1
|
Strasser M, Senger MH. Behind the Scenes: Radiotherapy technical training through professionals' eyes. Tech Innov Patient Support Radiat Oncol 2024; 30:100247. [PMID: 38600917 PMCID: PMC11004981 DOI: 10.1016/j.tipsro.2024.100247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 03/01/2024] [Accepted: 03/20/2024] [Indexed: 04/12/2024] Open
Abstract
Training technical professionals for Radiotherapy is essential due to growing demand caused by early cancer diagnoses, global population aging, rising cancer rates, and evolving equipment and techniques. Our objective was to gather insights from graduates of various courses who are now working professionally, based on the principle that one way to assess educational training is by considering the attributes that trained and active professionals deem important in the improvement courses they have taken. A cross-sectional study (approved at the local Research Ethics Committee) was conducted, involving an online survey for the opinion of professionals already qualified as radiotherapy technicians or technologists and engaged in this work. The questionnaire consisted of 12 objective multiple-choice questions and four open-ended questions. Of the 59 received responses, 49 professionals completed some course. Thirty-one (64.6%) pursued improvement/enhancement, followed by specialization (15; 31.2%) and extension (two; 4.2%). Thirty-four (69.4%) respondents had not engaged in any practical activities during their training. As for course weaknesses, respondents cited: inflexible schedule (29; 59.2%), distance from residence (12; 24.5%), low hourly load (four; 8.2%), and other issues (four; 8.2%). The data underscores the need to adjust technical training in Radiotherapy, emphasizing the importance of a recognized professional team, practical learning, flexible schedules, and financial viability. The strategic perspective of radiotherapy technicians currently working in this job market, emphasized the need for an adjustment in the offering of courses. These insights provide more well-structured foundations for contemporary teaching and learning processes, considering current societal characteristics, technological advances, and future student demands.
Collapse
Affiliation(s)
- M Strasser
- Radiation Oncologist, Luthes Radioterapia, Sorocaba, Master's student in Education for Health Professions Program, Pontifical Catholic University of São Paulo, Brazil
| | - M H Senger
- Full Professor in the Areas of Endocrinology and Education for Health Professions, Pontifical Catholic University of São Paulo, Brazil
| |
Collapse
|
2
|
Ahmadsei M, Christ SM, Kroese TE, Kühnis A, Willmann J, Balermpas P, Andratschke N, Tanadini-Lang S, Guckenberger M. Efficacy and safety analysis in metastatic cancer patients treated with multiple courses of repeat radiation therapy. Clin Transl Radiat Oncol 2023; 43:100687. [PMID: 37867613 PMCID: PMC10589769 DOI: 10.1016/j.ctro.2023.100687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/18/2023] [Accepted: 09/30/2023] [Indexed: 10/24/2023] Open
Abstract
Background and purpose Due to advances in oncology, a growing proportion of patients is treated with repetitive courses of radiotherapy. The aim of this study is to analyze whether radiotherapy maintains its safety and efficacy profile in patients treated with multiple repeat courses of irradiation. Material and methods All patients treated between 2011 and 2019 at our institution were screened for a minimum of five repeat irradiation courses, to analyze treatment characteristics, survival, safety and efficacy. The type of re-irradiation was classified according to ESTRO-EORTC consensus guidelines. Results A total of n = 112 patients receiving n = 660 radiotherapy courses were included in this retrospective cohort study. The most frequent primary tumors were lung cancer in 41.9 % (n = 47) and malignant melanoma in 8.9 % (n = 10). The most frequent re-irradiation types were repeat irradiation and Type 2 re-irradiation in 309 (46.8 %) and 113 (17.1 %) cases, respectively. Median survival after the first course of radiotherapy was 3.6 (0.3-13.4) years. Response to radiotherapy was observed in 548 (83.0 %) cases and CTCAE toxicity grade ≥ 3 was observed in 21 (3.2 %) cases. An increasing number of RT courses (HR: 1.30, p=<0.0001), Type 1 re-irradiation (HR 3.50, p = 0.008) and KPS ≤ 80 % (HR: 2.02, p = 0.002) were associated with significantly worse treatment responses. Toxicity rates remained stable with increasing numbers of RT courses. Conclusion Multiple courses of repeat radiotherapy maintain a favorable therapeutic ratio of high response combined with reasonable safety profile.
Collapse
Affiliation(s)
- Maiwand Ahmadsei
- Department of Radiation Oncology and Competence Center for Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Sebastian M. Christ
- Department of Radiation Oncology and Competence Center for Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Tiuri E. Kroese
- Department of Radiation Oncology and Competence Center for Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Anja Kühnis
- Department of Radiation Oncology and Competence Center for Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Jonas Willmann
- Department of Radiation Oncology and Competence Center for Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - Panagiotis Balermpas
- Department of Radiation Oncology and Competence Center for Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology and Competence Center for Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology and Competence Center for Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology and Competence Center for Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
| |
Collapse
|
3
|
Loewen SK, Ruan Y, Wu CHD, Arifin A, Kim M, Bashir B, Halperin R, McKenzie M, Archambault J, Thompson R, Ringash J, Brundage M, Brenner D, Stuckless T. Supply and Demand for Radiation Oncologists in Canada: Workforce Planning Projections From 2020 to 2040. Int J Radiat Oncol Biol Phys 2023:S0360-3016(23)07684-8. [PMID: 37562734 DOI: 10.1016/j.ijrobp.2023.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 07/05/2023] [Accepted: 07/18/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE The number of Canadians diagnosed with cancer, and subsequent demand for radiation therapy, are expected to increase over time. This study aimed to update our needs-based workforce planning model to ensure appropriate staffing levels in the future. METHODS AND MATERIALS The supply of radiation oncologists, by age group, sex, and full-time equivalent status, was projected from 2020 to 2040 using a recursive-aging, input-output model developed with seeding parameters derived from national sources. The demand for radiation oncologists until 2040 was estimated using referral patterns for radiation therapy and consultation workload metrics applied to projected annual cancer incident cases to calculate required full-time equivalent positions. Baseline model parameters were also applied to the 2005-2019 workforce and incident case data to evaluate preprojection supply and demand trends. RESULTS Preprojection trends for 2005 to 2019 revealed accelerated staffing growth that transitioned from a workforce shortage to a surplus state in 2014 followed by substantial growth slowdown in 2016. The model predicts a transient surplus of radiation oncologists until 2026 followed by a projected deficit in subsequent years. Sensitivity analyses using the plausible range for each parameter continued to favor an undersupply, suggesting a trainee shortage unable to meet workforce expansion needs. Considering possible future declining trends in radiotherapy utilization and workload, calculations to inform corrective efforts in resident numbers resulted in 25 entry positions per year, up from 21 per year currently. Geographic distribution of trainees, relative to workforce and cancer incidence distributions, could be improved with more residency positions in Canadian regions outside Ontario. CONCLUSIONS Demand for radiation therapy and radiation oncologists in Canada are expected to grow more quickly than future expansion in staffing levels. Our workforce planning model provides evidence for more trainee requirements to inform stakeholders of possible corrective actions to training programs and recruitment. Further research is needed to explore additional strategies to expand capacity and high-quality delivery of radiation therapy to meet the foreseeable increase in Canadian patients with cancer.
Collapse
Affiliation(s)
- Shaun K Loewen
- Division of Radiation Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada.
| | - Yibing Ruan
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Che Hsuan David Wu
- Division of Radiation Oncology, BC Cancer, Victoria, British Columbia, Canada
| | - Andrew Arifin
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Michael Kim
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Bashir Bashir
- Division of Radiation Oncology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Ross Halperin
- Division of Radiation Oncology, BC Cancer, Kelowna, British Columbia, Canada
| | - Michael McKenzie
- Division of Radiation Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Jean Archambault
- Department of Radiation Oncology, Centre Hospitalier Universitaire de Québec - Université Laval, Quebec City, Quebec, Canada
| | - Robert Thompson
- Department of Radiation Oncology, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Michael Brundage
- Department of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston, Ontario, Canada
| | - Darren Brenner
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Teri Stuckless
- Department of Radiation Oncology, Cancer Care Program of Eastern Health, St. John's, Newfoundland, Canada
| |
Collapse
|
4
|
Rosa AA, de Sousa CFPM, Pimentel LCF, Martins HL, Moraes FY, Marta GN, Castilho MS. Radiotherapy resources in Brazil (RT2030): a comprehensive analysis and projections for 2030. Lancet Oncol 2023; 24:903-912. [PMID: 37541272 DOI: 10.1016/s1470-2045(23)00284-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/02/2023] [Accepted: 06/08/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND The demand for radiotherapy in Brazil is unfulfilled, and the scarcity of data on the national network hampers the development of effective policies. We aimed to evaluate the current situation, estimate demands and requirements, and provide an action plan to ensure access to radiotherapy for those in need by 2030. METHODS The Brazilian Society for Radiation Oncology created a task force (RT2030) including physicians, medical physicists, policy makers, patient advocates, and suppliers, all of whom were major stakeholders involved in Brazilian radiotherapy care. The group was further divided into seven working groups to address themes associated with radiotherapy care in Brazil. From March 1, 2019, to Aug 3, 2020, there were monthly meetings between the group's leaders and the Central Committee and six general meetings. First, a comprehensive search of all different national databases was done to identify all radiotherapy centres. Questionnaires evaluating radiotherapy infrastructure and human resources and assing the availability, distribution, capacity, and workload of resources were created and sent to the radioprotection supervisor of each centre. Results were analysed nationally and across the country's regions and health-care systems. A pre-planned review of available databases was done to gather data on active radiation oncology centres and the distribution of radiotherapy machines (linear accelerators [LINACs]) across Brazil. We used national population and cancer incidence projections, recommended radiotherapy usage from the medical literature, and national working patterns to project radiotherapy demands in 2030. An action plan was established with suggestions to address the gaps and meet the demands. FINDINGS The database search yielded 279 centres with an active radiotherapy registry. After applying predefined exclusion criteria, 263 centres were identified that provided external beam radiotherapy machines with or without brachytherapy. All 263 operational centres answered the questionnaires sent on Dec 9, 2019, which were then returned between Jan 1 and June 30, 2020. There were 409 therapy machines, 646 radiation oncologists, 533 physicists, and 230 989 patients undergoing radiotherapy (150 628 [65·2%] in the public health-care system and 80 937 [35·0%] in private). The mean annual occupation rate was 566 patients per treatment machine (SD 250). The number of residents per treatment machine ranged from 258 333 to 1 800 000. Technology availability varied considerably among regions and systems. In 2030, 639 994 new cancer cases are expected, which will require 332 797 radiotherapy courses. Therefore, 530 LINACs, 1079 radiation oncologists, and 1060 medical physicists will be needed. INTERPRETATION The expected increase in cancer incidence in the coming years will probably increase the disparities in cancer care and the burden for Brazilian patients. We provide a roadmap of the current situation and the particularities of the Brazilian radiotherapy network, which can serve as a starting point for cancer policy planning to improve this scenario. FUNDING Accuray, BRAINLAB, Elekta, IBA, ONE medical solution, SUN NUCLEAR corporation, VARIAN, and ZIGMA.
Collapse
Affiliation(s)
- Arthur Accioly Rosa
- Grupo Oncoclínicas, Salvador, Bahia, Brazil; Latin America Cooperative Oncology Group, Porto Alegre, Brazil
| | | | | | | | - Fabio Ynoe Moraes
- Latin America Cooperative Oncology Group, Porto Alegre, Brazil; Department of Oncology, Division of Radiation Oncology, Kingston General Hospital, Queen's University, Kingston, ON, Canada.
| | - Gustavo Nader Marta
- Latin America Cooperative Oncology Group, Porto Alegre, Brazil; Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil
| | | |
Collapse
|
5
|
Ghandourh W, Holloway L, Batumalai V, Chlap P, Field M, Jacob S. Optimal and actual rates of Stereotactic Ablative Body Radiotherapy (SABR) utilisation for primary lung cancer in Australia. Clin Transl Radiat Oncol 2022; 34:7-14. [PMID: 35282142 PMCID: PMC8907547 DOI: 10.1016/j.ctro.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 03/01/2022] [Indexed: 12/02/2022] Open
Abstract
Stereotactic Ablative Body Radiotherapy (SABR) plays a major role in the management of early-stage non-small cell lung cancer (NSCLC). An evidence-based model is developed to estimate optimal rates of lung SABR utilisation within the Australian population. Optimal utilisation rates are compared against actual utilisation rates to evaluate service provision.
Background and purpose Radiotherapy utilisation rates considerably vary across different countries and service providers, highlighting the need to establish reliable benchmarks against which utilisation rates can be assessed. Here, optimal utilisation rates of Stereotactic Ablative Body Radiotherapy (SABR) for lung cancer are estimated and compared against actual utilisation rates to identify potential shortfalls in service provision. Materials and Methods An evidence-based optimal utilisation model was constructed after reviewing practice guidelines and identifying indications for lung SABR based on the best available evidence. The proportions of patients likely to develop each indication were obtained, whenever possible, from Australian population-based studies. Sensitivity analysis was performed to account for variations in epidemiological data. Practice pattern studies were reviewed to obtain actual utilisation rates. Results A total of 6% of all lung cancer patients were estimated to optimally require SABR at least once during the course of their illness (95% CI: 4–6%). Optimal utilisation rates were estimated to be 32% for stage I and 10% for stage II NSCLC. Actual utilisation rates for stage I NSCLC varied between 6 and 20%. For patients with inoperable stage I, 27–74% received SABR compared to the estimated optimal rate of 82%. Conclusion The estimated optimal SABR utilisation rates for lung cancer can serve as useful benchmarks to highlight gaps in service delivery and help plan for more adequate and efficient provision of care. The model can be easily modified to determine optimal utilisation rates in other populations or updated to reflect any changes in practice guidelines or epidemiological data.
Collapse
|
6
|
Christ SM, Ahmadsei M, Wilke L, Kühnis A, Pavic M, Tanadini-Lang S, Guckenberger M. Long-term cancer survivors treated with multiple courses of repeat radiation therapy. Radiat Oncol 2021; 16:208. [PMID: 34717664 PMCID: PMC8557578 DOI: 10.1186/s13014-021-01934-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/19/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction and background Through recent advances in cancer care, the number of long-term survivors has continuously increased. As a result, repetitive use of local radiotherapy for curative or palliative indications might have increased as well. This analysis aims to describe patterns of care and outcome of patients treated with multiple courses of repeat radiotherapy. Materials and methods All patients treated with radiotherapy between 2011 and 2019 at our department of Radiation Oncology were included into this analysis. A course of radiotherapy was defined as all treatment sessions to one anatomical site under one medical indication. Demographics, cancer and treatment characteristics and overall survival of patients having undergone multiple radiotherapy courses (minimum n = 5) were evaluated. Results The proportion of cancer patients treated with a minimum five courses of radiotherapy increased continuously from 0.9% in 2011 to 6.5% in 2019. In the 112 patients treated with a minimum of five radiotherapy courses, the primary tumor was lung in 41.9% (n = 47), malignant melanoma in 8.9% (n = 10) and breast in 8.0% (n = 9) of cases. A median interval of 3 years (maximum 8 years) elapsed between the first and the last radiotherapy course. The maximum number of courses in a single patient were n = 10. Treatment intent was curative or palliative in 46.4% and 53.6% for the first radiotherapy, respectively. The proportion of curative intent decreased to 11.6% at the 5th, and the last radiotherapy course was following a palliative intent in all patients. Five-year overall survival measured from the 1st radiotherapy course was 32.7%. Median overall survival was 3.3, 2.4, 1.3, and 0.6 years when measured from the 1st, the 1st palliative, the 5th and last course of radiotherapy, respectively. Discussion and conclusion A continuously increasing number of patients is treated with multiple courses of radiotherapy throughout their long-term cancer survivorship.
Collapse
Affiliation(s)
- Sebastian M Christ
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Maiwand Ahmadsei
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Lotte Wilke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Anja Kühnis
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Matea Pavic
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| |
Collapse
|
7
|
Barber J, Yuen J, Jameson M, Schmidt L, Sykes J, Gray A, Hardcastle N, Choong C, Poder J, Walker A, Yeo A, Archibald‐Heeren B, Harrison K, Haworth A, Thwaites D. Deforming to Best Practice: Key considerations for deformable image registration in radiotherapy. J Med Radiat Sci 2020; 67:318-332. [PMID: 32741090 PMCID: PMC7754021 DOI: 10.1002/jmrs.417] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/15/2020] [Accepted: 06/12/2020] [Indexed: 12/11/2022] Open
Abstract
Image registration is a process that underlies many new techniques in radiation oncology - from multimodal imaging and contour propagation in treatment planning to dose accumulation throughout treatment. Deformable image registration (DIR) is a subset of image registration subject to high levels of complexity in process and validation. A need for local guidance to assist in high-quality utilisation and best practice was identified within the Australian community, leading to collaborative activity and workshops. This report communicates the current limitations and best practice advice from early adopters to help guide those implementing DIR in the clinic at this early stage. They are based on the state of image registration applications in radiotherapy in Australia and New Zealand (ANZ), and consensus discussions made at the 'Deforming to Best Practice' workshops in 2018. The current status of clinical application use cases is presented, including multimodal imaging, automatic segmentation, adaptive radiotherapy, retreatment, dose accumulation and response assessment, along with uptake, accuracy and limitations. Key areas of concern and preliminary suggestions for commissioning, quality assurance, education and training, and the use of automation are also reported. Many questions remain, and the radiotherapy community will benefit from continued research in this area. However, DIR is available to clinics and this report is intended to aid departments using or about to use DIR tools now.
Collapse
Affiliation(s)
- Jeffrey Barber
- Sydney West Radiation Oncology NetworkBlacktown and WestmeadNSWAustralia
- Institute of Medical PhysicsUniversity of SydneySydneyNSWAustralia
| | - Johnson Yuen
- St George Cancer Care CentreSydneyNSWAustralia
- Ingham Institute for Applied Medical ResearchSydneyNSWAustralia
- South Western Clinical SchoolThe University of New South WalesSydneyNSWAustralia
| | - Michael Jameson
- Liverpool and Macarthur Cancer Therapy CentresSydneyNSWAustralia
- Ingham Institute for Applied Medical ResearchSydneyNSWAustralia
- South Western Clinical SchoolThe University of New South WalesSydneyNSWAustralia
| | | | - Jonathan Sykes
- Sydney West Radiation Oncology NetworkBlacktown and WestmeadNSWAustralia
- Institute of Medical PhysicsUniversity of SydneySydneyNSWAustralia
| | - Alison Gray
- Liverpool and Macarthur Cancer Therapy CentresSydneyNSWAustralia
- Ingham Institute for Applied Medical ResearchSydneyNSWAustralia
- South Western Clinical SchoolThe University of New South WalesSydneyNSWAustralia
| | - Nicholas Hardcastle
- Peter MacCallum Cancer CentreVictoriaAustralia
- Physical SciencesPeter MacCallum Cancer CentreVICAustralia
| | - Callie Choong
- Liverpool and Macarthur Cancer Therapy CentresSydneyNSWAustralia
| | - Joel Poder
- St George Cancer Care CentreSydneyNSWAustralia
- Physical SciencesPeter MacCallum Cancer CentreVICAustralia
| | - Amy Walker
- Liverpool and Macarthur Cancer Therapy CentresSydneyNSWAustralia
- Ingham Institute for Applied Medical ResearchSydneyNSWAustralia
- South Western Clinical SchoolThe University of New South WalesSydneyNSWAustralia
| | - Adam Yeo
- Peter MacCallum Cancer CentreVictoriaAustralia
- RMIT UniversityMelbourneVICAustralia
| | | | | | - Annette Haworth
- Institute of Medical PhysicsUniversity of SydneySydneyNSWAustralia
| | - David Thwaites
- Sydney West Radiation Oncology NetworkBlacktown and WestmeadNSWAustralia
- Institute of Medical PhysicsUniversity of SydneySydneyNSWAustralia
| |
Collapse
|
8
|
Barton M, Batumalai V, Spencer K. Health Economic and Health Service Issues of Palliative Radiotherapy. Clin Oncol (R Coll Radiol) 2020; 32:775-780. [DOI: 10.1016/j.clon.2020.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/19/2020] [Accepted: 06/18/2020] [Indexed: 01/31/2023]
|
9
|
Glicksman RM, Wong A, Wang J, Favell L, Matheson G, Brundage M, Renaud J, Malkoske K, MacPhail J, Finnerty D, Foxcroft S, Gutierrez E, Warde P. The Capital Investment Strategy for Radiation therapy in Ontario: A Framework to Ensure Access to Radiation Therapy. Adv Radiat Oncol 2019; 5:318-324. [PMID: 32529124 PMCID: PMC7280285 DOI: 10.1016/j.adro.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/28/2019] [Accepted: 12/23/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose Ontario Health (Cancer Care Ontario), formerly known as CCO, is the provincial governmental agency in Ontario, Canada responsible for developing radiation therapy-specific capital investment strategies, updated every 5 years, to ensure equitable access and to gain the highest value from these investments in infrastructure. These plans are informed by the changing landscape of health care delivery, technologic advancements affecting radiation therapy care, patient desire for care closer to home, and expected increases in utilization of radiation therapy services. In this article, we describe the development, model, and final recommendations of CCO's fifth radiation therapy capital investment strategy. Methods and Materials A panel of multidisciplinary provincial experts, in combination with 2 patient and family advisors, developed planning principles to guide the development of a patient-centered strategy. Adaption of the previously used model for radiation therapy planning was used. Results The development of the capital investment strategy took place from fall 2017 to fall 2018. The model included 3 main factors: patient demand (including utilization targets), machine throughput, and machine demand and supply. The final recommendation is for an investment of 26 new radiation therapy machines in the province by 2028. Conclusions The strategy plans for continued province-wide access to quality radiation therapy care and ensures machines are added to the system at the right place and in the right time. Ongoing data collection throughout this period is necessary to ensure the strategy achieves its goals and to allow for planning of future strategies.
Collapse
Affiliation(s)
- Rachel M Glicksman
- Radiation Treatment Program, Cancer Care Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Audrey Wong
- System and Infrastructure Planning, Cancer Care Ontario, Canada
| | - Jonathan Wang
- System and Infrastructure Planning, Cancer Care Ontario, Canada
| | - Lisa Favell
- System and Infrastructure Planning, Cancer Care Ontario, Canada
| | - Garth Matheson
- Planning and Regional Programs, Cancer Care Ontario, Canada
| | - Michael Brundage
- Radiation Treatment Program, Cancer Care Ontario, Canada.,Department of Cancer Care and Epidemiology, Queen's University, Kingston, Canada
| | - Julie Renaud
- Department of Radiation Therapy, The Ottawa Hospital, Ottawa, Canada
| | - Kyle Malkoske
- Department of Medical Physics, Royal Victoria Hospital, Barrie, Canada
| | | | | | | | - Eric Gutierrez
- Radiation Treatment Program, Cancer Care Ontario, Canada
| | - Padraig Warde
- Radiation Treatment Program, Cancer Care Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada.,Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| |
Collapse
|
10
|
Radiotherapy-Induced Changes in the Systemic Immune and Inflammation Parameters of Head and Neck Cancer Patients. Cancers (Basel) 2019; 11:cancers11091324. [PMID: 31500214 PMCID: PMC6770727 DOI: 10.3390/cancers11091324] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/16/2019] [Accepted: 08/27/2019] [Indexed: 12/24/2022] Open
Abstract
Though radiotherapy is a local therapy, it has systemic effects mainly influencing immune and inflammation processes. This has important consequences in the long-term prognosis and therapy individualization. Our objective was to investigate immune and inflammation-related changes in the peripheral blood of head and neck cancer patients treated with radiotherapy. Peripheral blood cells, plasma and blood cell-derived RNA were isolated from 23 patients before and at two time points after radiotherapy and cellular immune parameters, plasma protein changes and gene expression alterations were studied. Increased regulatory T cells and increased CTLA4 and PD-1 expression on CD4 cells indicated an immune suppression induced by the malignant condition, which was accentuated by radiotherapy. Circulating dendritic cells were strongly elevated before treatment and were not affected by radiotherapy. Decreased endoglin levels in the plasma of patients before treatment were further decreased by radiotherapy. Expression of the FXDR, SESN1, GADD45, DDB2 and MDM2 radiation-response genes were altered in the peripheral blood cells of patients after radiotherapy. All changes were long-lasting, detectable one month after radiotherapy. In conclusion we demonstrated radiotherapy-induced changes in systemic immune parameters of head and neck cancer patients and proposed markers suitable for patient stratification worth investigating in larger patient cohorts.
Collapse
|
11
|
Defourny N, Perrier L, Borras JM, Coffey M, Corral J, Hoozée S, Loon JV, Grau C, Lievens Y. National costs and resource requirements of external beam radiotherapy: A time-driven activity-based costing model from the ESTRO-HERO project. Radiother Oncol 2019; 138:187-194. [DOI: 10.1016/j.radonc.2019.06.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 06/11/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
|
12
|
D'Agostino GR, Di Brina L, Mancosu P, Franzese C, Iftode C, Franceschini D, Clerici E, Tozzi A, Navarria P, Scorsetti M. Reirradiation of Locally Recurrent Prostate Cancer With Volumetric Modulated Arc Therapy. Int J Radiat Oncol Biol Phys 2019; 104:614-621. [DOI: 10.1016/j.ijrobp.2019.02.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 02/08/2019] [Accepted: 02/21/2019] [Indexed: 12/18/2022]
|
13
|
Jin F, Luo HL, Zhou J, He YN, Liu XF, Zhong MS, Yang H, Li C, Li QC, Huang X, Tian XM, Qiu D, He GL, Yin L, Wang Y. Cancer risk assessment in modern radiotherapy workflow with medical big data. Cancer Manag Res 2018; 10:1665-1675. [PMID: 29970965 PMCID: PMC6021004 DOI: 10.2147/cmar.s164980] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Modern radiotherapy (RT) is being enriched by big digital data and intensive technology. Multimodality image registration, intelligence-guided planning, real-time tracking, image-guided RT (IGRT), and automatic follow-up surveys are the products of the digital era. Enormous digital data are created in the process of treatment, including benefits and risks. Generally, decision making in RT tries to balance these two aspects, which is based on the archival and retrieving of data from various platforms. However, modern risk-based analysis shows that many errors that occur in radiation oncology are due to failures in workflow. These errors can lead to imbalance between benefits and risks. In addition, the exact mechanism and dose-response relationship for radiation-induced malignancy are not well understood. The cancer risk in modern RT workflow continues to be a problem. Therefore, in this review, we develop risk assessments based on our current knowledge of IGRT and provide strategies for cancer risk reduction. Artificial intelligence (AI) such as machine learning is also discussed because big data are transforming RT via AI.
Collapse
Affiliation(s)
- Fu Jin
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Huan-Li Luo
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Juan Zhou
- Forensic Identification Center, College of Criminal Investigation, Southwest University of Political Science and Law, Chongqing, People’s Republic of China
| | - Ya-Nan He
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Xian-Feng Liu
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Ming-Song Zhong
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Han Yang
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Chao Li
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Qi-Cheng Li
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Xia Huang
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Xiu-Mei Tian
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Da Qiu
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Guang-Lei He
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Li Yin
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Ying Wang
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| |
Collapse
|
14
|
Rosenblatt E, Fidarova E, Zubizarreta EH, Barton MB, Jones GW, Mackillop WJ, Cordero L, Yarney J, Lim G, Gan JV, Cernea V, Stojanovic-Rundic S, Strojan P, Kochbati L, Quarneti A. Radiotherapy utilization in developing countries: An IAEA study. Radiother Oncol 2018; 128:400-405. [PMID: 29859755 DOI: 10.1016/j.radonc.2018.05.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/09/2018] [Accepted: 05/15/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND The planning of national radiotherapy (RT) services requires a thorough knowledge of the country's cancer epidemiology profile, the radiotherapy utilization (RTU) rates and a future projection of these data. Previous studies have established RTU rates in high-income countries. METHODS Optimal RTU (oRTU) rates were determined for nine middle-income countries, following the epidemiological evidence-based method. The actual RTU (aRTU) rates were calculated dividing the total number of new notifiable cancer patients treated with radiotherapy in 2012 by the total number of cancer patients diagnosed in the same year in each country. An analysis of the characteristics of patients and treatments in a series of 300 consecutive radiotherapy patients shed light on the particular patient and treatments profile in the participating countries. RESULTS The median oRTU rate for the group of nine countries was 52% (47-56%). The median aRTU rate for the nine countries was 28% (9-46%). These results show that the real proportion of cancer patients receiving RT is lower than the optimal RTU with a rate difference between 10-42.7%. The median percent-unmet need was 47% (18-82.3%). CONCLUSIONS The optimal RTU rate in middle-income countries did not differ significantly from that previously found in high-income countries. The actual RTU rates were consistently lower than the optimal, in particular in countries with limited resources and a large population.
Collapse
Affiliation(s)
| | | | | | - Michael B Barton
- Ingham Institute for Applied Medical Research, UNSW, Sydney, Australia
| | - Glenn W Jones
- The Cancer Centre Eastern Caribbean, St. John's, Antigua and Barbuda
| | | | | | - Joel Yarney
- Centre for Radiotherapy and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Gerard Lim
- National Cancer Institute, Putrajaya, Malaysia
| | - John V Gan
- Jose R. Reyes Memorial Medical Centre, Quezon City, Philippines
| | | | | | | | | | | |
Collapse
|
15
|
Borras JM, Grau C, Corral J, Wong K, Barton MB, Ferlay J, Bray F, Lievens Y. Estimating the number of fractions by tumour site for European countries in 2012 and 2025: An ESTRO-HERO analysis. Radiother Oncol 2018; 126:198-204. [PMID: 29198408 DOI: 10.1016/j.radonc.2017.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/08/2017] [Accepted: 11/16/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE The optimal number of radiotherapy fractions is a relevant input for planning resource needs. An estimation of the total number of fractions by country and tumour site is assessed for 2012 and 2025. METHODS European cancer incidence data by tumour site and country for 2012 and 2025 were extracted from the GLOBOCAN database. Incidence and stage data were introduced in the Australian Collaboration for Cancer Outcomes Research and Evaluation (CCORE) model, producing an evidence-based proportion of incident cases with an indication for radiotherapy and fractions by indication. An indication was defined as a clinical situation in which radiotherapy was the treatment of choice. RESULTS The total number of fractions if radiotherapy was given according to guidelines to all patients with an indication in Europe was estimated to be 30 million for 2012; with a forecasted increase of 16.1% by 2025, yet with differences by country and tumour. The average number of fractions per course was 17.6 with a small range of differences following stage at diagnosis. Among the treatments with radical intent the average was 24 fractions, while it decreased to 2.5 among palliative treatments. DISCUSSION An increase in the total number of fractions is expected in many European countries in the coming years following the trends in cancer incidence. In planning radiotherapy resources, these increases should be balanced to the evolution towards hypofractionation, along with increased complexity and quality assurance.
Collapse
Affiliation(s)
- Josep M Borras
- Department of Clinical Sciences, IDIBELL, University of Barcelona, Spain.
| | - Cai Grau
- Department of Oncology, Aarhus University Hospital, Denmark
| | | | - Karen Wong
- CCORE Ingham Institute for Applied Medical Research, University of South New Wales, Liverpool, Australia
| | - Michael B Barton
- CCORE Ingham Institute for Applied Medical Research, University of South New Wales, Liverpool, Australia
| | - Jacques Ferlay
- Section on Cancer Surveillance, International Agency for Research on Cancer (IARC), Lyon, France
| | - Freddie Bray
- Section on Cancer Surveillance, International Agency for Research on Cancer (IARC), Lyon, France
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital, Belgium
| |
Collapse
|
16
|
Mendez LC, Moraes FY, Fernandes GDS, Weltman E. Cancer Deaths due to Lack of Universal Access to Radiotherapy in the Brazilian Public Health System. Clin Oncol (R Coll Radiol) 2017; 30:e29-e36. [PMID: 28988891 DOI: 10.1016/j.clon.2017.09.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/22/2017] [Accepted: 08/29/2017] [Indexed: 11/26/2022]
Abstract
AIMS Radiotherapy plays a fundamental role in the treatment of cancer. Currently, the Brazilian public health system cannot match the national radiotherapy demand and many patients requiring radiotherapy are never exposed to this treatment. This study estimated the number of preventable deaths in the public health system if access to radiotherapy was universal. MATERIALS AND METHODS Incidence rates for the year 2016 provided by Instituto Nacional de Cancer were used in this analysis. The number of untreated patients requiring radiotherapy was obtained through the difference between the total number of patients requiring radiotherapy and the total amount of delivered radiotherapy treatments in the public health system. The number of deaths for the three most common cancers in each gender due to radiotherapy shortage was calculated. Initially, the total number of patients per cancer type was divided in stages using Brazilian epidemiological data. Subsequently, previously published tree arm diagrams were used to define the rate of patients requiring radiotherapy in each specific clinical setting. Finally, the clinical benefit of radiotherapy in overall survival was extracted from studies with level 1 evidence. RESULTS Over 596 000 cancer cases were expected in Brazil in 2016. The public health system covers more than 75% of the Brazilian population and an estimated 111 432 patients who required radiotherapy in 2016 did not receive this treatment. Breast, colorectal and cervix cancers are the most frequent malignant tumours in women and prostate, lung and colorectal in men. The number of deaths due to a radiotherapy shortage in the year 2016 for these types of cancer were: (i) breast: 1011 deaths in 10 years; (ii) cervix: 2006 deaths in 2 years; (iii) lung: 1206 deaths in 2 years; (iv) prostate, intermediate risk: 562 deaths in 13 years; high risk: 298 deaths in 10 years; (v) colorectal: 0 deaths, as radiotherapy has no proven benefit in overall survival. CONCLUSION Thousands of cancer patients requiring radiotherapy do not have access to this treatment in the Brazilian public health system. The shortage of radiotherapy has a significant detrimental effect on cancer survival; over 5000 deaths would probably be prevented in the most common cancer types if radiotherapy access was universal.
Collapse
Affiliation(s)
- L C Mendez
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
| | - F Y Moraes
- Princess Margaret Hospital, University of Toronto, Toronto, Canada
| | - G Dos S Fernandes
- Hospital Sírio-Libanês, Brasilia, Brazil; Sociedade Brasileira de Oncologia Clinica, Brazil
| | - E Weltman
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Sociedade Brasileira de Radioterapia, Brazil
| |
Collapse
|
17
|
Analysis of Global Radiotherapy Needs and Costs by Geographic Region and Income Level. Clin Oncol (R Coll Radiol) 2017; 29:84-92. [DOI: 10.1016/j.clon.2016.11.011] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 11/14/2016] [Accepted: 11/17/2016] [Indexed: 11/21/2022]
|
18
|
Rodríguez A, Borrás JM, López-Torrecilla J, Algara M, Palacios-Eito A, Gómez-Caamaño A, Olay L, Lara PC. Demand for radiotherapy in Spain. Clin Transl Oncol 2016; 19:204-210. [PMID: 27492014 DOI: 10.1007/s12094-016-1525-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 06/10/2016] [Indexed: 01/05/2023]
Abstract
AIM Assessing the demand for radiotherapy in Spain based on existing evidence to estimate the human resources and equipment needed so that every person in Spain has access to high-quality radiotherapy when they need it. MATERIAL AND METHODS We used data from the European Cancer Observatory on the estimated incidence of cancer in Spain in 2012, along with the evidence-based indications for radiotherapy developed by the Australian CCORE project, to obtain an optimal radiotherapy utilisation proportion (OUP) for each tumour. RESULTS About 50.5 % of new cancers in Spain require radiotherapy at least once over the course of the disease. Additional demand for these services comes from reradiation therapy and non-melanoma skin cancer. Approximately, 25-30 % of cancer patients with an indication for radiotherapy do not receive it due to factors that include access, patient preference, familiarity with the treatment among physicians, and especially resource shortages, all of which contribute to its underutilisation. CONCLUSIONS Radiotherapy is underused in Spain. The increasing incidence of cancer expected over the next decade and the greater frequency of reradiations necessitate the incorporation of radiotherapy demand into need-based calculations for cancer services planning.
Collapse
Affiliation(s)
- A Rodríguez
- Department of Radiation Oncology, Hospital Ruber Internacional, C/La Masó 38, 28034, Madrid, Spain.
| | - J M Borrás
- Universidad de Barcelona, IDIBELL, Gran Vía de L'Hospitalet 199, Hospitalet del Llobregat, 08908, Barcelona, Spain
| | - J López-Torrecilla
- Department of Radiation Oncology, ERESA Hospital General Universitario, Calle de la Casa Misericordia 12, 46014, Valencia, Spain
| | - M Algara
- Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut Mar, Barcelona, Spain
- Universitat Pompeu Fabra, San José de la Montaña 12, 08024, Barcelona, Spain
| | - A Palacios-Eito
- Department of Radiation Oncology, Hospital Universitario Reina Sofía, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - A Gómez-Caamaño
- Department of Radiation Oncology, Hospital Clínico Universitario Santiago de Compostela, Travesia de Choupana s/n, 15706, Santiago de Compostela, La Coruña, Spain
| | - L Olay
- Department of Radiation Oncology, Hospital Universitario Central de Asturias (HUCA), Avenida de Roma s/n, 33011, Oviedo, Spain
| | - P C Lara
- Department of Radiation Oncology, Hospital Universitario Dr Negrín, Barranco de la Ballena s/n, 35010, Las Palmas, Spain
- Clinical Oncology, Universidad de Las Palmas, Las Palmas, Spain
| |
Collapse
|
19
|
Abstract
BACKGROUND Planning radiation oncology equipment and staffing is necessary in public healthcare systems in Europe. METHODS Three different data inputs were considered: evidence-based indications for radiotherapy, the incidence of cancer, and the stage at diagnosis of each cancer type, both the latter using population-based data from cancer registries. The availability of these data and the implications for the estimation of the proportion of new cancer patients who would need radiotherapy treatment at least once during the course of the disease is reviewed. RESULTS Depending on the frequency of cancers and the stage at diagnosis, it has been estimated that between 47% and 53% of incident cases among European countries would require external beam radiotherapy. When the actual data of utilization is compared with the evidence-based target, only one country in Europe has achieved full coverage. CONCLUSION It is argued that these should be considered the optimal proportions of cancer patients, but a more realistic policy target could be set at 80% or higher of the optimal proportion. This realistic target also takes into account the inherent uncertainties in the assessment of evidence, and other factors that influence clinical decision-making in cases of multi-morbidity or patient preferences. Other factors are associated with problems that should be dealt with in the framework of a cancer plan, such as accessibility, preference bias in physician evaluation of the indication or shortage of resources, and the impact of the reimbursement system. Finally, it is argued that a cancer plan is the framework for achieving policy targets in the appropriate coverage of the evidence-based indications for radiation oncology forecasts.
Collapse
Affiliation(s)
- Josep M Borras
- a Department of Clinical Sciences , University of Barcelona, IDIBELL, Hospitalet , Barcelona , Spain
| | - Yolande Lievens
- b Radiation Oncology Department,Ghent University Hospital , Ghent , Belgium
| | - Cai Grau
- c Department of Oncology , Aarhus University Hospital , Aarhus , Denmark
| |
Collapse
|
20
|
Rosenblatt E, Barton M, Mackillop W, Fidarova E, Cordero L, Yarney J, Lim G, Abad A, Cernea V, Stojanovic-Rundic S, Strojan P, Kobachi L, Quarneti A. Optimal radiotherapy utilisation rate in developing countries: An IAEA study. Radiother Oncol 2015; 116:35-7. [DOI: 10.1016/j.radonc.2015.06.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 06/09/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
|
21
|
The optimal utilization proportion of external beam radiotherapy in European countries: An ESTRO-HERO analysis. Radiother Oncol 2015; 116:38-44. [PMID: 25981052 DOI: 10.1016/j.radonc.2015.04.018] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 04/29/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE The absolute number of new cancer patients that will require at least one course of radiotherapy in each country of Europe was estimated. MATERIAL AND METHODS The incidence and relative frequency of cancer types from the year 2012 European Cancer Observatory estimates were used in combination with the population-based stage at diagnosis from five cancer registries. These data were applied to the decision trees of the evidence-based indications to calculate the Optimal Utilization Proportion (OUP) by tumour site. RESULTS In the minimum scenario, the OUP ranged from 47.0% in the Russian Federation to 53.2% in Belgium with no clear geographical pattern of the variability among countries. The impact of stage at diagnosis on the OUP by country was rather limited. Within the 24 countries where data on actual use of radiotherapy were available, a gap between optimal and actual use has been observed in most of the countries. CONCLUSIONS The actual utilization of radiotherapy is significantly lower than the optimal use predicted from the evidence based estimates in the literature. This discrepancy poses a major challenge for policy makers when planning the resources at the national level to improve the provision in European countries.
Collapse
|
22
|
Zubizarreta EH, Fidarova E, Healy B, Rosenblatt E. Need for radiotherapy in low and middle income countries – the silent crisis continues. Clin Oncol (R Coll Radiol) 2014; 27:107-14. [PMID: 25455407 DOI: 10.1016/j.clon.2014.10.006] [Citation(s) in RCA: 185] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 10/17/2014] [Indexed: 12/11/2022]
Abstract
About 57% of the total number of cancer cases occur in low and middle income countries. Radiotherapy is one of the main components of cancer treatment and requires substantial initial investment in infrastructure and training. Many departments continue to have basic facilities and to use simple techniques, while modern technologies have only been installed in big cities in upper-middle income countries. More than 50% of cancer patients requiring radiotherapy in low and middle income countries lack access to treatment. The situation is dramatic in low income countries, where the proportion is higher than 90%. The overall number of additional teletherapy units needed corresponds to about twice the installed capacity in Europe. The figures for different income level groups clearly show the correlation between gross national income per capita and the availability of services. The range of radiotherapy needs currently covered varies from 0% and 3-4% in low income countries in Latin America and Africa up to 59-79% in upper-middle income countries in Europe and Central Asia. The number of additional radiation oncologists, medical physicist, dosimetrists and radiation therapists (RTTs) required to operate additional radiotherapy departments needed is 43 200 professionals. Training and education programmes are not available in every developing country and in many cases the only option is sending trainees abroad, which is not a cost-effective solution. The implementation of adequate local training should be the following step after establishing the first radiotherapy facility in any country. Joint efforts should be made to establish at least one radiotherapy facility in countries where they do not exist, in order to create radiotherapy communities that could be the base for future expansion.
Collapse
Affiliation(s)
| | - E Fidarova
- International Atomic Energy Agency, Vienna, Austria
| | - B Healy
- International Atomic Energy Agency, Vienna, Austria
| | - E Rosenblatt
- International Atomic Energy Agency, Vienna, Austria
| |
Collapse
|