Abstract
Radiation therapy is one of the core components of multidisciplinary cancer care. Although ~ 50% of all European cancer patients have an indication for radiotherapy at least once in the course of their disease, more than one out of four cancer patients in Europe do not receive the radiotherapy they need. There are multiple reasons for this underutilisation, with limited availability of the necessary resources – in terms of both trained personnel and equipment – being a major underlying cause of suboptimal access to radiotherapy. Moreover, large variations across European countries are observed, not only in available radiotherapy equipment and personnel per inhabitant or per cancer patient requiring radiotherapy, but also in workload. This variation is in part determined by the country's gross national income. Radiation therapy and technology are advancing quickly; hence, recommendations supporting resource planning and investment should reflect this dynamic environment and account for evolving treatment complexity and fractionation schedules. The forecasted increase in cancer incidence, the rapid introduction of innovative cancer treatments and the more active involvement of patients in the healthcare discussion are all factors that should be taken under consideration. In this continuously changing oncology landscape, reliable data on the actual provision and use of radiotherapy, the optimal evidence‐based demand and the future needs are crucial to inform cancer care planning and address and overcome the current inequalities in access to radiotherapy in Europe.
Highlights
Radiotherapy is an essential part of the multidisciplinary treatment approach for a large number of cancer types
The results showed that the overall utilisation was 37%, significantly lower than the calculated optimum of 53%, but in line with the advised radiotherapy from the multidisciplinary cancer team (MDT) (35%)
While Directory of Radiotherapy Centres (DIRAC) collects data from departments on voluntary basis, the European Society for Radiotherapy and Oncology (ESTRO)-Health Economics in Radiation Oncology (HERO) taskforce collected radiotherapy resource data in Europe at country level, through an 84-item web-based survey, which was completed through close interaction between the HERO collaborators and the representatives of the National Societies (NS) for radiation oncology in 40 European countries (Dunscombe et al, 2014; Grau et al, 2014; Lievens et al, 2014)
Summary
Radiotherapy is an essential part of the multidisciplinary treatment approach for a large number of cancer types. The slow and variable implementation of innovative treatment strategies into clinical practice has been described as a major barrier leading to substantial inequalities in cancer care (Ringborg, 2019) This may partly be attributed to the variation in availability of and access to the necessary healthcare resources, which should be addressed (Sullivan et al, 2011). Examples of similar analyses and subsequent actions carried out at country level – for example in The Netherlands and Denmark – demonstrate the usefulness of such approach to effectively cope with existing availability and access gaps (Overgaard, 2015; Slotman and Vos, 2013) In this Review article, we first address the needs for and actual use of radiotherapy, and describe the actual provision of radiotherapy resources in Europe, one of the main factors determining radiotherapy utilisation, to conclude with some policy recommendations that could address the described gaps in use and provision
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