ESTRO 36 Abstract Book

S46 ESTRO 36 2017 _______________________________________________________________________________________________

Purpose or Objective Planning for radiotherapy (RT) services requires information on the proportion of patients who should be given RT during their cancer journey. CCORE has previously estimated optimal rates of radiotherapy utilization (RTU) based on the development of decision- trees using evidence-based treatment guidelines and epidemiological data. Mackillop and colleagues in Ontario established a Criterion-Based Benchmarking (CBB) approach to estimate the proportion of cancer patients who should be treated with RT. Aims: 1. Calculate actual RTU rates for NSW-ACT patients 2. Identify benchmark communities 3. Calculate RTU rates for the benchmark communities 4. Compare actual and CBB RTU with the estimated optimal RTU rates Material and Methods RT data were collected from all RT centers in NSW and ACT for Jan-2004 to Jun-2007 and were linked to Central Cancer Registry records. Road distance between patient residence and the nearest RT center was calculated. Cancer patients who lived nearer to RT center outside NSW or ACT were excluded. Non NSW-ACT residents who were treated in NSW or ACT were also excluded. Adjacent Local Government Areas (LGAs) with <500 patients in each LGA were merged to form larger geographical areas with number of patients equivalent approximately to the average number of patients in other LGAs. LGAs with public RT center that satisfy the following RT benchmarking criteria were selected, where: 1. Patients make no direct payment for RT 2. All RT is provided by site-specialized radiation oncologists in multi-disciplinary centers 3. Radiation oncologist receive a salary for their service 4. >75% of patients live within 30 km from the nearest RT, and 5. Patients waiting times were <4 weeks Results Overall, 25.4% of patients received radiotherapy as part of their initial treatment (within 1-year of diagnosis) in the CBB LGAs compared to 22.1% in all LGAs. For patients diagnosed with cancer of breast, prostate, lung, rectum or cervix, the proportions of patients who received RT within 1-year were 60%, 22%, 40%, 26% and 53% in the CBB LGAs compared to 51%, 19%, 36%, 24% and 49% in all LGAs, respectively. The corresponding optimal RTU were 82%, 55%, 70%, 63% & 71%, respectively. Table-1 shows a comparison between our data and Ontario, Canada. Figure 1 shows RTU rates for all LGAs in NSW and ACT.

for England. Hence, the gap between delivered and theoretical maximum demand can be calculated. With the gap quantified, adjustments can be made to the delivered radiotherapy treatments in different age groups, or to access rates, to estimate the increase in demand for services. Results Figure 1. shows the difference between modelled demand and delivered treatment. In the age bands there is a small fall-off in the number of fractions prescribed per incidence at the ages above 75 and a more marked drop- off above 80, shown in Table 1. However, the access rate appears to be declining steadily from an earlier age. If the average attendance per episode was to increase to a more steady decline of a few fractions per age band (80-84: 12.5#, 85+:10#) then demand would increase by 41,000 fractions per year. If access rate was to increase to account for a greater number of elderly being treated (80- 84:32%, 85+:28%) then demand would increase by 44,000 fractions per year. If both the access rate and fractionation increased then demand would increase by 97,000 fractions per year. The effects on local populations will vary, considering Malthus predicts demand across England to vary between 19,000 fractions per million to 80,000 fractions per million.

Conclusion Even with relatively minor increases to access rate and fractionation, the modelled fraction burden increases significantly enough to require extra investment in services. The numbers presented here are for England as a whole, however considerable regional differences are to be expected. A non-urban retirement area could expect a much greater increase in fraction burden with a change in the paradigm for treatment of the elderly, compared to inner-city hospitals that have a much younger population. Additionally, machine throughput would have to be studied closely as the elderly often take longer to treat due to patient factors such as decreased mobility. PV-0092 Criterion-Based Benchmarking approach of the appropriate use of radiotherapy in NSW-ACT, Australia G. Gabriel 1 , G. Delaney 1 , M. Barton 1 1 Ingham Institute for Applied Medical Research, Collaboration for Cancer Outcomes Research and Evaluation CCORE and University of NSW, Liverpool- NSW, Australia