ESTRO 2024 - Abstract Book

S1987

Clinical - Mixed sites, palliation

ESTRO 2024

1 University of Leeds, Leeds Institute of Health Sciences, Leeds, United Kingdom. 2 Leeds Teaching Hospitals NHS Trust, Leeds Cancer Centre, Leeds, United Kingdom. 3 NHS England, National Disease Registration Service, London, United Kingdom. 4 University College London, Behavioural Science and Health, London, United Kingdom

Purpose/Objective:

Modelling suggests that approximately 40-50% of all patients with cancer will require radiotherapy during their disease course, with radiotherapy contributing to 40% of cancer cures and forming the principle treatment modality in 16%.(1 – 4) Yet estimates of observed utilisation rates demonstrate wide variation between healthcare jurisdictions. In particular, the UK has been found to have lower rates of utilisation than international peers.(1) Whilst important these analyses are inherently limited by the available data, leading to limited understanding of the underlying causes of variation and risking policy marginalisation as a result. By using robust, patient-level data captured and curated by the National Disease Registration Service (NDRS), in partnership with The Radiotherapy Transformation Programme, NHS England, this study seeks to better understand variation in radiotherapy utilisation across the English NHS. By considering utilisation across regional healthcare geographies, we aim to identify areas with low utilisation to inform future in-depth analyses that can enable targeted intervention to improve utilisation. The National Radiotherapy Dataset (RTDS), collected by NDRS, is a mandated dataset that captures information on all radiotherapy episodes delivered in the English NHS.(5) To understand utilisation of radiotherapy across the English NHS during a calendar period, all records for radiotherapy activity taking place in 2020 were linked to cancer registration data for tumours diagnosed during 1995-2020.(6) 2020 was the most recent year for which linked cancer registration and radiotherapy data were available. First, we calculated a measure of overall radiotherapy activity as the ratio of the number of malignant tumours (ICD10 C00-C97, D05 excl. C44) treated with RT during 2020 over the number of malignant tumours diagnosed during 2020 (those in the numerator not always being in the denominator). Subsequently we considered only those diagnosed with stage 1-3 cancers and treated with curative radiotherapy during 2020 within a year of diagnosis (potentially treatable with curative intent radiotherapy) relative to a denominator of the number of stage 1-3 cancers diagnosed in 2020. These measures were calculated nationally and for patients resident in each sub-Integrated Care Board (sub-ICB) at the time of diagnosis.(7) Whilst a cohort approach, following up all patients diagnosed within a calendar period, would enable identification of the percentage of patients diagnosed with cancer who underwent radiotherapy, to capture all radiotherapy activity this approach relies upon a prolonged follow-up period, thus limiting interpretation with reference to contemporaneous radiotherapy services. The methodology applied here addresses this concern by considering all radiotherapy delivered in a given calendar period, however, it must be recognised that the presented measure is not as intuitive. Material/Methods:

Results:

A total of 294,366 tumours were diagnosed in 2020. In the same period 112,494 malignant tumours were treated with radiotherapy (corresponding to 133,678 episodes of radiotherapy). This latter group could have been diagnosed prior to 2020. As such, for every 100 tumours diagnosed in England in 2020, 38.2 tumours were treated