Estimating the demand for radiotherapy from the evidence: a review of changes from 2003 to 2012.
OBJECTIVE
In 2003 we estimated that 52.3% of new cases of cancer in Australia had an indication for external beam radiotherapy at least once at some time during the course of their illness. This update reviews the contemporary evidence to define the optimal proportion of new cancers that would benefit from radiotherapy as part of their treatment and estimates the changes to the optimal radiotherapy utilisation rate from 2003 to 2012.


METHODS
National and international guidelines were reviewed for external beam radiotherapy indications in the management of cancers. Epidemiological data on the proportion of new cases of cancer with each indication for radiotherapy were identified. Indications and epidemiological data were merged to develop an optimal radiotherapy utilisation tree. Univariate and Monte Carlo simulations were used in sensitivity analysis.


RESULTS
The overall optimal radiotherapy utilisation rate (external beam radiotherapy) for all registered cancers in Australia changed from 52.3% in 2003 to 48.3% in 2012. Overall 8.9% of all cancer patients in Australia have at least one indication for concurrent chemo-radiotherapy during the course of their illness.


CONCLUSIONS
The reduction in the radiotherapy utilisation rate was due to changes in epidemiological data, changes to radiotherapy indications and refinements of the model structure.
Ingham Institute for Applied Medical Research, Sydney, Australia; Collaboration for Cancer Outcomes Research and Evaluation, Sydney, Australia; Faculty of Medicine, University of NSW, Sydney, Australia.
Michael B
MB
Barton
Ingham Institute for Applied Medical Research, Sydney, Australia; Collaboration for Cancer Outcomes Research and Evaluation, Sydney, Australia; Faculty of Medicine, University of NSW, Sydney, Australia. Electronic address: Susannah.Jacob@sswahs.nsw.gov.au.
Susannah
S
Jacob
Ingham Institute for Applied Medical Research, Sydney, Australia; Collaboration for Cancer Outcomes Research and Evaluation, Sydney, Australia; Faculty of Medicine, University of NSW, Sydney, Australia.
Jesmin
J
Shafiq
Ingham Institute for Applied Medical Research, Sydney, Australia; Collaboration for Cancer Outcomes Research and Evaluation, Sydney, Australia; Faculty of Medicine, University of NSW, Sydney, Australia.
Karen
K
Wong
Faculty of Medicine, University of NSW, Sydney, Australia; Prince of Wales Hospital, Sydney, Australia.
Stephen R
SR
Thompson
Ingham Institute for Applied Medical Research, Sydney, Australia; Collaboration for Cancer Outcomes Research and Evaluation, Sydney, Australia; Faculty of Medicine, University of NSW, Sydney, Australia.
Timothy P
TP
Hanna
Ingham Institute for Applied Medical Research, Sydney, Australia; Collaboration for Cancer Outcomes Research and Evaluation, Sydney, Australia; Faculty of Medicine, University of NSW, Sydney, Australia.
Geoff P
GP
Delaney
D001315:Australia / Q000453:epidemiology; D019317:Evidence-Based Medicine; D006801:Humans; D009010:Monte Carlo Method; D009369:Neoplasms / Q000453:epidemiology / Q000532:radiotherapy*; D017410:Practice Guidelines as Topic
Evidence-based practice; Radiotherapy; Standards; Utilisation