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Estimation of the optimal radiotherapy utilization rate for childhood neuroblastoma
Azumi Fukushima1, Varsha Hande2, Katherine Wakeham2
1Applied Radiation Biology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria; Department of Health Risk Communication, Fukushima Medical University, Fukushima, Japan.
Insights
The optimal utilization rate of radiotherapy (oRUR) for pediatric neuroblastoma is 64% globally. This rate varies by income, with low- and middle-income countries showing higher needs due to advanced tumor stages.
Area of Science:
- Pediatric Oncology
- Radiation Oncology
- Health Services Research
Background:
- Optimal utilization rate of radiotherapy (oRUR) is key for cancer care access.
- Radiotherapy is used in ~50% of adult cancers, but data for pediatric cancers is scarce.
- This study focuses on estimating oRUR for childhood neuroblastoma.
Purpose of the Study:
- To develop a model for estimating the optimal utilization rate of radiotherapy in pediatric neuroblastoma.
- To assess global and regional variations in radiotherapy needs for this cancer.
Main Methods:
- A decision tree model was developed using systematic review and meta-analysis of radiotherapy indications and epidemiological data.
- Sensitivity analyses were conducted to assess the impact of variations in treatment protocols.
- oRUR was calculated for global, high-income, and low- and middle-income settings.
Main Results:
- The global oRUR for pediatric neuroblastoma was estimated at 64% (95% CI: 58%-71%).
- oRUR was 50% in high-income countries and 68% in low- and middle-income countries.
- Variations in radiotherapy indications across major international protocols had minimal impact.
Conclusions:
- Estimating oRUR is vital for evaluating radiotherapy practices and access in childhood cancer care.
- Approximately 64% of children with neuroblastoma require radiotherapy.
- Disparities in tumor stage distribution, linked to healthcare access, result in higher radiotherapy indications in low- and middle-income countries.
Background And Purpose:
The optimal utilization rate of radiotherapy (oRUR) serves as a benchmark for assessing service demand and improving access to cancer care. While it is estimated that approximately 50 % of adult cancer patients require external beam radiotherapy during their treatment, there is a scarcity of data regarding the optimal use of radiotherapy in pediatric cancer. In this study, we adopted an established method and developed a model to estimate the oRUR in childhood neuroblastoma.
Materials And Methods:
We developed a decision tree model to calculate the oRUR using indications for radiotherapy and corresponding epidemiological data collected through systematic review and meta-analysis. Sensitivity analyses were performed to evaluate the impact of variations in radiotherapy indications between treatment protocols and variables in the model. We calculated and compared the oRUR for global, high-income, and low- and middle-income settings.
Results:
The oRUR for pediatric neuroblastoma was 64 % (95 % CI: 58 %-71 %) in the global setting, 50 % in high-income countries, and 68 % in low- and middle-income countries. The impact of variation in radiotherapy indications between major international treatment protocols was negligible.
Conclusion:
The knowledge of oRUR is crucial for evaluating current practices, identifying gaps in access, and planning future radiotherapy services for treating childhood cancer. Based on our results, 64 % of children with neuroblastoma have an indication for radiotherapy. Patients in low- and middle-income countries have more indications for radiotherapy than those in high-income countries, due to a more adverse tumour stage distribution caused by limited access to healthcare resources.
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