Japanese Structure Survey of Radiation Oncology in 2007 Based on Institutional Stratification of Patterns of Care Study

Abstract

The ongoing structure of radiation oncology in Japan in terms of equipment, personnel, patient load and geographic distribution was evaluated in order to radiation identify and improve any deficiencies. A questionnaire-based national structure survey was conducted from March 2010 to January 2011 by the Japanese Society for Therapeutic Radiology and Oncology (JASTRO). These data were analyzed in terms of the institutional stratification of the Patterns of Care Study (PCS). The total numbers of new cancer patients and total of cancer patients (new and repeat) treated with radiation in 2009 were estimated at 201,000 and 240,000, respectively. The type and numbers of systems in actual use consisted of Linac (816), telecobalt (9), Gamma Knife (46), 60 Co remote afterloading system (RALS) (29) and 192 Ir RALS systems (130). The Linac systems used dual energy function for 586 (71.8%), 3DCRT for 663 (81.3%) and IMRT for 337 units (41.3%). There were 529 JASTRO-certified radiation oncologists (ROs), 939.4 full-time equivalent (FTE) ROs, 113.1 FTE medical physicists and 1836 FTE radiation therapists. The frequency of interstitial radiation therapy use for prostate and of intensity-modulated radiotherapy increased significantly. PCS stratification can clearly identify the maturity of structures based on their academic nature and caseload. Geographically, the more JASTRO-certified physicians there were in a given area, the more radiation therapy tended to be used for cancer patients. In conclusion, the Japanese structure has clearly improved during the past 19 years in terms of equipment and its use, although a shortage of manpower and variations in maturity disclosed by PCS stratification remained problematic in 2009.

Prescription of Cancer Treatment Modalities in Developing Countries: Results from a Multi-Centre Observational Study

“…The results in these assessments varied from 26% in Japan (2007) [19] to 48% in the Netherlands (1997) [14]. The results from the Dutch survey were consistent with the assessment made by the Swedish Council on Technology Assessment in Health Care (SBU) which in 2001 established a radiotherapy utilization rate of 47% in Sweden, 15% higher than in 1992 [11] [15].…”

“…The development of new and/or strengthening of operational services delivering these therapies is associated with increasingly high costs [8], therefore making realistic projections is critical to maximize infrastructure, equipment, financial and human resources at a population level. Considering radiotherapy, the information available has been generated mainly in developed countries; the estimates of service demand are based on expert's opinion [9], rate of utilization [10]- [19], or on what should be prescribed according to clinical guidelines [18] [20] [21]. However, patterns of cancer incidence, stage at diagnosis and access to treatment in developing countries are distinct, thus indications for surgery, systemic therapies and radiotherapy may vary considerably.…”

Japanese Structure Survey of Radiation Oncology in 2007 with Special Reference to Designated Cancer Care Hospitals

“…JASTRO carried out a national structure survey of radiation oncology in 2007 by administering a questionnaire in 2008 [19]. The questionnaire consisted of items related to the number of treatment machines and modality by type, the number of personnel by job category, the number of patients by type, and the site.…”

“…On the other hand, the current utilization rate of radiotherapy for new cancer patients in Japan is only 26.1% [19] and surgery is still predominant. In Japan, the Cancer Control Act has been implemented since 2007 in response to patients' urgent petitions to the government [8].…”

“…At the same time, the Ministry of Health, Labor, and Welfare began the accreditation of "designated cancer care hospitals (DCCHs)" with the aim of correcting regional differences in the quality of cancer care and strengthening cooperation between regional cancer care hospitals [3,9,13]. The Japanese Society of Therapeutic Radiology and Oncology (JASTRO) has conducted national structure surveys of radiotherapy facilities in Japan every 2 years since 1990 [18,19]. The structure of radiation oncology in Japan has improved in terms of equipment and its functions in response to the increasing number of cancer patients who require radiotherapy.…”