S2824
RTT - RTT education, training, and advanced practice
ESTRO 2026
and the use of frailty assessment tools were seen as essential. Care with integrity and humanityParticipants found the clinical assessment of older cancer patients prior to RT to be complex, which led to doubts about treatment choices. This was particularly the case for patients receiving palliative care, frailty, or cognitive decline. Participants felt uncertain, and had ethical concerns as well as feeling powerless, when treatment seemed inappropriate or overly burdensome. Oncology nurses emphasised the importance of clinical judgement, discussing treatment decisions with colleagues and the oncologist, when patients were in a poor condition. Although existing treatment plans often remained unchanged, prompting ongoing reflection about providing appropriate, patient- centred care for frail older adults.Receiving support in treatment decisionsFrailty assessment tools were seen as a possible aid to guide personalised care and reduce uncertainty. These tools could help to assess older cancer patients before RT, determine their treatment tolerance and improve communication between healthcare providers and patients. However, concerns were raised about potential overreliance on these tools, as well as need for adequate knowledge
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Radiotherapy staff experiences of clinical judgement, treatment decisions, and frailty management in older cancer patients: a qualitative study Sofia Axelsson 1,2 , Per Fessé 3,4 , Per Fransson 5 , Agneta Schröder 6,7 , Antonis Valachis 1 , Emma Ohlsson-Nevo 6,8 1 Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. 2 University Health Research Centre, Faculty of Medicine and Helath, Örebro University, Örebro, Sweden. 3 Center for Research & Development, Uppsala University/region Gävleborg, Gävle, Sweden. 4 Sahlgrenska Academy, Institute of Health and Care Science, University of Gothenburg, Göteborg, Sweden. 5 Department of Nursing, Umeå University, Umeå, Sweden. 6 University Health Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. 7 Department of nursing, Faculty of Health, Care and Nursing. Norwegian University of Science and Technology (NTNU, Gjøvik, Norway. 8 Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden Purpose/Objective: BackgroundFrailty frequently complicates cancer care in older adults. Radiotherapy (RT) is widely used, yet its efficacy and appropriateness for frail patients are not fully established. RT staff play a crucial role in identifying and monitoring risks and tailoring treatment to individual patient needs. Understanding their experiences is essential for implementing structured frailty assessment in practice and navigate clinical judgment, treatment decision, and frailty management in older cancer patients.PurposeTo explore RT staff's experiences of clinical judgement, treatment decision-making and the management of frail older cancer patients. Material/Methods: An inductive qualitative design was employed. Sixteen RT staff from four RT departments in Sweden participated in semi-structured interviews. Data were analysed using reflexive thematic analysis. Results: Analysis identified three overarching themes and nine subthemes:
and training. Conclusion:
RT staff encounter multifaceted challenges in the treatment of frail older cancer patients, often accompanied by uncertainty and emotional strain. The current awareness and routine use of structured frailty assessments are limited. Integrating such assessments into clinical practice may enhance decision-making, communication, and patient outcomes, thereby fostering more ethical and person- centred care. Keywords: Frailty assessment, Radiotherapy, Qualitative References: Braun V, Clark V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health 2019;11(4):589– 97.Morris L, Thiruthaneeswaran N, Lehman M, Franz CR, Hasselburg G, Turner S. Are future radiation oncologists equipped with the knowledge to manage elderly patients with cancer? Int J of Radiat Oncol Biol Phys 2017;98(4):743–47. Naseer A, Cree A, Simcock R, Starup Jeppesen S, Morris L, Kenis C, et al. International efforts in geriatric radiation oncology. J Geriatr Oncol 2022;13(3):356–362. Wildiers H, Heeren P, Puts M, Topinkova E, Janssen-Heijnen MLG, Exterman M, et al. International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol 2014;32(24): 2595– 2603.
Putting the patient in firstParticipants highlighted the importance of considering the QoL, wellbeing and individual circumstances of older and frail patients when planning RT. Treatment should offer more benefits than harms, with symptom relief being prioritised. Patient involvement, open communication
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