Europe plagued by fragmentation in RT services

An analysis of radiotherapy (RT) services in 33 European countries showed wide disparities in access, multiple areas of fragmentation and unmet needs, according to a study published online Jan. 23 in The Lancet Oncology. 

Approximately, 3.2 million Europeans are diagnosed with cancer, and half require RT, with another 20 to 25 percent requiring a second course of treatment. Cancer incidence is expected to rise given the aging population and obesity epidemic.

“Despite being more cost-effective than surgery and chemotherapy for treating cancer, the building and running of a radiotherapy center requires substantial financial and technical investment, so countries need to plan ahead,” Eduardo Rosenblatt, MD, from the applied radiation biology and radiotherapy section of the International Atomic Energy Agency, in Vienna, said in a press release.

Thus, an estimate of RT equipment supply and need is essential.

Rosenblatt and colleagues reviewed data on RT infrastructure in the 33 European countries registered in the Directory of Radiotherapy Centres (DIRAC) database. They calculated a total of 1,286 RT centers as of July 2012.

Germany operates 289 RT centers, followed by France at 177, Italy at 172, Spain at 117, Turkey at 95 and the U.K. at 76. The remaining 27 countries had between one and 36 centers. The mean number of systems per center was 2.5, with the average ranging from 1.2 in Bulgaria to 7 in Slovenia.

“In general, the Nordic countries, the U.K., the Netherlands and Slovenia had a more centralized infrastructure with a high number of machines per center,” wrote Rosenblatt and colleagues.

The researchers estimated the number of cancer patients per RT system per year ranged from 307 in Switzerland to 1,583 in Romania. They defined unmet need as the percentage of patients with cancer who would not have access to RT, based on criteria of 450 patients per system per year. This formula suggests an apparent shortage of RT systems in Germany, Italy Austria, Portugal and the U.K. However, the researchers cautioned that these countries may compensate for gaps between supply and demand by more efficient organization of RT services.

In general, Rosenblatt and colleagues determined two approaches to the provision of RT services. Nordic countries, the U.K. and the Netherlands employ a centralized approach, with services concentrated in a few large centers that provide all types of techniques on four to ten systems. In most other countries, facilities vary in size and capacity, with many small facilities specializing in specific types of cancers.

Rosenblatt and colleagues applied a benchmark of below four systems per center to define fragmentation, and found fragmentation in 28 countries.

The researchers encouraged governments, European Union bodies and international organizations to use the DIRAC initiative as a guideline for setting standards and planning investments in RT.