Review: demand for radiotherapy
Estimating the demand for radiotherapy from the evidence: A review of changes from 2003 to 2012

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Abstract

Background and Purpose

In 2003 we estimated that 52.3% of new cases of cancer in Australia had an indication for external beam radiotherapy at least once at some time during the course of their illness. This update reviews the contemporary evidence to define the optimal proportion of new cancers that would benefit from radiotherapy as part of their treatment and estimates the changes to the optimal radiotherapy utilisation rate from 2003 to 2012.

Materials and Methods

National and international guidelines were reviewed for external beam radiotherapy indications in the management of cancers. Epidemiological data on the proportion of new cases of cancer with each indication for radiotherapy were identified. Indications and epidemiological data were merged to develop an optimal radiotherapy utilisation tree. Univariate and Monte Carlo simulations were used in sensitivity analysis.

Results

The overall optimal radiotherapy utilisation rate (external beam radiotherapy) for all registered cancers in Australia changed from 52.3% in 2003 to 48.3% in 2012. Overall 8.9% of all cancer patients in Australia have at least one indication for concurrent chemo-radiotherapy during the course of their illness.

Conclusions

The reduction in the radiotherapy utilisation rate was due to changes in epidemiological data, changes to radiotherapy indications and refinements of the model structure.

Section snippets

Materials and methods

The methodology for this updated review is based on that used in our original review of optimal radiotherapy utilisation [2] and is outlined in brief below.

The study population included all cancer cases notified to Australian Central Cancer Registries as reported by the Australian Institute of Health and Welfare (AIHW) in Australia in 2008 (the most recently available year) [22]. An indication for radiotherapy was defined as a clinical situation for which radiotherapy is recommended as the

Results

The optimal RUR by tumour site calculated in 2003 and the revised rates calculated in 2012 are shown in Table 1, which also reports the number of changes to the radiotherapy indications for each cancer site. The overall optimal RUR for all registered cancers in Australia changed from 52.3% in 2003 to 48.3% in 2012.

The 2012 optimal RUR decreased by more than 5% compared to the optimal rate estimated in 2003 for cancers of the bladder, brain, colon, kidney, oesophagus, pancreas, stomach, uterus,

Discussion

This update of our original model was undertaken to inform planning models for future radiotherapy services. The revised optimal RUR calculated in 2012 was 48.3% as compared to the original rate of 52.3% calculated in 2003. The reduction in the optimal utilisation rate was caused by changes in epidemiological data, changes in radiotherapy recommendations and structural changes to the model.

The factors that accounted for maximum variability in the model were the uncertainty in the choice between

Conflict of interest statement

All authors declare that there are no conflicts of interest.

Acknowledgements

This study was funded by the Commonwealth Department of Health and Ageing, Australia. The work of Timothy P. Hanna was funded in part by the Ontario Institute for Cancer Research through funding provided by the Government of Ontario.

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