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SERVICES Where should cancer radiotherapy centres be located? The intuitive answer is that radiotherapy centres should follow the population concentration distribution in a country [3.30]. A single centre may suffice in small countries or even in large countries with a small population if transportation services between centres of population are adequate. In general, however, a network of oncology services will be required, with a radiotherapy centre within each region of a country. For those patients living at a distance from the radiotherapy centre, funding will have to be set aside to pay for the costs of transportation and accommodation. Countries where a significant proportion of the population are living at a distance or geographically isolated from the main centres may also consider either the implementation of consultation clinics as focal points for further referral (primary care clinics can fulfil this role) or, alternatively, facilitate patient commuting through an organized transportation service. A study from Ontario, Canada [3.31], showed that the province’s highly centralized radiotherapy network did not provide adequate or equitable access to care to the province’s dispersed population. In this study, the radiotherapy utilization rate was 29%, which is much lower than the generally accepted rate for a developed country. A similar study from the north of England showed socioeconomic gradients in access to services [3.32] related to education levels and car use. 3.7. SUMMARY About 50% of all cancer patients need radiotherapy at least once in order to cure their cancer, increase the chance of cure or relieve symptoms caused by cancer. It is likely that the proportion that need radiotherapy is greater in LMICs because patients present with more advanced cancers and alternative treatments, such as complex surgery, are less likely to be available. The demand for radiotherapy can be estimated from cancer registry data and used to determine the number of MV machines and staff required to meet the demand. 55 3.8. KEY POINTS — Estimating demand requires knowledge of the types and numbers of cancers and the indications for services. — Cancer registries provide information on the types and frequency of cancer in a population. They may also record data about stage at presentation, which has a critical influence on outcomes. — Planning sufficient services to meet the needs of the treatment population is vital in providing optimal care. — The proportion of cancer patients in low and middle income countries (LMICs) with an indication for radiotherapy is likely to be higher than that in high income countries because of the types of cancers. — In addition, these cancers are often diagnosed at a more advanced stage, which limits surgical options. — Because the types of cancer vary from region to region, the proportion with an indication for radiotherapy varies from 48% of new cases of cancer in Mexico and Central America, and the Middle East, to 55% in the Caribbean. — About 25% of these may benefit from re-treatments (re-irradiation). — The capacity of a megavoltage machine is between 400 and 600 courses of treatment per year, depending on the complexity of the techniques used. — In LMICs, the radiotherapy utilization rate will be higher, the number of courses per machine will be higher and the re-treatment rate will be lower. REFERENCES [3.1] DELANEY, G., JACOB, S., FEATHERSTONE, C., BARTON, M., The role of radiotherapy in cancer treatment: Estimating optimal utilization from a review of evidence-based clinical guidelines, Cancer 104 6 (2005) 1129–1137. [3.2] SLOTMAN, B.J., et al., Overview of national guidelines for infrastructure and staffing of radiotherapy, ESTRO-QUARTS: Work package 1, Radiother. Oncol. 75 3 (2005) 349.E1–349.E6. [3.3] SCOTTISH EXECUTIVE HEALTH DEPARTMENT, Report of the Radiotherapy Activity Planning Group, Radiotherapy Activity Planning for Scotland 2011–2015, Edinburgh (2005). [3.4] TYLDESLEY, S., BOYD, C., SCHULZE, K., WALKER, H., MacKILLOP, W.J., Estimating the need for radiotherapy for lung cancer: An evidence-based, epidemiologic approach, Int. J. Radiat. Oncol. Biol. Phys. 49 4 (2001) 973–985. [3.5] BARTON, M.B.,