Radiation Therapy Utilization in Middle-Income Countries.

The planning of national radiotherapy services requires a thorough knowledge of the national cancer epidemiology profile, the radiotherapy utilization (RTU) rates, and a realistic future projection of these data. The hypothesis is that optimal RTU rates are similar in middle income to those in high-income countries, while the actual utilization proportion is lower. The IAEA conducted a project to establish the optimal and actual RTU rates in 9 middle-income countries. The optimal RTU rate is the proportion of all cancers with an indication for radiotherapy. An indication is defined as a clinical scenario where radiotherapy is the treatment of choice because it yields superior clinical outcomes as per published literature. The distribution of tumor types for each country was obtained from Globocan-2012. An evidence-based computation model was used based on data from high income countries (CCORE Australia). The actual RTU rate was determined by prospectively registering 300 consecutive patients receiving radiotherapy at a leading RT center in each country, capturing detailed data on patient, tumor, and treatment characteristics from this sample. The total number of patients receiving RT in the index year (2012) was obtained from all RT departments in each country. The optimal and actual overall RTU rates for the 9 countries are shown (Table 1). There was a difference of 9% between the lowest optimal RTU in Costa Rica (47%) and the highest in Tunisia (56%) due to differences in the incidence of cancer types treatable with radiotherapy. The results show that the actual proportion of cancer patients receiving RT (median actual RTU rate = 28%) is lower than the optimal RTU rate for each country, with a difference between 10% (Tunisia) and 42.7% (Philippines). The median percent unmet need was 47%.Tabled 1Abstract 82; Table 1CountryNew cancer cases 2012No tele- therapy machines (in 2012)TT machines/ 1000 cancer cases (in 2012)ALL RT patients in 2012New RT patients in 2012Reirradia tion rate (%)Optimal RTU rate (%)Actual RTU rate (%)Unmet need (%)*Costa Rica8,90080.893,4873,13810473525.5Ghana15,80030.191,4801,376751982.3Malaysia37,400360.9611,63610,38512532847Philippines98,200340.3410,89410,0877.45310.380.5Romania78,800230.2919,49017,34611522257.6Serbia42,200150.3512,73910,046215223.854Slovenia11,50080.74,7523,60224483135.4Tunisia12,200161.36,3005,67010564618Uruguay13,357141.055,7505,02013523729(*) Percent unmet need = [(optimal RTU rate – actual RTU rate)/optimal RTU rate] × 100. Open table in a new tab (*) Percent unmet need = [(optimal RTU rate – actual RTU rate)/optimal RTU rate] × 100. The optimal RTU rate in this group of middle-income countries did not differ significantly from that in high income countries. However, the actual RTU rates were consistently lower than optimal RTU rates. The gap between optimal and actual RTU rates as well as the calculated percent unmet need could be partially explained by obstacles to access to existing RT services.