Access to Radiation Treatment

Key findings

Radiation treatment utilization has shown an overall improvement over the past several years. While large regional variations persist at the county level for prostate cancer, the variability has decreased for rectal cancer. Radiation appears to be well accepted as treatment for breast and lung cancer.

Measure	Desired Direction	As of this Report
Percentage of patients treated with radiation at some point during their illness
See Methodology and Approach to find out how the ratings are calculated.

What is radiation treatment?

• Radiation treatment uses energy (radiation) from X-rays, gamma rays and electrons to destroy cancer cells.
• In high doses, radiation destroys cells in the area being treated. It does this by damaging the DNA in cancer cell genes, making it impossible for them to grow and divide.
• During radiation treatment, both cancer cells (which are growing in an uncontrolled way) and healthy cells are affected, but most healthy cells can repair themselves.
• Radiation can be used with curative intent before or after surgery, or for palliative purposes (to relieve symptoms such as pain).
• This report measures radiation use for both scenarios.
• Approximately half of cancer patients require radiation treatment at some point during their illness.

What are utilization targets and benchmarks?

• Several different methods are used to calculate expected radiation treatment utilization rates.
• Cancer Care Ontario’s provincial target for radiation utilization (48%) is set by the provincial Radiation Treatment Program. The aim is a longer-term goal.
• Benchmarks for each type of cancer are created from the best possible disease-specific rates achieved in Ontario by counties with few access barriers to radiation treatment¹.

What do the results show?

Use of radiation treatment remains stable despite increasing complexity of treatment (Figure 1).

• Overall, 39% of cancer patients in the province received radiation treatment at some point in 2015/2016. The Ontario average continues to slowly improve, up 0.6% over the previous year.
• As the incidence of cancer increases, the additional need for radiation affects utilization rates. For example, a 3% increase in the number of cases treated is needed to maintain the same utilization rate from one year to the next, and an additional 3% increase in the number of cases treated is needed to improve the overall utilization rate by 1% over a 1-year period.
• The use of radiation treatment has increased despite the introduction of high-precision Intensity Modulated Radiation Therapy (IMRT), which could have resulted in slight decreases in utilization rates because of the higher complexity and workload associated with this new type of treatment.

Utilization rates are rising for most regions, but regional variation persists (Figure 1).

• Utilization rates across the province have steadily increased over the past several years. Most Local Health Integration Networks (LHINs) have shown improvements.
• These improvements can be attributed to the introduction, through the Radiation Treatment Capital Investment Strategy , of new radiation treatment facilities and additional radiation treatment units in existing centres from 2005 to 2012, along with investment in additional radiation oncology positions from the Ministry of Health and Long-Term Care.
• Regional variation exists in the use of radiation treatment.
• North East has seen an increase in radiation treatment utilization from 39% in 2010/2011 to 47% in 2015/2016, which may be partly attributed to the addition of a treatment facility in Sault Ste. Marie.

The use of radiation treatment varies across types of cancer and counties (Breast, Prostate, Lung and Rectal Maps).

• The use of radiation treatment varies across both LHINs and the counties within each LHIN.
• The percentage of shortfall from the benchmarks for breast, prostate, lung and rectal cancers is shown in the maps.
• Radiation seems fairly well accepted as a treatment for breast and lung cancer, as shown by most counties falling within 10% of the benchmark rate.
• Variability in radiation treatment for prostate cancer is high and varies by county.
• The radiation treatment rate for rectal cancer also varies by county during the reporting period, but an improvement has been observed in recent years. However, this variation could be due to small cases in many of the counties.
• This variability in treatment patterns at the county level likely reflects differences in physician referral patterns, access to radiation treatment facilities and the distance of treatment facilities from patient homes.
• Patients in North West LHIN may have received treatment in Manitoba, and these patients are not included in the maps.

Why is this important to patient care?

• Radiation treatment is used to destroy cancer cells or provide relief from cancer symptoms.
• In some cases, radiation is the only option for treatment. In other cases, it is combined with surgery and chemotherapy to destroy any remaining cancer cells and prevent the cancer from returning.
• Medical evidence has shown that not using radiation treatment when it is indicated can lead to serious adverse outcomes, such as a higher chance that the cancer will return (recurrence) and decreased survival³.
• Radiation treatment is not appropriate for every patient with cancer, and each type of cancer has its own benchmark rate.
• By measuring county-level radiation utilization rates, we can identify areas where physicians are less likely to refer patients for radiation treatment.
• Cancer incidence is increasing, and it is projected to continue to increase (see the section in “Cancer in Ontario” on incidence).
• Radiation utilization rates need to increase just to keep up with the resulting demand for care.
• In past years, the expansion of radiation treatment centres has allowed Ontario to keep up with this increasing demand and improve utilization. If the province is to meet aggressive utilization targets while matching growing demand, however, radiation capacity also must increase.

Find out more

For more information on the Radiation Treatment Program, visit Cancer Care Ontario’s website.

View Notes

1. Sullivan T, et al., editors. Radiotherapy: quality and access issues. Strengthening the quality of cancer services in Ontario. Ottawa: CHA Press; 2003.
2. Cancer Care Ontario. Radiation treatment capital investment strategy, April 2012 [Internet]. Toronto: Cancer Care Ontario; 2012 [cited 2013 Mar 14]. Available from: https://cancercare.on.ca/common/pages/UserFile.aspx?fileId=155722.
3. Zhang-Salomons J, Mackillop WJ. Estimating the lifetime utilization rate of radiotherapy in cancer patients: the Multicohort Current Utilization Table (MCUT) method. Comput Method Prog Biomed. 2008; 92(1):99–108.