Variation in the Use of Radiotherapy for Cancer Patients: Population-based Studies in the South of the Netherlands

Since the 1950’s and especially since the 70’s upon the introduction of megavoltage radiotherapy plays a growing and more important role in the treatment of cancer, especially in breast, rectal, prostate and lung cancer and lymphoma. With curative intention it can be part of the primary treatment, often in combination with surgery and/or chemotherapy or it can be used for treatment of recurrence. In palliation, either as primary treatment or in case of recurrence or metastases, a short course of radiotherapy often relieves pain or other symptoms.1 Of all newly diagnosed cancer patients about 50% are generally assumed to receive radiotherapy during the course of their disease.2, 3 This percentage is only an estimation but is nevertheless often used in the process of decision making to plan the future capacity of radiotherapy equipment and personnel needed. It consists of a mixture of immediate radiotherapy (as part of the primary treatment) and delayed (or secondary) radiotherapy. In Australia a technique was developed to estimate the ideal proportion of new cases of cancer that should receive radiotherapy at least once during the course of their illness based on the best available evidence, which was 52%.4 Population-based studies, however, (which are hardly done in the field of radiotherapy use or outcome) give a real insight in the use of radiotherapy. They are also essential to explore trends in time. And they might be very suitable to extrapolate the consumption of radiotherapy in the future, which will provide a contribution to planning and programming the required capacity of equipment and personnel.5 Population-based studies of the use of radiotherapy for different tumour types, preferably by stage and age, can also illustrate necessary as well as arbitrary changes in treatment and provide an impression of adherence to guidelines.

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