title: Utilization of radiation therapy in Norway after the implementation of the national cancer plan--a national, population-based study.
abstract: OBJECTIVE
  To estimate actual utilization rates of radiation therapy (RT) in Norway, describe time trends (1997-2010), and compare these estimates with corresponding optimal RT rates.
  
  
  METHODS
  Data from the population-based Cancer Registry of Norway was used to identify all patients diagnosed with cancer and/or treated by RT for cancer in 1997-2010. Radiation therapy utilization rates (RURs) were calculated as (1) the proportion of incident cancer cases who received RT at least once within 1 year of diagnosis (RUR1Y); and (2) the proportion who received RT within 5 years of diagnosis (RUR5Y). The number of RT treatment courses per incident cancer case (TCI) was also calculated for all cancer sites combined. The actual RURs were compared with corresponding Australian and Canadian epidemiologic- and evidence-based model estimates and criterion-based benchmark estimates of optimal RURs. The TCIs were compared with TCI estimates from the 1997 Norwegian/National Cancer Plan (NCP). Joinpoint regression was used to identify changes in trends and to estimate annual percentage change (APC) in actual RUR1Y and actual TCI.
  
  
  RESULTS
  The actual RUR5Y (all sites) increased significantly to 29% in 2005 but still differed markedly from the Australian epidemiologic- and evidence-based model estimate of 48%. With the exception of RUR5Y for breast cancer and RUR1Y for lung cancers, all actual RURs were markedly lower than optimal RUR estimates. The actual TCI increased significantly during the study period, reaching 42.5% in 2010, but was still lower than the 54% recommended in the NCP. The trend for RUR1Y (all sites) and TCI changed significantly, with the annual percentage change being largest during the first part of the study period.
  
  
  CONCLUSIONS
  Utilization rates of RT in Norway increased after the NCP was implemented and RT capacity was increased, but they still seem to be lower than optimal levels.
authors.affiliation: Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway. Electronic address: linn.merete.asli@kreftregisteret.no.
authors.forename: Linn M
authors.initials: LM
authors.lastname: Asli
authors.affiliation: Division of Cancer, Surgery, and Transplantation, Oslo University Hospital and University of Oslo, Oslo, Norway.
authors.forename: Stein O
authors.initials: SO
authors.lastname: Kvaløy
authors.affiliation: Department of Medical Physics, Oslo University Hospital, Oslo, Norway.
authors.forename: Vidar
authors.initials: V
authors.lastname: Jetne
authors.affiliation: Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway.
authors.forename: Tor Å
authors.initials: TÅ
authors.lastname: Myklebust
authors.affiliation: Department of Medical Physics, Oslo University Hospital, Oslo, Norway; The Norwegian Radiation Protection Authority, Østerås, Norway.
authors.forename: Sverre G
authors.initials: SG
authors.lastname: Levernes
authors.affiliation: Department of Oncology, Oslo University Hospital and University of Oslo, Oslo, Norway.
authors.forename: Kjell M
authors.initials: KM
authors.lastname: Tveit
authors.affiliation: Department of Medical Physics, Oslo University Hospital, Oslo, Norway.
authors.forename: Tor O
authors.initials: TO
authors.lastname: Green
authors.affiliation: Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway.
authors.forename: Tom B
authors.initials: TB
authors.lastname: Johannesen
mesh_terms: D006284:Health Plan Implementation / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D009369:Neoplasms / Q000453:epidemiology / Q000532:radiotherapy*; D009664:Norway / Q000453:epidemiology; D011878:Radiotherapy / Q000706:statistics & numerical data / Q000639:trends; D019233:Retreatment / Q000706:statistics & numerical data