ESTRO 2025 - Abstract Book

S2279

Interdisciplinary – Health economics & health services research

ESTRO 2025

1528

Digital Poster Referral pathways in Radiation Oncology: A qualitative study of stakeholder experience across high income countries in Europe. Claire Poole 1,2 , Prof Michelle Leech 1,2 , Prof Laure Marignol 1,2 1 Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College, Dublin, Ireland. 2 Discipline of Radiation Therapy, Trinity St. James’s Cancer Institute, Dublin, Ireland Purpose/Objective: In well-resourced European countries, radiation therapy (RT) remains underutilised despite established referral structures and guidelines [1]. The persistent barriers to accessing RT in these countries is not well understood [2]. This research aims to investigate referral pathways from primary care to RT across high income countries to identify key barriers and facilitators affecting RT access. Material/Methods: High-income countries, defined by ESTRO-HERO data as having 7 linear accelerators per million inhabitants, were classified as ‘well-resourced’ [3]. A purposive sampling approach was employed to capture a diverse range of experiences and cancer diagnosis across professional roles (GPs, ROs) and patients. Semi-structured interviews were conducted online (n=11), and data was analysed following Braun and Clarke’s six-step reflexive thematic analysis [4]. Results: Four themes emerged from stakeholder perspectives: (1) the GP role in primary care, (2) factors influencing patient decision-making in cancer treatment, (3) barriers and facilitators to RT access, and (4) the understanding of palliative care and RT within primary care settings. Key findings suggest that well-established healthcare structures can act as both barriers and facilitators to RT access, with GPs playing a limited role in direct referrals to RT. The involvement of the perceived expert (hospital based clinicians such as urologist, haematologist etc) strongly influences patient decision-making. RO lacks visibility to GPs and has a poor professional identity within medicine. Professional knowledge (specialist and other medics) about RT is often limited—not an absence of all knowledge but rather a gap in understanding its effectiveness and benefits. Conclusion: This study highlights that, despite well-structured healthcare systems, RO remains largely undervalued, particularly outside of site-specific guidelines for its use. This limited visibility becomes a critical issue when patients have multiple treatment options, as the lack of knowledge may impact referral practices and patient choices. Increasing the visibility of RT—both as an effective treatment modality and radiation oncology as a distinct professional field— is essential to ensure equitable access and informed decision-making. Strengthening professional identity, public and professional understanding of RO could better position it within multidisciplinary teams, supporting its integration as an effective cancer treatment.

Keywords: radiation oncology, referral pathways,

References:

1. Lievens, Y., et al., Radiotherapy access in Belgium: How far are we from evidence-based utilisation? European Journal of Cancer, 2017. 84 : p. 102-113. 2. Cramp, L., T. Burrows, and Y. Surjan, Perceived barriers and facilitators affecting utilisation of radiation therapy services: Scoping review findings - Health professional influences. Radiother Oncol, 2024. 199 : p. 110423. 3. Grau, C., et al., Radiotherapy equipment and departments in the European countries: Final results from the ESTRO HERO survey. Radiotherapy and Oncology, 2014. 112 (2): p. 155-164. 4. Clarke, V. and V. Braun, Thematic analysis: a practical guide. Thematic Analysis, 2021: p. 1-100.