What is Ethics-Guided Radiation Therapy (EGRT)?
EGRT is an initiative that I am leading now. It’s Ethics-Guided Radiation Therapy. So it is the radiation therapy but ethically guided and the reason for this is because sometimes we may face certain circumstances that the person or the institute ask themselves whether this is ethically guided or not. Even in research sometimes, whether this research is ethically guided or not. So I’m raising this initiative and waiting down the road to draft a statement, kind of guidelines, to refine the practice and research in radiation oncology.
What is your study about?
I’m going to present the initiative, the concept of this initiative, what will be the steps that I’m going to arrange. This will include the global survey and consensus between the experts. After that we release the findings and hopefully it will be sponsored and endorsed by the professional organisations that are famous in the field of radiation oncology.
What were the results of this study and are there any situations where you think EGRT is important?
We, as radiation oncologists, sometimes are facing some circumstances, whether… Just for example, I have a breast patient and I have a study that’s recommending 50Gy in 25 sessions and another study is recommending 26Gy in 5 sessions. So obviously the 5 sessions is more convenient to the patient and also to the publicly funded institutes. However, the 25 sessions might be favoured if I am working at a private set-up because more fractions means more incentive to the treating physician or to the private institute. So I need to end up with a statement, with the guidelines, how we can choose what is better for the patient, that is meeting more patient-centred care rather than physician- or institute-centred care. So this is the point.
There are many examples. In our daily practice we need to be aligned and refined according to the EGRT principles.
Why is EGRT needed?
EGRT is important because if we will keep the clinical practice not interacting with medical ethics, sometimes the clinical practice will be moving to malpractice; the clinical practice will be moving to money-minded practice; the clinical practice will be moving to personal-interest practice. So we need to put guidelines and statements that will refine the practice and meet the best interests of the patients, which is the target of our practice down the road.
What can be done to make practice better in LMICs?
In low- and middle-income countries we have many issues and I will mention two things. In the low- and middle-income countries in the publicly funded sectors sometimes we need to have certain guidelines that are ethically sound and we want to apply it for the patients. At the same time in the low- and middle-income countries we have also private sectors and sometimes those private sectors, because of their situation, they want to grow as much as possible and sometimes this growing can be regardless of their ethical guidance and the principles. So it’s important for the low- and middle-income countries and also for the high-income countries because even in the high-income countries if we don’t have this guidance from the medical ethics we will be in a tunnel with many things that can keep us away from the medical ethics field.
Even in research sometimes there is a need for a trial but that trial is not obviously ethically sound. When we are arguing this with the people responsible for the trial they are saying, ‘We don’t have level 1 evidence.’ However, there is no need to have this example or there is no need to have this level 1 evidence and we know mostly that this trial will be ending as a positive trial so why we are putting a certain group of patients in the control arm and we know the investigative arm is mostly going to be a positive trial. To me it sounds unethical to approve this trial because mostly it will be a positive trial so there is no need, you can just go ahead.
For example, water and orange and you are thirsty. There is no need for a trial to prove that the water is better than orange for thirsty patients. Water is superior to improve this level of problem. So sometimes there are certain problems in clinical practice that are so obvious and there is no need for a trial. I know that clinical trials are very important to refine the practice but sometimes we are overusing the research and the trials and sometimes the victims are the patients.
Is there anything else you would like to add?
Earlier this year I put this editorial and then we formed a group of the investigators from over 25 members across the globe from Japan to Canada and through the Middle East and Europe. Now we are in the process of the global survey, we are in the process of IRB approval to get this survey ready. Then hopefully by early next year the findings will be presented and published and hopefully it will be endorsed by certain organisations. So the EGRT concept will be more as a roadmap for all the practitioners in radiation oncology across the globe.
