Radiation oncology in a Canadian province: measures of workload and treatment complexity

Aims

A growing and aging population is associated with an increased incidence of cancer. Advances in radiotherapy technology have changed the way radiation is planned and delivered. This population-based study documented changes in workload and treatment complexity over a 10 year period in a Canadian province.

Materials and methods

We examined the population-based radiation records of a provincial Canadian cancer centre from 2000 (or from 2005 for some measures) to 2009 inclusive. We propose new measures of workload and treatment complexity currently used in our centre that can be easily adopted by other cancer centres.

Results

Workload measured by total new-to-doctor consultations increased 30% from 2000 to 2009 (3.3% annually, P = 0.0008). Total treatment commencements increased 35% over the same time (3.9% annually, P < 0.0001) but linear accelerator (linac) commencements increased at a slower rate of 2.0% annually (P = 0.0002). The rates of increase in consultations and total commencements were faster than the rates of increase in the total population, the population over age 50 years, or the incidence of cancer. Implementation of stereotactic radiosurgery and increased brachytherapy treatments explain much of the increased workload. Measures of treatment complexity including simulations per linac course and radiation computer plans per linac course increased at steady rates of 3.6% (P = 0.0019) and 3.2% (P = 0.0088) annually, respectively, but portals (fields) per linac treatment course increased exponentially after the implementation of intensity-modulated radiotherapy. The number of fractions per linac patient declined by 2.6% annually (P < 0.0001).

Conclusions

This population-based study showed that radiation oncology workload increased at faster rates than the population or incidence of cancer. Measures of treatment complexity indicate an increasing investment for each course of linac treatment, but also the adoption of hypofractionated regimens. These results indicate that radiotherapy manpower requirements cannot be based on population or cancer incidence alone if current technological trends continue.