title: The Malthus Programme: developing radiotherapy demand models for breast and prostate cancer at the local, regional and national level.
abstract: OBJECTIVE
  The Malthus Programme has delivered a tool for modelling radiotherapy demand in England. The model is capable of simulating demand at the local level. This article investigates the local and regional level variation in predicted demand with respect to Breast and Prostate cancer, the two tumour types responsible for the majority of radiotherapy treatment workload in England.
  
  
  METHODS
  Simulations were performed using the Malthus model, using base population incidence data for the period from 2007-2009. Simulations were carried out at the level of Primary Care Trusts, Cancer Networks, and nationwide, with annual projections for 2012, 2016 and 2020. Benchmarking was undertaken against previously published models from the UK, Canada and Australia.
  
  
  RESULTS
  For breast cancer, the fraction burden for 2012 varied from 5537 fractions per million in Tower Hamlets PCT to 18 896 fractions per million in Devon PCT (national mean - 13 592 fractions per million). For prostate cancer, the fraction burden for 2012 varied from 4874 fractions per million in Tower Hamlets PCT to 23 181 fractions per million in Lincolnshire PCT (national mean - 15 087 fractions per million). Predictions of population growth by age cohort for 2016 and 2020 result in the regional differences in radiotherapy demand becoming greater over time. Similar effects were also observed at the level of the cancer network.
  
  
  CONCLUSIONS
  Our model shows the importance of local population demographics and cancer incidence rates when commissioning radiotherapy services.
authors.affiliation: Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospital NHS Trust, Cambridge, UK.
authors.forename: C
authors.initials: C
authors.lastname: Round
authors.forename: T
authors.initials: T
authors.lastname: Mee
authors.forename: N F
authors.initials: NF
authors.lastname: Kirkby
authors.forename: T
authors.initials: T
authors.lastname: Cooper
authors.forename: M V
authors.initials: MV
authors.lastname: Williams
authors.forename: R
authors.initials: R
authors.lastname: Jena
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology* / Q000532:radiotherapy; D019583:Dose Fractionation, Radiation; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D015994:Incidence; D008297:Male; D015233:Models, Statistical; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011878:Radiotherapy / Q000706:statistics & numerical data
keywords: Breast cancer; demand; modelling; prostate cancer; radiotherapy