Palliative Radiotherapy at the Crossroads of Supportive Oncology: Addressing Global Gaps, Guideline Deficits, and the Expanding Need for Symptom-Directed Cancer Care.

Radiotherapy has been a central component of cancer therapy for over a century, with the field rapidly evolving over time, resulting in improved outcomes. These advances have contributed to a changing demographic, with growing numbers of people living longer with, and surviving the disease. This has been accompanied by an increasing burden of chronic physical and psychological side effects, including radiotherapy-related toxicity. These long-term consequences have a substantial impact on patients, their carers, and healthcare systems. Significant global inequities persist, particularly in low- and middle-income countries (LMICs), where access to radiotherapy and comprehensive supportive and palliative care remains limited. Supportive oncology has emerged as a new field focusing on the management of acute, chronic, and emergent problems in people living with and beyond cancer. Despite its benefits, palliative radiotherapy continues to be underused, especially in specific patient groups including paediatrics, older age adults, and those with a short prognosis. Often treatment decisions in these patient groups are challenging and the integration of supportive oncology could help overcome this. Furthermore, radiotherapy toxicity and its management has been under-researched despite huge advancements in cancer treatments leading to a lack of guidelines and varied practice globally. Supportive oncology offers a framework to address these challenges through earlier integration into treatment pathways, multidisciplinary collaboration, and a stronger focus on symptom control, survivorship, and equity. Embedding supportive oncology within radiotherapy services is essential to delivering high-quality, patient-centred cancer care worldwide.