Presentation (CTI)

OBJECTIVES: Radiopharmaceutical therapy (RPT) offers targeted cancer treatment with potentially fewer side effects than conventional therapies. Its novel use of radioactive isotopes raises concerns including evidentiary uncertainty, environmental impact, logistical and equity-related barriers, and public apprehension toward radiation (“radiophobia”). These concerns align with domains emphasized in a Whole Health approach, which broadens evaluation frameworks to consider societal, environmental, and system-level impacts alongside clinical outcomes. We qualitatively explored Canadian patient and public perspectives on RPT implementation in a publicly funded health system, focusing on acceptability, equity, and decision-making within a Whole Health context.
METHODS: We conducted virtual focus groups in English and French with participants across Canada, including individuals with and without personal cancer experience, and analyzed the data using thematic analysis. Patient partners guided development of the semi-structured topic guide and finalized themes.
RESULTS: Thirty-two individuals participated across five focus groups. Participants viewed RPT as a positive extension of conventional therapies, minimizing concerns of radiophobia. Environmental impacts and access inequities were acknowledged but described with pragmatic resignation, viewed as longstanding system issues beyond individual control. While participants hoped institutions would address these concerns, they were reluctant to delay access while awaiting reform. Most participants prioritized timely availability over collective or long-term impacts. Comfort with evidentiary uncertainty varied, influenced by health circumstances, life priorities, and perceptions of risk perceived as dynamic and context-dependent. Some participants suggested that uncertainty may increase their reliance on clinician guidance, potentially limiting opportunities for shared decision-making and person-centered care.
CONCLUSIONS: Participants expressed optimistic support for RPT despite acknowledged societal risks. Their views highlight a core tension in Whole Health: optimism about innovation may obscure persistent equity and sustainability challenges. Resigned acceptance should not be interpreted as endorsement. Implementation should address access, environmental stewardship, and shared decision-making barriers to ensure clinical advances also contribute to broader public value and health equity.