The American Society for Radiation Oncology (ASTRO) has developed a framework for radioligand therapy patient-centred care pathways which outlines what is needed to ensure safe, high-quality care for people with cancer.1 The framework aims to help set up new radioligand therapy services and expand existing centres; it can be adapted to different types of radioligand therapy and different settings.2 This adaptability means that the framework can be used widely and applied to new therapies in the future.


Radioligand therapies are likely to require changes to current models of care, as they involve coordination between healthcare professionals from different specialties and interaction between different sectors. The ASTRO framework was developed to support these changes, helping set up new radioligand therapy services or expand existing centres so that services are ready for the anticipated increase in demand for radioligand therapy.2 3

Given that delivery of radioligand therapy is highly multidisciplinary, the development of a care pathway needs to involve a multidisciplinary team. In 2020, an ASTRO taskforce – comprising experts from radiation oncology, nuclear medicine and medical physics as well as a patient advocate – created a framework for a collaborative, patient-centred care pathway for radiopharmaceutical therapies.1-3 By working and learning together, the taskforce was able to deliver an optimal model for what fully integrated centres delivering radioligand therapy should look like.3

A care pathway offers a comprehensive and integrated guide to caring for a person from start to end of care.4 The ASTRO framework outlines how to set up the care pathway from an administrative, regulatory and financial perspective, as well as the types of specialists that need to be involved and what training is required for them.2  It highlights the optimal workflows to ensure safe, high-quality care for people with cancer at every step of the pathway, including: referral, treatment planning and delivery, clinical coordination and follow up.1

To meet anticipated future demand, there is an expectation that more healthcare professionals will need to deliver radioligand therapy in the future, but may not have the experience to do so.2 The ASTRO framework can highlight to various stakeholders, including hospital administrators, regulators, insurance companies or heads of staffing, what needs to be done to enable delivery of the therapy.2

The framework also recognises that some centres will not have the same resources as academic medical centres.3 Therefore, it can be adapted to different contexts and the majority of it can be used on a global scale.2

What has been achieved?

The ASTRO framework is highly adaptable to various factors, such as disease area and stage, specialties involved, type of therapy and local infrastructure.1 This makes it a useful tool to plan service delivery for new therapies and contexts, suitable for a wide audience and adaptable over time.

Authors of the framework have been contacted by various groups to discuss it in greater detail.3 It is already being used to build new centres for radiopharmaceutical therapy, including joint clinics between radiation oncology and nuclear medicine and centres for radiopharmaceutical therapy trials in the US.3

As well as being a valuable resource for practically setting up centres, the framework can aid stakeholder education on how these centres function.3

Having a common, comprehensive framework helps to ensure that everyone can receive high-quality, effective and safe care.1 The ASTRO framework is a key step in establishing radioligand therapy as a standard therapy for people with cancer.1

Future relevance

Developing a comprehensive framework takes time and concerted effort from different types of specialists.2 The ASTRO framework demonstrates that it is possible to achieve consensus on what such a framework should look like, and offers a step-by-step guide to implementing patient-care pathways that can help provide the best care for people with cancer.

ASTRO is exploring hosting educational events about the framework in the future.2 3

Further information

Contact: Ronald Ennis

  1. Buatti JM, Pryma DA, Kiess AP, et al. A Framework for Patient-Centered Pathways of Care for Radiopharmaceutical Therapy: An ASTRO Consensus Document. International Journal of Radiation Oncology, Biology, Physics 10.1016/j.ijrobp.2020.11.048:
  2. Ennis R. 2022. Interview with Oriana Carswell at The Health Policy Partnership (video conference). 11/08/22
  3. Buatti J. 2022. Interview with Oriana Carswell at The Health Policy Partnership (video conference). 08/09/22
  4. Schrijvers G, van Hoorn A, Huiskes N. 2012. The care pathway: concepts and theories: an introduction. Int J Integr Care 12 (Spec Ed Integrated Care Pathways): e192