deliver access now and in the future.

The experts highlighted that there is a real case for change, and, despite the current challenges, progress can be made – and at pace. But if the UK is to match or even exceed the performance of other countries in terms of cancer outcomes, then action – at all levels, including government, integrated care boards, and service providers – is needed now.

References

^[1] British Nuclear Medicine Society. What is nuclear medicine?  [Last Accessed May 2023] 

^[2] Freedom of Information Request to the Department of Health on numbers of NM Techs & Radiographersg - British Nuclear Medicine Society (bnms.org.uk)

^[3] BMNS et al. (2021) Review of molecular radiotherapy services in the UK. [Accessed May 2023]