title: Towards evidence-based guidelines for radiotherapy infrastructure and staffing needs in Europe: the ESTRO QUARTS project.
abstract: OBJECTIVE
  Adequate and equitable access to radiotherapy (RT) must be a reasonable health care goal for the EU. However, there are large variations among the EU countries and even regional variations within countries in the provision of RT. In this report, we combine the best available evidence on the indications for RT with national epidemiological data to arrive at estimates for the appropriate level of RT infrastructure in the 25 EU countries.
  
  
  METHODS
  Data from three systematic overviews of the best available evidence for the indication for RT in 23 main cancer types are combined with epidemiological data from the EUCAN and GLOBOCAN databases on the crude incidence of each of these cancers in the 25 EU countries. Together with published benchmarks for accelerator throughput this allows estimation of the number of linear accelerators per million people required to facilitate appropriate RT utilization rates in each country. Where possible, the estimates are compared with the detailed data available from Sweden.
  
  
  RESULTS
  The crude incidence of the main cancer types shows large variation among the 25 EU countries. This reflects in part differences in exposure to aetiological risk factors and partly differences among the countries in population age structure. Correspondingly, the estimate of the required number of linear accelerators per million people showed considerable variation: ranging from 4.0 in Cyprus to 8.1 in Hungary. The average for the 25 countries was 5.9 per million people. These estimates were compared with available national guidelines and actual data on RT infrastructure and large shortfalls were found in many countries. Implications for health economics and capacity planning are briefly discussed.
  
  
  CONCLUSIONS
  The QUARTS project has developed a model that establishes a direct and transparent link between epidemiological data and indications for RT based on the best available evidence. Comparison of the model estimates with current levels of RT infrastructure has revealed major inequalities in provision of RT in the 25 EU countries. Continuation of this study is recommended as a way of improving RT provision on rational grounds throughout the European community and as a model for health care planning in the EU.
authors.affiliation: Gray Cancer Institute and the Cancer Centre, Mount Vernon Hospital, Northwood, UK. bentzen@humonc.wisc.edu
authors.forename: Søren M
authors.initials: SM
authors.lastname: Bentzen
authors.forename: Germaine
authors.initials: G
authors.lastname: Heeren
authors.forename: Brian
authors.initials: B
authors.lastname: Cottier
authors.forename: Ben
authors.initials: B
authors.lastname: Slotman
authors.forename: Bengt
authors.initials: B
authors.lastname: Glimelius
authors.forename: Yolande
authors.initials: Y
authors.lastname: Lievens
authors.forename: Walter
authors.initials: W
authors.lastname: van den Bogaert
mesh_terms: D000328:Adult; D000367:Age Factors; D003362:Cost-Benefit Analysis; D005060:Europe; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009369:Neoplasms / Q000453:epidemiology / Q000532:radiotherapy*; D010561:Personnel Staffing and Scheduling; D017410:Practice Guidelines as Topic; D011878:Radiotherapy / Q000191:economics / Q000379:methods*; D011880:Radiotherapy Planning, Computer-Assisted