This project has been completed

Summary

Cancer is 2nd only to heart disease as cause of death. Along with life expectancy cancer incidence is still going up. Long-term strategies for providing adequate care to the EU citizens are needed.  Together with surgery radiotherapy (RT) remains the most effective instrument for local control of tumours.  Non-invasive, organ function and limb preserving, it is the curative treatment of choice for many tumour types and a cheap and highly effective option for palliation and symptom control.  QUARTS aims at providing health care authorities with objective criteria for infrastructure and staffing needs for RT. A quantitative analysis of demands on staff and infrastructure per tumour site and type and of a population-based hierarchy of treatment facilities, adaptable to local epidemiology and staffing costs will assist in prioritising financial resources.  As a first step an inventory of facilities, their geographic spread and existing national guidelines will be drafted.

Rationale

50 to 60% of cancer patients will need radiotherapy (RT) in the course of their disease. Earlier diagnosis and gradual implementation of high precision imaging and RT delivery tools improve the perspective on uncomplicated tumour control, reducing metastatic spread with huge associated costs.  36% of the cured patients received RT alone (24%) or in combination with surgery or chemotherapy (12%).  RT is a cost-effective treatment using only 3 to 5% of cancer care budgets. Still, capital intensive equipment, written off over a period of 10 years, remains an easy target for cuts in health care budgets, resulting in waiting lists and sub-optimal treatment outcome. In-depth analysis revealed inequitable access to care in the UK and inadequate RT facilities in The Netherlands.  This led to massive investment in RT in both countries. A long-term policy for infrastructure and staff development is needed. QUARTS aims at providing health care authorities with the tools for a well-targeted planning.

Objectives

The aim of the project is to collect data for a comparative analysis of the existing infrastructure (equipment and staffing) and relevant national guidelines as a first step towards a comprehensive study, to be carried out at a later stage, establishing objective and quantifiable criteria for a harmonised and long term strategy for the provision of RT services in Europe.

Long term objectives (extending beyond the scope of the present study)

• To provide national health care authorities and other non-RT professionals with a set of parameters allowing them to extrapolate and quantify, for the specific situation in their country, the needs for radiotherapy infrastructure and staffing.
  
• To create a refined instrument for geographic, cross border mapping and continuous monitoring of the situation in Europe in order to facilitate the development of a harmonised long term strategy.
  
• To provide guidance at the European level for the development of a rational, evidence based, and optimised approach to the provision of radiotherapy services in a cost-effective, mature health care system.
  
• To lay the basis for an infrastructure (data-base) for future research in the variation in health care provision, the functioning of health care systems, medical practice and patterns of care, the correlation of treatment outcome with the provision of services and health economics in general.

Short term objectives to be reached within the scope of this study:

Within the scope of the present project and as step 1 for the comprehensive study outlined before, QUARTS will:

• Compile, analyse and publish an inventory of the existing data (infrastructure, staffing, national guidelines),
  
• Create software and a data base for finely tuned prospective data collection as described in work package 3 and
  
• Develop operating procedures, networks and task distribution for tackling action points 1-6 in work plan hereafter. A statistician and health economist, who accepted to also monitor the preparatory work, will oversee the objectivity of the study.
  
  While yielding valuable endpoints in its own (data as a basis for European guidance), this AM-action will also be an important stepping stone in a wider design for future long term and overdue research in support of a European policy aiming at equal access to quality health care provisions within its borders.

Methodology and Work Plan

Steps to be accomplished

1. Review of literature on incidence figures and cancer registry data for the EU+applicant states. What is the confidence margin, where are the grey areas?
   
2. Define the current role of radiotherapy in cancer treatment.  Investigate evidence-based indications per tumour site, type and grading.
   
3. Describe for each of them a hierarchy of RT treatment options: external beam therapy Vs brachytherapy, standard, (intensity modulated) conformal, proton/light ion treatment.
   
4. Analyse cost structure of radiotherapy (RT) per treatment option. Quantify time-cost units for staff, facilities and equipment per treatment.
   
5. Define on the basis of points 1 to 4 above, a hierarchy of treatment facilities for different levels of treatment complexity.  Is there an optimum size for a RT-department?
   
6. Publish white book on? RT for cancer: quantification of infrastructure and staffing needs? for non-RT professionals.
   
   Part 1: Inventory of Radiotherapy Services in Europe: Comparative Analysis of  Infrastructure, Staffing and National Guidelines (present project)
   
   Part 2: Radiotherapy services in Europe:  prospective quantification of infrastructure and Staffing needs for an ageing population (future study)

Partners

	ESTRO Project Promoter		Walter van den Bogaert ESTRO Exec. Administrator
	Project Co-ordinator Project management		Germaine. Heeren, ESTRO Guy François, ESTRO Frédéric Talbot, ESTRO
	VUMC		Ben Slotman, RT
	Clatterbridge Centre for Oncology		Brian Cottier, RT
	KU Leuven		Katrien Kesteloot, health economist Walter van den Bogaert, RT Yolande Lievens, RT
	Gray Cancer Centre		Soeren Bentzen, bio-statistician
	Uppsala University		Bengt Glimelius, oncologist
	The ESTRO "Radiotherapy 2003" Committee
	National QUARTS Contact Persons National Radiation Oncology Societies

Tasks or Work Packages

	WP1:		Comparative analysis of guidelines for staffing and infrastructure for Radiotherapy within the European Union:Ben Slotman
	WP2:		A review and comparative quantitative analysis of radiotherapy services in Europe: Brian Cottier.
	WP3:		Data collection and analysis Brian Cottier
	WP4:		Cancer incidence-Epidemiology-Indications-Treatment Options: Health economic aspects and bio-statistical analysis.  Bengt Glimelius: clinical aspects. Soeren Bentzen: bio-statistical aspects. Katrien Kesteloot, Walter Van Den Bogaert, Yolande Lievens: Health Economic aspects

Milestones

Project start: 1 January, 2003  - Project end: 30 June 2004

Month 18: completion and publication on ESTRO website of:

• overview of cancer incidence figures and availability of reliable cancer registry data
• comparative analysis of European guidelines for RT infrastructure and staffing
• overview of available data on RT-Services (infrastructure and staffing) in EU
• concept for central data base to store these data - normalisation of available data sets?
     - comparative quantitative analysis of data
     - overview evidence based indications for RT-methodology for analysis of cost
        structure and

• health economic and statistical evaluation

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