The malthus programme - a new tool for estimating radiotherapy demand at a local level

摘要

The radiotherapy delivery service in England is emerging from a 25 year blight on strategic planning and forecasting of radiotherapy demand. Two of the most influential documents used as evidence for renovation and expansion in radiotherapy services are the Royal College of Radiologists (RCR) equipment, workload and staffing survey [1} and the National Radiotherapy Advisory Group (NRAG) report [2]. Where the RCR survey quantified significant variation in allocation and consumption of radiotherapy resources across England and Wales, the NRAG 2007 report generated national targets for radiotherapy service provision in terms of fraction burden (40,000 fractions per million of population by 2010 and up to 54,000 fractions per million by 2016) and the proportion of cancer patients receiving radiotherapy at some point in their cancer journey (access rate), which was estimated at 52% [3]. Although the NRAG model has been instrumental in providing evidence of radiotherapy under provision, it has proven difficult for clinicians and local commissioning groups to apply the model at a regional level, just as the RCR report would have predicted. Independent of any differences in clinical practice among radiation oncologists across the country, local variation in radiotherapy demand is driven by differences in population demographics and age distribution, co-morbidity, disease incidence and variation in the diagnostic and surgical pathways leading to radiotherapy treatment. It clear that a national 'best fit' model cannot provide a good fit for commissioning and service provision at the local level.