ESTRO 37 Abstract book

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ESTRO 37

5 The Norwegian Radiation Protection Authority, KVIST group, Østerås, Norway Purpose or Objective Palliative radiotherapy (PRT) comprises half of all radiotherapy use and is an effective and important treatment modality for improving quality of life in incurable cancer patients. In this study, we aimed to describe the use of PRT in Norway and to identify and quantify factors associated with PRT utilization. Material and Methods We used population-based data from the Cancer Registry of Norway to identify the 25,281 patients who died of cancer, 1 Jul 2009–31 Dec 2011, and to obtain complete, prospectively registered radiotherapy data on each cancer patient. Individual-level data on socioeconomic status was retrieved from Statistics Norway. The proportion of patients who had PRT within the last two years of life (PRT 2Y ) was calculated, and multivariable logistic regression was used to determine factors that influenced the PRT 2Y . Results The overall PRT 2Y for all cancer sites combined was 29.6% with wide geographic variations (standardized inter- county range, 21.8%–36.6%). Female gender, advanced age at death, certain cancer sites, short survival time, and previous receipt of curative radiotherapy were all associated with decreased odds of receiving PRT. Patients with low education, those living in certain counties, or with travel distances 100–499 km, were also less likely to receive PRT. Patients with high household income (adjusted odds ratio (OR) 1.58; 95% confidence interval (CI) 1.39–1.78) and those diagnosed in hospitals with radiotherapy facility (OR 1.42; 95% CI 1.30–1.55) had higher likelihood of receiving PRT. Conclusion Despite free and universal healthcare coverage in a highly egalitarian country such as Norway, the use of PRT seems to be influenced by factors unrelated to patients’ needs. Even after adjustments for relevant factors, unexplained geographic variations exist. OC-0067 Radiotherapy in small countries M. Barton 1 , E. Zubizarreta 2 , J. Polo Rubio 2 1 Ingham Institute for Applied Medical Research, Collaboration for Cancer Outcomes Research and Evaluation CCORE, Liverpool BC- NSW, Australia 2 International Atomic Energy Agency, Applied Radiation Biology and Radiotherapy Section- Division of Human Health e Department of Nuclear Sciences and Applications, Vienna, Austria Purpose or Objective Radiotherapy is an essential part of the treatment of cancer and is indicated at least once in about half of all cancer patients. However access to the therapy is often limited or not available at all in many countries. Countries with smaller populations and lower economic status face additional challenges to justify the investment in the treatment. This study aims to examine the availability of radiotherapy in small countries and the factors influencing the establishment of radiotherapy. Material and Methods A small country was defined as a country with a population less than one million persons. The economic status of each country was defined using the World Bank Classification. The number of cancers in each country was obtained from GLOBOCAN 2012. The number of cancer cases with an indication for radiotherapy was calculated using the CCORE model. The available radiotherapy equipment in the country was obtain through the DIRAC database and complemented with information obtained directly from certain countries Results

Results The national cost estimate of EBRT in Europalia was 206,788,579€. The cost of personnel and equipment respectively represented 37% and 34%; the EBRT process- support 20% and the RO program support 9%. The cost of curative breast cancer treatment accounts for 25% of the national cost of EBRT while 18% was linked to radical prostate and 12% to lung treatments. The average cost per EBRT course was 3691€. The cost varied depending on the type of technique (e.g. 3D-CRT 3284€, IMRT 4394€) and fractionation schedule (e.g. standard fractionation 5633€, extreme hypofractionation 1157€), translating into different average costs per tumor site (e.g. 3525€; 6347€; 5667€ respectively for breast, prostate and lung EBRT). The choice for optional procedures (e.g. daily imaging, average cost 1079€) adds to the variability. Besides cost estimation, resource time utilization was calculated as shown in figure 1. Based on the working hours of personnel and procedure times in Europalia, treatment delivery and planning task groups would require an additional 68% and 38% of FTE. In analogy, treatment machines were over-used by 45%.

Conclusion While the presented results are not generalizable, this example of using the TD-ABC model illustrates how it estimates the cost of EBRT at the national level and the cost per EBRT course distinguishing between technologies, fractionation schedules and tumor sites. Insights into the utilization of the available national resources contribute to predicting the need for EBRT, but highlight the necessity for more validated time estimates. The methodology can be used to test different operational scenarios simulating future changes of practice. OC-0066 Factors influencing access to palliative radiotherapy - a Norwegian population-based cohort study L. Asli 1 , T.A. Myklebust 2 , S. Kvaløy 3 , V. Jetne 4 , B. Møller 2 , S. Levernes 5 , T.O. Green 4 , T.B. Johannesen 2 1 Oslo University Hospital and The Cancer Registry of Norway, Department of Oncology and Department of Registration, Oslo, Norway 2 Cancer Registry of Norway, Department of Registration, Oslo, Norway 3 Oslo University Hospital, Department of Oncology, Oslo, Norway 4 Oslo University Hospital, Department of Medical Physics, Oslo, Norway