title: Radiotherapy staffing in the European countries: final results from the ESTRO-HERO survey.
abstract: BACKGROUND
  The ESTRO Health Economics in Radiation Oncology (HERO) project has the overall aim to develop a knowledge base of the provision of radiotherapy in Europe and build a model for health economic evaluation of radiation treatments at the European level. The first milestone was to assess the availability of radiotherapy resources within Europe. This paper presents the personnel data collected in the ESTRO HERO database.
  
  
  METHODS
  An 84-item questionnaire was sent out to European countries, through their national scientific and professional radiotherapy societies. The current report includes a detailed analysis of radiotherapy staffing (questionnaire items 47-60), analysed in relation to the annual number of treatment courses and the socio-economic status of the countries. The analysis was conducted between February and July 2014, and is based on validated responses from 24 of the 40 European countries defined by the European Cancer Observatory (ECO).
  
  
  RESULTS
  A large variation between countries was found for most parameters studied. Averages and ranges for personnel numbers per million inhabitants are 12.8 (2.5-30.9) for radiation oncologists, 7.6 (0-19.7) for medical physicists, 3.5 (0-12.6) for dosimetrists, 26.6 (1.9-78) for RTTs and 14.8 (0.4-61.0) for radiotherapy nurses. The combined average for physicists and dosimetrists is 9.8 per million inhabitants and 36.9 for RTT and nurses. Radiation oncologists on average treat 208.9 courses per year (range: 99.9-348.8), physicists and dosimetrists conjointly treat 303.3 courses (range: 85-757.7) and RTT and nurses 76.8 (range: 25.7-156.8). In countries with higher GNI per capita, all personnel categories treat fewer courses per annum than in less affluent countries. This relationship is most evident for RTTs and nurses. Different clusters of countries can be distinguished on the basis of available personnel resources and socio-economic status.
  
  
  CONCLUSIONS
  The average personnel figures in Europe are now consistent with, or even more favourable than the QUARTS recommendations, probably reflecting a combination of better availability as such, in parallel with the current use of more complex treatments than a decade ago. A considerable variation in available personnel and delivered courses per year however persists among the highest and lowest staffing levels. This not only reflects the variation in cancer incidence and socio-economic determinants, but also the stage in technology adoption along with treatment complexity and the different professional roles and responsibilities within each country. Our data underpin the need for accurate prediction models and long-term education and training programmes.
authors.affiliation: Ghent University Hospital, Belgium. Electronic address: yolande.lievens@uzgent.be.
authors.forename: Yolande
authors.initials: Y
authors.lastname: Lievens
authors.affiliation: European Society for Radiotherapy and Oncology, Belgium.
authors.forename: Noémie
authors.initials: N
authors.lastname: Defourny
authors.affiliation: Trinity College Dublin, Ireland.
authors.forename: Mary
authors.initials: M
authors.lastname: Coffey
authors.affiliation: University of Barcelona, Spain.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Borras
authors.affiliation: University of Calgary, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Dunscombe
authors.affiliation: VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Ben
authors.initials: B
authors.lastname: Slotman
authors.affiliation: Poznan University of Medical Sciences and Greater-Poland Cancer Centre, Poland.
authors.forename: Julian
authors.initials: J
authors.lastname: Malicki
authors.affiliation: Cancer Diagnosis and Treatment Centre, Katowice, Poland.
authors.forename: Marta
authors.initials: M
authors.lastname: Bogusz
authors.affiliation: European Society for Radiotherapy and Oncology, Belgium.
authors.forename: Chiara
authors.initials: C
authors.lastname: Gasparotto
authors.affiliation: Aarhus University Hospital, Denmark.
authors.forename: Cai
authors.initials: C
authors.lastname: Grau
authors.forename: Arianit
authors.initials: A
authors.lastname: Kokobobo
authors.forename: Felix
authors.initials: F
authors.lastname: Sedlmayer
authors.forename: Elena
authors.initials: E
authors.lastname: Slobina
authors.forename: Philippe
authors.initials: P
authors.lastname: Coucke
authors.forename: Roumen
authors.initials: R
authors.lastname: Gabrovski
authors.forename: Milan
authors.initials: M
authors.lastname: Vosmik
authors.forename: Jesper Grau
authors.initials: JG
authors.lastname: Eriksen
authors.forename: Jana
authors.initials: J
authors.lastname: Jaal
authors.forename: Catherine
authors.initials: C
authors.lastname: Dejean
authors.forename: Csaba
authors.initials: C
authors.lastname: Polgar
authors.forename: Jakob
authors.initials: J
authors.lastname: Johannsson
authors.forename: Moya
authors.initials: M
authors.lastname: Cunningham
authors.forename: Vydmantas
authors.initials: V
authors.lastname: Atkocius
authors.forename: Carlo
authors.initials: C
authors.lastname: Back
authors.forename: Martin
authors.initials: M
authors.lastname: Pirotta
authors.forename: Vanja
authors.initials: V
authors.lastname: Karadjinovic
authors.forename: Sverre
authors.initials: S
authors.lastname: Levernes
authors.forename: Boguslaw
authors.initials: B
authors.lastname: Maciejewski
authors.forename: Maria Lurdes
authors.initials: ML
authors.lastname: Trigo
authors.forename: Barbara
authors.initials: B
authors.lastname: Šegedin
authors.forename: Amalia
authors.initials: A
authors.lastname: Palacios
authors.forename: Bert
authors.initials: B
authors.lastname: Pastoors
authors.forename: Charlotte
authors.initials: C
authors.lastname: Beardmore
authors.forename: Sara
authors.initials: S
authors.lastname: Erridge
authors.forename: Gaile
authors.initials: G
authors.lastname: Smyth
authors.forename: Ramon
authors.initials: R
authors.lastname: Cleries Soler
mesh_terms: D003625:Data Collection; D016208:Databases, Factual; D005060:Europe; D006801:Humans; D015994:Incidence; D009369:Neoplasms / Q000532:radiotherapy; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data*; D018787:Radiation Oncology; D011795:Surveys and Questionnaires; D000078329:Workforce
keywords: Europe; Radiotherapy; Resources; Staffing