Klik om de stijl te bewerkenVUmc

Guidelines for radiotherapy staffing and infrastructure in Europe

“QUARTS”

Ben Slotman, MD,PhD

Professor & Chair

VU University medical center

Amsterdam, The Netherlands

Klik om de stijl te bewerkenVUmc Methods

• 2003 Q1: Questionnaires on guidelines for equipment and personnel and on reimbursment system

• 2003 Q1-2: Contact by phone, fax, mail, e-mail

• 3 groups of countries based on GDP/capita:– High resource >10 K USD (n=23)– Medium resource 3-10 K USD (n= 9)– Low resource <3 K USD (n=12)

Klik om de stijl te bewerkenVUmc Results

• Response– 41/44 countries (93.2%)

• excl. Iceland, Monaco and Moldova– Representing 805/809 M inhabitants (99.4%)

Where applicable, guidelines were recalculated from patients to population size using 2.500 new radiotherapy patients / 1.000.000 inhabitants

Klik om de stijl te bewerkenVUmc Guidelines linacs available: 17/41 (42%)

Population

High resources Medium resources Low resources

Countries

1 linac per ….2.500

NP

1.500NP

500NP

Klik om de stijl te bewerkenVUmc Guidelines linacs

CountryAverage(popul.)

Range(popul.)

Average(patients)

Range(patients)

High resources 1:183.000 80-250.000 1: 458 200-625

Medium resources 1:284.000 200-400.000 1: 710 500-1.000

Low resources 1:500.000 250-1.000.00 1:1.250 625-2.500

Klik om de stijl te bewerkenVUmc Radiation oncologists

• Guidelines available: 17 (42%)• High 43%• Med 44%• Low 36%

• In general: 1 per 250 patients (range 150-400)

Klik om de stijl te bewerkenVUmc Radiation oncologists

Patients

Countries

High resources Medium resources Low resources

Klik om de stijl te bewerkenVUmc Physicists

• Guidelines available: 18 (43.9%)• High 52%• Med 33%• Low 36%

• In general 1 per 565 patients (range 300-1.250)

Klik om de stijl te bewerkenVUmc Physicists

Patients

Countries

High resources Medium resources Low resources

Klik om de stijl te bewerkenVUmc Technologists

• Guidelines available: 18 (44%)• High 43%• Med 56%• Low 36%

• Great diversity: in general 2 per linac + for other tasks

Klik om de stijl te bewerkenVUmc Treatment planning perfomed by

High Med-Low

Technologist/dosimetrist 42.8% 0.0%Physicists 42.8% 85.0%Both 14.4% 15.0%

Klik om de stijl te bewerkenVUmc Quality assurance performed by

High Med-Low

Technologist/Assistant 14.3% 0.0%Physicists 66.7% 90.0%Both 19.0% 10.0%

Klik om de stijl te bewerkenVUmc Re-imbursement

• Great diversity• Often more than one system

High resource Medium resource Low resource

Budget-based 48% 44% 91%

Case-based 24% 33% 46%

Fee for service 81% 50% 18%

Klik om de stijl te bewerkenVUmc Special re-imbursement

High resource Medium resource Low resource

Intensive/CRT 62% 33% 27%

IMRT 24% 33% 9%

SRT 48% 56% 9%

Klik om de stijl te bewerkenVUmc General guidelines

• Linacs: 1 per 450 patients (1 per 180.000 population); with increasing complexicity 1 per 400-450 patients

• Radiation oncologist: 1 per 250 patientswith increasing complexity 1 per 200-250 patients

• Physicists: 1 per 500 patients or 1 per linac

Klik om de stijl te bewerkenVUmc CAUTION !

• These are only crude guidelines, which do not take into account the specific structure of the population, differences in cancer incidence and treatment strategies, etc.

• Better approaches to determine the real needs within a country or region are warranted !

Klik om de stijl te bewerkenVUmc Evidence-based guidelines

Klik om de stijl te bewerkenVUmc

• Differences in crude cancer incidences in Europe, due to differences in exposure to risk factors and differences in age structure

• Use evidence-based indications to calculate needs (SBU, CCORE, QCRI)

Evidence-based guidelines

Klik om de stijl te bewerkenVUmc Estimated # of linacs per 1.000.000

Klik om de stijl te bewerkenVUmc Linacs realized and required

Klik om de stijl te bewerkenVUmc Conclusions

• Large difference in guidelines among Europe and large difference in cancer incidences

• National incidence rates for various cancers as basis

• Use evidence based guidelines for use of radiotherapy in these tumors to detemine total number of patients requiring radiotherapy (= number of treatments)

• On average 450 treatments per linac