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OC-0570: Radiotherapy staffing in the European countries: Final results from the ESTRO-HERO survey
S222 23% and 14% (p=0.91). Local control rates at 6 month were 88% after 5x4 Gy and 94% after 10x3 Gy (p=0.18) and 6-month survival rates were 46% and 44% (p=0.98). Conclusions: The preliminary results of the SCORE-2 trial suggest that 5x4 Gy is not inferior to 10x3 Gy for MSCC in patients with a poor or intermediate survival prognosis. OC-0568 Quality of life in very elderly radiotherapy patients: prospective study using the new EORTC QLQ-ELD14 module D. Vordermark1, A. Kaufmann1, H. Schmidt2, C. Ostheimer1, J. Ullrich1, M. Landenberger2 1 Martin Luther University Halle-Wittenberg, Radiation Oncology, Halle / Saale, Germany 2 Martin Luther University Halle-Wittenberg, Health and Nursing Science, Halle / Saale, Germany Purpose/Objective: In Europe and the US, marked increases in cancer incidence are expected in the elderly (>65 years) and very elderly (>80 years) population. In very elderly cancer patients, health-related quality of life (HRQOL) is a particularly important issue in patient counseling, but has rarely been studied due to a lack of specific instruments and of reference data. We performed a prospective analysis of HRQOL in patients ≥ 80 years undergoing radiotherapy with the newly validated elderly-specific HRQOL module EORTC QLQ-C14 [Wheelwright et al., Br J Cancer 2013]. Materials and Methods: To chararacterize patterns of care and clinical outcomes in very elderly radiotherapy patients, we first analyzed retrospectively the clinical course of n=115 consecutive patients ≥ 80 years treated from 2008 to 2009. We prospectively assessed HRQOL in n=50 radiotherapy patients of this age group, treated between 11/2011 and 01/2013, at the start (t1), end (t2) and six months after (t3) radiotherapy, using EORTC QLQ-C30 and EORTC QLQ-ELD14. Results: In the retrospective cohort (20% gynaecologic, 14.8% gastrointestinal, 11.3% head-and-neck, 11.3% lung cancer; 54.8% palliative concept; 70.4% radiotherapy alone), median overall survival was 7.8 months (23.6 months in subgroup treated with curative intent) and was significantly associated with Karnofsky performance status, tumor stage, nodal status, surgical resection and total dose on multivariate analysis. In the prospective HRQOL analysis (30% lung cancer, 20% gastrointestinal cancer), no significant changes in any HRQOL domain were observed during the course of treatment (t1 to t2). Six months after radiotherapy (t3), a significant and clinically relevant deterioration of HRQOL was seen in the EORTC QLQ-C30 for physical function, role function and insomnia and in the EORTC QLQ-ELD14 for future worries, burden of illness and family support (see Fig. 1 for time course of QLQ-ELD14 scores; higher score worse except 'family support' and maintaining purpose' with higher scores better; * = p<0.05 between t3 and t1). Statistically significant differences were also of clinically relevance as defined by Osoba et al. (1998). Conclusions: In radiotherapy patients ≥ 80 years HRQOL was maintained until the end of radiotherapy, but deteriorated in general and elderlyspecific areas thereafter, suggesting a need to develop specific supportive interventions for this age group.
PROFFERED PAPERS: CLINICAL 12: HEALTH ECONOMICS OC-0569 Radiotherapy departments and equipment in the European countries: Final results from the ESTRO-HERO survey C. Grau1, N. Defourney2, J. Malicki3, P. Dunscombe4, J.M. Borras5, M. Coffey6, B. Slotman7, M. Bogusz8, C. Gasparotto2, Y. Lievens9 1 Aarhus University Hospital, Department of Oncology, Aarhus C,
ESTRO 33, 2014 Denmark 2 ESTRO, Office, Brussels, Belgium 3 Greater Poland Cancer Centre, Administration, Poznan, Poland 4 Tom Baker Cancer Centre, Department of Medical Physics, Calgary Alberta, Canada 5 University of Barcelona, Department of Oncology, Barcelona, Spain 6 Trinity Centre for Health Sciences, Radiological Sciences, Dublin, Ireland Republic of 7 VU University Medical Centre, Department of Radiation Oncology, Amsterdam, The Netherlands 8 Cancer Diagnosis and Treatment Centre, Administration, Katowice, Poland 9 Ghent University Hospital, Department of Radiation Oncology, Ghent, Belgium Purpose/Objective: Documenting the distribution of radiotherapy departments and the availability of radiotherapy equipment in the European countries is an important part of HERO - the ESTRO Health Economics in Radiation Oncology project. HERO 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 aim of the current report is to describe the distribution of radiotherapy equipment in European countries. Materials and Methods: An 84-item questionnaire was sent out to 39 nations of greater Europe, as defined by the European Cancer Observatory (ECO), principally through their national societies. The current report includes a detailed analysis of radiotherapy departments and equipment in Europe (questionnaire items 26-29), analyzed in relation to the annual number of patients treated in the same countries. The analysis was conducted in November 2013, and is based on validated responses from 24 countries. Results: A large variation between countries was found for most parameters studied. There was a median of 1 simulator per 2.1 (range 0.7-3.8) MV machine and 1.5 (range 0.4-3.0) simulators per department. Of the 852 simulators, a total of 636 (75%) were capable of 3D imaging (CT-scanner or CBCT-option). There were 2,140 linear accelerators and 79 cobalt machines reported in the 24 countries, and 12 countries had at least one cobalt machine in use. The number of MV machines (cobalt, linear accelerators and dedicated stereotactic machines) per million inhabitants ranged from 1.8 to 9.6 (median 5.2) and the average number of MV machines per department from 0.9 to 8.0 (median 2.6). The average number of patients treated per year per MV machine varied from 262 to 1,061 (median 438). Although 94% of the MV machines were linear accelerators, only 46% of these were capable of IMRT and only 36% were equipped for image guidance (IGRT). In many Central-Eastern European countries there was very limited access to IMRT or IGRT. Conclusions: Although the European average number of MV machines per million inhabitants and per department is now in line with QUARTS recommendations, the results of this survey document a significant heterogeneity, in the order of a factor of 3-5, in the access to modern radiotherapy equipment in Europe. The majority of Northern and Western European countries are well-served with radiotherapy resources, whereas other countries are facing important shortages in terms of equipment capable of delivering IMRT and IGRT. OC-0570 Radiotherapy staffing in the European countries: Final results from the ESTRO-HERO survey Y. Lievens1, M. Coffey2, N. Defourney3, P. Dunscombe4, J. Borras5, B. Slotman6, J. Malicki7, M. Bogusz8, C. Gasparotto9, C. Grau10 1 Universitair Ziekenhuis Gent, Department of Radiation Oncology, Gent, Belgium 2 Trinity Centre for Health Sciencs, Radiological Sciences, Dublin, Ireland Republic of 3 ESTRO, Health Economics, Brussels, Belgium 4 Tom Baker Cancer Centre, Medical Physics, Calgary Alberta, Canada 5 University of Barcelona, Oncology, Barcelona, Spain 6 VU University Medical Centre, Oncology, Amsterdam, The Netherlands 7 Greater Poland Cancer Centre, Administration, Poznan, Poland 8 Cancer Diagnosis and Treatment Centre, Administration, Katowice, Poland 9 ESTRO, Administration, Brussels, Belgium 10 Aarhus University Hospital, Oncology, Aarhus, Denmark Purpose/Objective: The first milestone in the Health Economics in Radiation Oncology (HERO) project of ESTRO is to assess availability of and accessibility to radiotherapy in the different European countries. As part of the European blueprint of radiotherapy resources, this report focuses on the data received with respect to personnel availability and their roles and responsibilities.
ESTRO 33, 2014
Materials and Methods: An 84 part questionnaire was sent out to 39 nations of greater Europe, as defined by the European Cancer Observatory (ECO), as well as Turkey and Armenia, principally through their national societies. Thirty-four countries provided partial or complete responses. The current analysis, conducted on the validated dataset in November 2013, reports on the 14 questions concerning personnel resources, and relates them to population statistics from the World Bank database and to the reported national data on radiotherapy treatments delivered and availability of equipment. Results:
S223 Purpose/Objective: Radiation therapy (RT), one of the key therapeutic modalities in the management of cancer is required in about 50% of newly diagnosed cancer patients and 25% of those previously irradiated. The study evaluates the present status ofRT infrastructure and related human resources along with its projected needs by 2020 in low-middle income (LMI) countries. Materials and Methods: One hundred and thirty-five countries with GNI/capita of
Twenty-three of the 34 countries (68%) responding to the questionnaire have provided data regarding the personnel resources in their country. This analysis focuses on the actual numbers of personnel, hence 2 countries only reporting full time equivalents were not withheld in this report. Table 1 demonstrates the large variation observed in terms of number of personnel per million inhabitants (MI). Countries with the highest numbers/MI are depicted in decreasing shades of red, those with the lowest numbers/MI in shades of blue. Similar large variations are observed for the number of treatments delivered per type of personnel: radiation oncologists (RO) on average perform 209 treatments per year (range 103-415), medical physicists (MP) 337 (range 155-623) and dosimetrists 771 (range 149-2122). Using a combined figure of radiation technologists (RTT) and nurses, an average of 61 treatments is delivered, varying between 29 and 88. The number of personnel per megavoltage (MV) machine also varies quite considerably. The range for RO/MV is 0.9-4.5 and for MP/MV 0.92.8. The ranges for RRTs and nurses are even larger: 0.2-11.0 for RTT/MV with two countries not providing data and 0.9-7.5 for nurses/MV with 9 countries not providing data. Conclusions: The average number of annual treatments per RO and MP is now lower than the QUARTS recommendations, in line with evolving treatment complexity. Nevertheless, a large variation in available personnel exists amongst European countries. Apart from different cancer incidence and socio-economical determinants, this variation also reflects differences in educational level and background (e.g. of the personnel working in planning or on the MV units) and different roles and responsibilities taken by the professional disciplines (e.g. radiation oncologists all or not involved with chemotherapy delivery) in each country. OC-0571 Present and future status of radiation therapy in low-middle income countries: An imminent global crisis N.R. Datta1, M. Samiei2, S. Bodis1 1 Centre for Radiation Oncology KSA-KSB Kantonsspital Aarau, Radiation Oncology, Aarau, Switzerland 2 International Consultant Vienna Austria, Former Director Programme of Action for Cancer Therapy (PACT) International Atomic Energy Agency, Vienna, Austria
Conclusions: The immense gap in the present availability of RT facilities and supplementary needs by 2020 in LMI countries is a matter of great concern. This warrants an urgent review of on-going efforts by national and international organizations and professional institutions to ensure effective and feasible strategies are in place to confront the 'cancer epidemic' and to meaningfully improve access to RT services in LMI countries. 1www.worldbank.org; 2http://globocan.iarc.fr; 3http://wwwnaweb.iaea.org/nahu/dirac/default.asp;4IAEA Technical series 1462; 5 Radiother Oncol2005;75:349.e1-349.e6 OC-0572 Patterns of practice in palliative radiotherapy in Africa ñ case revisited B. Jeremic1, V. Vanderpuye2, S. Abdel-Wahab3, P.M. Gaye4, L. Kochbati5, D. Dawotola6, T. Wondemagegnehu7, M. Diwani8, C. Nyongesa9, T. Shouman10 1 Tygerberg Hospital, Radiation Oncology, Cape Town, South Africa 2 National Center for Radiotherapy, Radiation Oncology, Accra, Ghana 3 Ain Shams University, Oncology, Cairo, Egypt 4 Institut de Curie, Radiation Oncology, Dakar, Senegal 5 Institute Salah Aziz, Radiation Oncology, Tunis, Tunisia 6 A B University Teaching Hospital, Radiation Oncology, Zaria, Nigeria 7 Addis Ababa University, Radiation Oncology, Addis Ababa, Ethiopia 8 Ocean Road Cancer Institute, Radiation Oncology, Dar es Salaam, Tanzania 9 Kenyatta National Hospital, Radiation Oncology, Nairobi, Kenya 10 National cancer Institute, Radiation Oncology, Cairo, Egypt Purpose/Objective: To investigate patterns of practice in palliative radiotherapy (RT) in Africa. Materials and Methods: Fifteen centres in Africa provided detailed information about RT in both metastatic and locally advanced disease via questionnaire. Information included general one (institution status, equipment, staff, patient number), and then RT and other treatment characteristics in bone metastasis, brain metastasis, metastatic spinal cord compression, lung and liver metastasis as well as locally advanced tumours. Results: Number of patients annually seen/treated ranged 285 to 5000. Breast, cervix, head and neck,gastrointestinal and prostate cancer were top five cancers overall. Eight (53%) institutions were without linear accelerators, four (27%) had a single one, while one institution each has each 2, 3, and 4 Linacs. The number of Cobalt machines ranged 0-2 (median, 1). Majority of centres still prefer the use of fractionated RT
PROFFERED PAPERS: CLINICAL 12: HEALTH ECONOMICS OC-0569 Radiotherapy departments and equipment in the European countries: Final results from the ESTRO-HERO survey C. Grau1, N. Defourney2, J. Malicki3, P. Dunscombe4, J.M. Borras5, M. Coffey6, B. Slotman7, M. Bogusz8, C. Gasparotto2, Y. Lievens9 1 Aarhus University Hospital, Department of Oncology, Aarhus C,
ESTRO 33, 2014 Denmark 2 ESTRO, Office, Brussels, Belgium 3 Greater Poland Cancer Centre, Administration, Poznan, Poland 4 Tom Baker Cancer Centre, Department of Medical Physics, Calgary Alberta, Canada 5 University of Barcelona, Department of Oncology, Barcelona, Spain 6 Trinity Centre for Health Sciences, Radiological Sciences, Dublin, Ireland Republic of 7 VU University Medical Centre, Department of Radiation Oncology, Amsterdam, The Netherlands 8 Cancer Diagnosis and Treatment Centre, Administration, Katowice, Poland 9 Ghent University Hospital, Department of Radiation Oncology, Ghent, Belgium Purpose/Objective: Documenting the distribution of radiotherapy departments and the availability of radiotherapy equipment in the European countries is an important part of HERO - the ESTRO Health Economics in Radiation Oncology project. HERO 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 aim of the current report is to describe the distribution of radiotherapy equipment in European countries. Materials and Methods: An 84-item questionnaire was sent out to 39 nations of greater Europe, as defined by the European Cancer Observatory (ECO), principally through their national societies. The current report includes a detailed analysis of radiotherapy departments and equipment in Europe (questionnaire items 26-29), analyzed in relation to the annual number of patients treated in the same countries. The analysis was conducted in November 2013, and is based on validated responses from 24 countries. Results: A large variation between countries was found for most parameters studied. There was a median of 1 simulator per 2.1 (range 0.7-3.8) MV machine and 1.5 (range 0.4-3.0) simulators per department. Of the 852 simulators, a total of 636 (75%) were capable of 3D imaging (CT-scanner or CBCT-option). There were 2,140 linear accelerators and 79 cobalt machines reported in the 24 countries, and 12 countries had at least one cobalt machine in use. The number of MV machines (cobalt, linear accelerators and dedicated stereotactic machines) per million inhabitants ranged from 1.8 to 9.6 (median 5.2) and the average number of MV machines per department from 0.9 to 8.0 (median 2.6). The average number of patients treated per year per MV machine varied from 262 to 1,061 (median 438). Although 94% of the MV machines were linear accelerators, only 46% of these were capable of IMRT and only 36% were equipped for image guidance (IGRT). In many Central-Eastern European countries there was very limited access to IMRT or IGRT. Conclusions: Although the European average number of MV machines per million inhabitants and per department is now in line with QUARTS recommendations, the results of this survey document a significant heterogeneity, in the order of a factor of 3-5, in the access to modern radiotherapy equipment in Europe. The majority of Northern and Western European countries are well-served with radiotherapy resources, whereas other countries are facing important shortages in terms of equipment capable of delivering IMRT and IGRT. OC-0570 Radiotherapy staffing in the European countries: Final results from the ESTRO-HERO survey Y. Lievens1, M. Coffey2, N. Defourney3, P. Dunscombe4, J. Borras5, B. Slotman6, J. Malicki7, M. Bogusz8, C. Gasparotto9, C. Grau10 1 Universitair Ziekenhuis Gent, Department of Radiation Oncology, Gent, Belgium 2 Trinity Centre for Health Sciencs, Radiological Sciences, Dublin, Ireland Republic of 3 ESTRO, Health Economics, Brussels, Belgium 4 Tom Baker Cancer Centre, Medical Physics, Calgary Alberta, Canada 5 University of Barcelona, Oncology, Barcelona, Spain 6 VU University Medical Centre, Oncology, Amsterdam, The Netherlands 7 Greater Poland Cancer Centre, Administration, Poznan, Poland 8 Cancer Diagnosis and Treatment Centre, Administration, Katowice, Poland 9 ESTRO, Administration, Brussels, Belgium 10 Aarhus University Hospital, Oncology, Aarhus, Denmark Purpose/Objective: The first milestone in the Health Economics in Radiation Oncology (HERO) project of ESTRO is to assess availability of and accessibility to radiotherapy in the different European countries. As part of the European blueprint of radiotherapy resources, this report focuses on the data received with respect to personnel availability and their roles and responsibilities.
ESTRO 33, 2014
Materials and Methods: An 84 part questionnaire was sent out to 39 nations of greater Europe, as defined by the European Cancer Observatory (ECO), as well as Turkey and Armenia, principally through their national societies. Thirty-four countries provided partial or complete responses. The current analysis, conducted on the validated dataset in November 2013, reports on the 14 questions concerning personnel resources, and relates them to population statistics from the World Bank database and to the reported national data on radiotherapy treatments delivered and availability of equipment. Results:
S223 Purpose/Objective: Radiation therapy (RT), one of the key therapeutic modalities in the management of cancer is required in about 50% of newly diagnosed cancer patients and 25% of those previously irradiated. The study evaluates the present status ofRT infrastructure and related human resources along with its projected needs by 2020 in low-middle income (LMI) countries. Materials and Methods: One hundred and thirty-five countries with GNI/capita of
Twenty-three of the 34 countries (68%) responding to the questionnaire have provided data regarding the personnel resources in their country. This analysis focuses on the actual numbers of personnel, hence 2 countries only reporting full time equivalents were not withheld in this report. Table 1 demonstrates the large variation observed in terms of number of personnel per million inhabitants (MI). Countries with the highest numbers/MI are depicted in decreasing shades of red, those with the lowest numbers/MI in shades of blue. Similar large variations are observed for the number of treatments delivered per type of personnel: radiation oncologists (RO) on average perform 209 treatments per year (range 103-415), medical physicists (MP) 337 (range 155-623) and dosimetrists 771 (range 149-2122). Using a combined figure of radiation technologists (RTT) and nurses, an average of 61 treatments is delivered, varying between 29 and 88. The number of personnel per megavoltage (MV) machine also varies quite considerably. The range for RO/MV is 0.9-4.5 and for MP/MV 0.92.8. The ranges for RRTs and nurses are even larger: 0.2-11.0 for RTT/MV with two countries not providing data and 0.9-7.5 for nurses/MV with 9 countries not providing data. Conclusions: The average number of annual treatments per RO and MP is now lower than the QUARTS recommendations, in line with evolving treatment complexity. Nevertheless, a large variation in available personnel exists amongst European countries. Apart from different cancer incidence and socio-economical determinants, this variation also reflects differences in educational level and background (e.g. of the personnel working in planning or on the MV units) and different roles and responsibilities taken by the professional disciplines (e.g. radiation oncologists all or not involved with chemotherapy delivery) in each country. OC-0571 Present and future status of radiation therapy in low-middle income countries: An imminent global crisis N.R. Datta1, M. Samiei2, S. Bodis1 1 Centre for Radiation Oncology KSA-KSB Kantonsspital Aarau, Radiation Oncology, Aarau, Switzerland 2 International Consultant Vienna Austria, Former Director Programme of Action for Cancer Therapy (PACT) International Atomic Energy Agency, Vienna, Austria
Conclusions: The immense gap in the present availability of RT facilities and supplementary needs by 2020 in LMI countries is a matter of great concern. This warrants an urgent review of on-going efforts by national and international organizations and professional institutions to ensure effective and feasible strategies are in place to confront the 'cancer epidemic' and to meaningfully improve access to RT services in LMI countries. 1www.worldbank.org; 2http://globocan.iarc.fr; 3http://wwwnaweb.iaea.org/nahu/dirac/default.asp;4IAEA Technical series 1462; 5 Radiother Oncol2005;75:349.e1-349.e6 OC-0572 Patterns of practice in palliative radiotherapy in Africa ñ case revisited B. Jeremic1, V. Vanderpuye2, S. Abdel-Wahab3, P.M. Gaye4, L. Kochbati5, D. Dawotola6, T. Wondemagegnehu7, M. Diwani8, C. Nyongesa9, T. Shouman10 1 Tygerberg Hospital, Radiation Oncology, Cape Town, South Africa 2 National Center for Radiotherapy, Radiation Oncology, Accra, Ghana 3 Ain Shams University, Oncology, Cairo, Egypt 4 Institut de Curie, Radiation Oncology, Dakar, Senegal 5 Institute Salah Aziz, Radiation Oncology, Tunis, Tunisia 6 A B University Teaching Hospital, Radiation Oncology, Zaria, Nigeria 7 Addis Ababa University, Radiation Oncology, Addis Ababa, Ethiopia 8 Ocean Road Cancer Institute, Radiation Oncology, Dar es Salaam, Tanzania 9 Kenyatta National Hospital, Radiation Oncology, Nairobi, Kenya 10 National cancer Institute, Radiation Oncology, Cairo, Egypt Purpose/Objective: To investigate patterns of practice in palliative radiotherapy (RT) in Africa. Materials and Methods: Fifteen centres in Africa provided detailed information about RT in both metastatic and locally advanced disease via questionnaire. Information included general one (institution status, equipment, staff, patient number), and then RT and other treatment characteristics in bone metastasis, brain metastasis, metastatic spinal cord compression, lung and liver metastasis as well as locally advanced tumours. Results: Number of patients annually seen/treated ranged 285 to 5000. Breast, cervix, head and neck,gastrointestinal and prostate cancer were top five cancers overall. Eight (53%) institutions were without linear accelerators, four (27%) had a single one, while one institution each has each 2, 3, and 4 Linacs. The number of Cobalt machines ranged 0-2 (median, 1). Majority of centres still prefer the use of fractionated RT