Radiotherapy demand and activity in England 2006-2020.

Area of Science:

• Oncology
• Radiotherapy
• Health Services Research

Background:

• Accurate prediction of radiotherapy demand is crucial for effective health resource allocation.
• Previous models, such as the National Radiotherapy Advisory Group (NRAG) model, provided estimates for radiotherapy needs.
• Observed radiotherapy usage data is available through the English radiotherapy dataset (RTDS).

Purpose of the Study:

• To compare radiotherapy demand predictions from the Malthus model with the NRAG model, international literature, and observed RTDS data in England.
• To assess current radiotherapy provision against estimated demand and international best practices.

Main Methods:

• A systematic review of evidence for radiotherapy across cancer types and stages was conducted.
• Twenty-two decision trees were developed to calculate radiotherapy demand using English cancer incidence and stage at presentation data (2007-2009).
• The Malthus model was utilized, incorporating population growth and aging for predictive analysis.

Main Results:

• The Malthus model suggests reduced indications for radiotherapy, particularly for lung cancer and rarer tumors, estimating 40.6% of patients should receive radiotherapy.
• In 2011, estimated demand was 48,827 attendances per million population, significantly higher than the observed 32,071 attendances per million in the RTDS.
• A 50% increase in activity is required to meet estimated demand, indicating underprovision across all cancers and non-compliance with international dose fractionation norms.

Conclusions:

• Despite a 14% increase in service activity between 2006-2011, radiotherapy access in England remains low.
• Estimated demand has risen by 11%, outpacing service increases.
• English radiotherapy dose fractionation practices continue to deviate from international evidence-based standards.