OC-0193: Current radiotherapy capacity in post-Soviet countries; an IAEA survey

Eduardo Rosenblatt, Elena F. Fidarova, Olga Utehina, С. И. Ткачев, M. Kislyakova, Nataliya G. Semikoz, Valery Sinaika, V. Kim, Nerses Karamyan, I. Isayev

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Kamal Akbarov, Darejan Lomidze, Oksana Bondareva, P. Tuzlukov, Manzura Zardodkhonova, Jamshid M Alimov, G.W. Jones, Michael Bernard Barton, W.J. Mackillop

2015

Full text Open access: Hybrid Metadata (CSL-JSON)
DOI 10.1016/s0167-8140(15)40191-4
Data confidence 70 medium
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Abstract

Purpose/Objective: Optimal radiotherapy utilization (RTU) rate has been studied for developed countries following an evidence-based, criterion-based method or based on assessment of current practice.In Australia, it has been determined to be 52.3% in 2003 later adjusted to 48.3% in 2012.For developing countries, current estimates of the proportion of cancer patients who require radiotherapy can be estimated from the distribution of cancer types and stages.The purpose of this project was to assess the optimal RTU rates in 9 middle-income countries, following an evidence based method.Materials and Methods: Nine middle-income countries were selected to participate in this assessment.International guidelines were reviewed for external beam radiotherapy indications.Epidemiological data on the proportion of new cases of cancer with indication for radiotherapy specifically for the 9 target countries were identified.Indications and epidemiological data were merged to develop an optimal radiotherapy utilisation tree following the Collaboration for Cancer Outcomes Research and Evaluation (CCORE) method.Univariate and Monte Carlo simulations were used in sensitivity analysis.Globocan-2012 lists 27 tumour types and there is a difference between the total for the individual tumour sites and the total number of cancers reported overall.The database does not report a separate 'unknown' category.The difference between the total cancer cases and the sum of the 27 identified cancer types is a combination of 'other' and 'unknown' cancers.'Other' and 'unknown' are split roughly 50:50 in Australia where 'other' has an optimal RTU rate of 19% and 'unknown' of 61%.The average is thus 40%.We have assumed this is the same in the 9 target countries.It is probably an underestimate as there are likely to be higher proportions of unknown in middle income countries.This project also includes a prospective direct assessment of the actual RTU rates in these countries and the results will be reported separately. Results:The optimal overall RTU rates found for the target countries were: Costa Rica 47%, Ghana 50%, Malaysia 52%, Philippines 52%, Romania 51%, Serbia 53%, Slovenia 48%, Tunisia 54% and Uruguay 51%.The mean value was 51%.There was a difference of 7% between the lowest optimal RTU in Costa Rica (47%) and the highest in Tunisia (54%).This difference may be due to the incidence of three types of cancers treatable with radiotherapy and which have a lower incidence in Costa Rica than in Tunisia: bladder (1.8% vs. 6.5%),lung (6.6% vs. 20.0%)and nasopharynx (0.8% vs. 3.8%).27.4% of all cancers in Ghana were cervix ca. with colorectal 1.7%.However, the category 'other and unknown' in Ghana was 11.5% probably reflecting issues with cancer registration.Conclusions: The optimal RTU rate in this group of 9 middleincome countries did not differ significantly from that found in higher income countries.