Shortfalls in Radiotherapy in Many European Countries

Although radiotherapy is more cost effective than surgery and chemotherapy for treating cancer, and is used in about half of all cancer patients, its provision is inadequate in many European countries, according to an analysis published online today in the Lancet Oncology.

Several countries in Western Europe have too few radiotherapy machines to ensure that cancer patients in need of this treatment receive it, report first author Eduardo Rosenblatt, MD, from the International Atomic Energy Agency (IAEA) in Vienna, Austria, and colleagues.
 There is an apparent gap in treatment supply in Germany and the United Kingdom, where around 21% of need is unmet, and in Austria (20%), Portugal (19%), and Italy (16%), they note.

 The availability of radiotherapy services varies widely between countries.
Belgium, the Netherlands, and Switzerland are well equipped; they have sufficient radiotherapy machines to meet the demand for treatment, the researchers note. However, most countries in Eastern and Southeastern Europe are insufficiently equipped and have the greatest need to expand and modernize their equipment.
This is particularly true for Bulgaria, Macedonia, and Romania, they report. "Our data should enable governments, European Union (EU) bodies, and international organizations to see at a glance how adequate the provision of radiotherapy is in each European country," said Dr. Rosenblatt. "For the first time, it gives countries the ability to plan investment objectively and ensure the building and maintenance of sufficient capacity to meet the ever-increasing demand," he said in a press statement.

For their analysis, Dr. Rosenblatt and colleagues collected data on radiotherapy capacity from the European section of the Directory of Radiotherapy Centers (DIRAC), which is managed by the IAEA. For the purpose of this report, Europe encompassed 33 countries — the 27 members of the EU, 3 candidate countries for membership (Croatia, Macedonia, and Turkey), and 3 countries that are part of the European Free Trade Association (Iceland, Norway, and Switzerland).
As of July 2012, Europe had 1286 active radiotherapy centers registered in the DIRAC database.
Germany had the most (289), followed by France (177), Italy (172), Spain (117), Turkey (95), and the United Kingdom (76); the remaining countries had 36 or fewer centers each. Most of the centers have linear accelerators; a few offer radionuclide teletherapy and a few offer proton or heavy-ion particle beams.
The DIRAC data probably underestimate the use of brachytherapy, because they do not include centers that provide only manual brachytherapy, the researchers note. They used population, epidemiologic, and economic data to compute basic indicators that allowed comparisons of radiotherapy equipment between countries.

To calculate whether the machines would meet the demand for radiotherapy in a given country, they used a benchmark for radiotherapy usage of 450 patients per machine per year. "This first comprehensive analysis of DIRAC data for Europe shows a substantial disparity in the availability and organization of radiotherapy between countries," the researchers conclude. They identify shortfalls in infrastructure and manpower in some European countries. "We hope that governments, EU bodies, and international organizations will take advantage of the DIRAC initiative and use it as a guideline for setting standards and planning investment into radiotherapy services," they add.

Lancet Oncol. Published online January 24, 2013. Abstract With thanks to Medscape

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