Radiotherapy access in Belgium: How far are we from evidence-based utilisation?

Area of Science:

• Oncology
• Health Economics
• Radiation Oncology

Background:

• Global underutilization of radiotherapy is a recognized issue.
• The European SocieTy for Radiotherapy and Oncology - Health Economics in Radiation Oncology (ESTRO-HERO) project established optimal utilization proportions (OUPs).

Purpose of the Study:

• To evaluate radiotherapy utilization in Belgium by comparing actual utilization proportions (AUPs) with OUPs and advised radiotherapy from multidisciplinary team (MDT) meetings.
• To analyze the impact of independent variables on radiotherapy utilization.

Main Methods:

• Calculated AUPs and advised radiotherapy for 110,810 cancer diagnoses (2009-2010) using reimbursement data.
• Distinguished between palliative and curative external beam radiotherapy (EBRT) and brachytherapy (BT).
• Performed sensitivity analyses on follow-up period, survival length, and patient age.

Main Results:

• Overall AUP was 37% (39% with BT), lower than the OUP of 53%, but aligned with advised radiotherapy (35%).
• Significant variations observed by tumor type, with lower AUP than OUP for lung and prostate cancers, but concordance for breast and rectal cancers.
• 84% of treatments initiated within 9 months; survival influenced AUP, and elderly patients received less radiotherapy.

Conclusions:

• Actual radiotherapy delivery in Belgium aligns with MDT advice but falls short of evidence-based optimal levels.
• Further investigation into barriers is crucial for effective radiotherapy forecasting, planning, and ensuring adequate patient access.