ESTRO 38 Abstract book

S123 ESTRO 38

The objective of this study was to assess the actual utilization of external beam radiotherapy in two population based cancer registries in Girona and Tarragon, Catalonia, Spain. In addition, problems of access due to distance between patients residence to radiotherapy departments were analysed. Material and Methods There are two cancer registries in Catalonia, Girona (750,000 inhabitants) and Tarragona (800,000 inhabitants), in both cases only one Radiation oncology department is available in each health region. All incident cancer patients (with the exception of non-melanoma skin cancers) of both regions diagnosed during the years 2009- 2011 were linked to the reimbursement database of the Catalonian Health Care Service. We calculated the proportion of patients receiving a external radiotherapy treatment during the first year after the diagnosis of the cancer, by type of tumour. Only the first radiotherapy treatment was included in this analysis, even if they subsequently received a retreatment. Results The proportion of incident cases receiving radiotherapy treatment during the first year after diagnosis was 24.3%. The proportion of treatments decreased significantly at older ages (from 21.3% younger than 40 years old and 32% for 40-64 to 14.3% in patients older than 75 years). There were no differences in uptake of radiotherapy by distance from the residence of the patient to the Radiation oncology department. The tumour sites (all stages at diagnosis) with highest proportion of radiotherapy use in the first year after diagnosis were breast (58%), head and neck (42%), Rectum (41%), Prostate (33%) and lung (30%). Conclusion There is a significant gap between optimal use and actual use (although this study is focused on first year after diagnosis) and this is especially relevant in some tumour sites like bladder and haematological cancers. Population based data on actual use is an essential element for planning resources needed and it makes feasible to assess potential factors to explain the optimum-actual utilization gap and to reduce it when required to increase evidence based indications of radiation oncology. PV-0253 A critical quality appraisal of studies estimating the cost of radiotherapy N. Defourny 1 , Y. Lievens 2 , C. Monten 2 , J. Monnet 3 , P.B. Dunscombe 4 , C. Grau 5 , L. Perrier 6 1 ESTRO A.I.S.B.L., HERO, Brussels, Belgium; 2 Ghent University Hospital, Department of Radiation Oncology, Ghent, Belgium ; 3 Leon Berard Cancer Centre, Univ Lyon, Lyon, France; 4 University of Calgary, Department of Medical Physics, Calgary, Canada; 5 Aarhus University Hospital, Department of Oncology, Aarhus, Denmark ; 6 Leon Berard Cancer Centre, Clinical research platform, Lyon, France Purpose or Objective The rapid innovation in technique and technology of the radiotherapy increases the necessity of health economic evaluation (HEE). Indeed, given their increasing impact of HEE studies on policy, it is essential to appreciate their quality. We aim to assess the quality of selected HEE studies of radiotherapy against quality instruments, such as checklists. In addition, we want to evaluate differences between quality instruments and how well they perform in practice, with a dedicated focus on the costing side. Material and Methods Building upon a previous systematic literature review of EBRT costing studies (Defourny et al., 2016) published from 2004-2015 in MEDLINE, Embase and the NHS EED databases, an assessment of the quality of the selected articles was performed by four independent reviewers. Based on 3 existing instruments - CHEC, CHEERS, and QHES - the selected articles were critically rated focusing on the

(Qikiqtaaluk), to other regions in Canada and England. We calculated this region’s RTU from 2011–2016, and compared it to the modelled optimal RTU (ORTU) using the evidence-based MALTHUS model, which contains 2,000 clinical decisions relating to RT. RTU for the Qikiqtaaluk region was obtained using incidence data from the Nunavut cancer registry and treatment data from the region’s oncology referral centre, The Ottawa Hospital Cancer Centre (TOHCC). Results The all-cancer incidence rate in the Qikiqtaaluk region was 265 per 100,000 over a 5-year period, compared to 524 in Canada, 546 in Ontario, and 536 in England. Figure 1 displays the incidence rate split by age range. This, in contrast to the lower overall cancer incidence rate, reveals a markedly higher incidence among older age ranges in the Qikiqtaaluk region compared to others. Of the cancer registry patients, 68% were seen at TOHCC. However, at least 20 cancer patients seen at TOHCC did not have a record in the cancer registry, suggesting under- reporting of Nunavut’s cancer incidence. The majority of patients were diagnosed at stage IV (33%). The most common cancer type was lung (38%). The ORTU, based on the UK Malthus evidence-base, is 43% (excluding retreatments). Actual RTU for the Qikiqtaaluk region was 54%.

Conclusion This is the first study to describe RTU among any Inuit population worldwide. The Qikiqtaaluk region displays a lower overall cancer incidence, which may in part be due to under-reporting. Despite this, the 3-fold increased incidence among the region’s older population is alarming. The higher calculated RTU among the Qikiqtaaluk region is also likely attributed to under-reporting of the cancer incidence. Solutions to increase RT uptake should include the development of robust systems for cancer reporting within the territory, in partnership with their oncology referral centres. Concurrently, novel models of RT delivery must not only address geographical barriers, but also the unique sociodemographic and cultural needs of this under-served population. Further in-depth analyses comparing incidence, stage and RTU for regions within HICs exhibiting LMIC traits is in progress. PV-0252 From theory to practice: assessing the use of radiotherapy in population based cancer registries J.M. Borras 1 , J. Corral 1 , J. Galceran 2 , R. Marcos-Gragera 3 , L. Vilardell 3 , J. Solà 1 , A. Ameijide 2 , M. Carulla 2 , X. Cardó 2 , À. Izquierdo 3 , J.A. Espinàs 1 1 IDIBELL, Catalan Cancer Plan, Hospitalet del Llobregat, Spain ; 2 FUNCA, Registre de Càncer de Tarragona, Reus, Spain; 3 IDIBGI, Unitat d'Epidemiologia i Registre del Càncer de Girona, Girona, Spain Purpose or Objective Planning for radiotherapy services requires evidence based information on the optimum and the actual use of this therapy in a population in order to assess the potential gaps in the utilization of external beam radiotherapy.