Japanese structure survey of radiation oncology in 2009 based on institutional stratification of the Patterns of Care Study

摘要

Table?1 shows that the numbers of new patients and total patients (new plus repeat) undergoing radiation in 2009 were estimated at 201?000 and 240?000, respectively, showing a 11.0% increase over 2007 [6], with 40% of the patients being treated at academic institutions (categories A1 and A2), even though these academic institutions constituted only 20% of the 700 radiotherapy facilities nationwide. Table?2 shows an overview of RT equipment and related functions. There were 816 Linac, 46 Gamma Knife, 29 60Co remote afterloading system (RALS), 130 192Ir and 1 137Cs RALS systems in actual use, as well as 9 of the 15 telecobalt systems installed. The Linac systems used dual energy function for 586 (71.8%), 3D conformal radiation therapy (3DCRT) for 663 (81.3%) and intensity-modulated radiation therapy (IMRT) for 337 units (41.3%). The IMRT function was employed more frequently for the equipment of academic institutions (A1: 73.4% and A2: 49.5%) than that of non-academic institutions (B1: 42.3% and B2: 18.1%). However, 3DCRT functions were disseminated widely in both academic and non-academic institutions, with 69% even in B2 institutions. The use of image-guided radiation therapy (IGRT) has been steadily expanding from A1 institutions (30.4% to 33.5%) to the other types of institutions (14.0% to 35.5%). The annual numbers of patients/Linac were 393.2 for A1, 244.3 for A2, 339.1 for B1 and 118 for B2 institutions and showed a 9.8 % increase compared with the data from 2007. The number of institutions with telecobalt in actual use showed a major decrease to 9 and became stable compared with 2007. Gamma Knife was installed more frequently in B1 and B2 institutions. A significant replacement of 60Co RALS with 192Ir RALS was observed especially in academic institutions, while the number of new 60Co RALS-type systems in use did not increase. Six particle machines were registered in this survey, two with carbon-beam and five with proton-beam irradiation. One machine in Hyogo Prefecture can deliver either carbon or proton beams. Although the HIMAC in Chiba Prefecture has two synchrotrons, it was registered as one machine in the 2009 survey. The total number of new cancer patients treated at these six institutions was estimated at 2038 (1.19% of all new patients in Japan). Twenty-seven advanced institutions were included in the A1 category and treated more than 800 patients per year. They were equipped with Linacs with dual energy (75.3% of the institutions), 3DCRT (97.2%) and IMRT function (82.2%), as well as with 192Ir RALS (92.6%) and a computed tomography (CT) simulator (96.3%). Table?4 shows the staffing patterns and patient loads by institutional stratification. ‘Full-time or part-time' refers to the style of employment. Since even full-time ROs must share the diagnosis in a week at smaller institutions such as found in the B2 category, we felt that these numbers were not adequate for an accurate evaluation of man power. Therefore, data for full-time equivalent (FTE: 40?h/week for radiation oncology service only) were assessed in terms of the clinical working hours in RT of each individual. This is thus a method to determine actual man power at each institution. The total number of FTE ROs in Japan stood at 939.4, while the average numbers were 4.6 for A1, 1.6 for A2, 1.3 for B1 and 0.6 for B2 institutions. The number in B1 improved by 30% compared with 2007 [6]. The overall patient load per FTE RO in Japan was 231.9, and for A1, A2, B1 and B2 institutions the loads were 193.5, 205.2, 290.6 and 198.4, respectively, with the patient load for B1 institutions being by far the highest. The increase in the overall patient load per FTE RO was 13.7% compared with 2007 (6). In Japan, 42.6 % of the institutions providing RT have their own designated beds, where ROs must also take care of their in-patients. The percentage distribution of institutions by patient load per FTE RO shown in Fig.?1a indicates that the largest number of facilities featured a patient/FTE staff level in the 101–150 range, and in the 151–200 range for the second largest number. The blue areas of the bars show that 47.7% of the institutions (334/700) had less than one FTE RO. Compared with 2007 [6], the patient load has increased even more. Table?5 shows the distribution of primary sites by institutional stratification. The most common disease site was the breast, followed by the lung/bronchus/mediastinum and genito-urinary region. In Japan, the number of patients with prostate cancer undergoing RT was 17?919 in 2009, showing an increase of 10.4% over 2007 [6]. By disease site, the rate of increase compared with 2007 was the highest for prostate cancer at 10.4%, the second highest for breast cancer at 9.6% and the third highest for head and neck cancer at 9.3%. The stratification of institutions indicates that the rate of increase for lung cancer was notable for A1 instituti