Radiation Oncology Collection and variation initiative
The Radiation Oncology Collection and variation initiative is a key action in the Radiation Oncology National Plan 2017–2021. Over 2017–18 the Ministry worked with DHBs and private providers to develop the Radiation Oncology Collection, a central repository of detailed radiation oncology information. The purpose of the collection is to inform linear accelerator capacity planning, support fairer access to radiotherapy, and drive more cost-effective treatment.
The Radiation Oncology Collection is now operational. The next phase of the project is to use analysis derived from the Collection to support service improvement. The Radiation Oncology Working Group has identified some variations and is undertaking further investigations.
- Currently there is some variation in radiotherapy treatment for breast cancer patients across the DHBs. Radiotherapy treatment usually consists of a number of fractions (sessions receiving radiotherapy from a linear accelerator machine). Most DHBs treat early stage breast cancer patients with 15–16 fractions however there are some outliers. This is important because 15–16 fractions is more cost effective than delivering a higher number of fractions, but is considered clinically equivalent.
- The percentage of cancer patients receiving radiotherapy for rectal cancer across the DHBs varies. This is significant because radiotherapy treatment may be linked to improved survival. There is also variation in the number of fractions delivered to patients receiving pre-operative radiotherapy for rectal cancer.
- Currently palliative radiotherapy treatment for patients with bone metastases varies across the DHB. The percentage of patients that receive a single fraction varies between 37% to 80% across the DHBs. This is important because delivering a single fraction is more cost effective and delivers equivalent pain relief.
- Treating patients with uncomplicated painful bone metastases with a single fraction is a recommendation in a Choosing Wisely Canada report and the United Kingdom Royal College of Radiology fractionation guidance.
- Currently, there are variations in access to radiotherapy treatment across different tumour types. Investigations are ongoing and it is important to note that not all variation reflects inferior practice.
The data from the Radiation Oncology Collection has also been used to inform other initiatives such as the Bowel Cancer Quality Performance Indicator development.
