Indicators for radiotherapy utilisation amongst adult patients with cancer in England
Daniela Tataru, Alex Kao, Kat Roe, Georgios Lyratzopoulos, Katie Spencer, Katherine Thackray, Emily Jones
Publication date: 17th January 2025
1 Introduction
Background
Access to healthcare is recognised to incorporate multiple elements. These include, for example, the approachability and affordability of care, elements which will be influenced by: the availability of transport; caring and work responsibilities; and health literacy amongst a wide array of others. The data available are not able to measure all these factors, many of which are qualitative in nature. As such, this report focuses upon utilisation of radiotherapy (RT) amongst adults treated for cancer in England. It offers a valuable proxy for access to radiotherapy treatment but one that recognises the limitations of the data in providing a full assessment across all elements. These results will provide valuable information to guide targeted interventions and highlight areas where further investigation is required. Specifically, this analysis will provide: estimates of the overall and site-specific radiotherapy utilisation at national and local geography level, including the estimates of the number of malignant tumours treated, the number of malignant tumours diagnosed and the number of tumours of the patients who had died in a given calendar year; descriptions of variation by key demographic factors at the local level, to support targeted interventions. The report does not account for the use of other cancer modalities for example surgrey and chemotherapy. For the treatment of some tumour groups there are multiple comparable treatment modalities that can be utilised based on the needs of individual patients.
2 Radiotherapy Utilisation Measures
It is acknowledged at the outset that there is no clear consensus in the literature about approaches to measuring radiotherapy use in patient populations for the purposes of routine monitoring (public health surveillance). A very large number of measures can theoretically be considered.
Two alternative approaches, taking opposing perspectives are reported in the literature . These seek to estimate the optimal utilisation rate for radiotherapy or conversely, to report an observed utilisation rate in a given patient population.
Here we will undertake the latter approach. Previous cohort studies have faced challenges with variable data availability and differing follow-up periods. Many studies have focussed on individual diagnoses rather than an overall population of patients with cancer. As such variation between studies prevails. Where multiple diagnoses have been included concern has been raised about possible unwarranted variation in utilisation across the NHS.Hoskin et al [1]
Over recent decades, estimates of an ideal utilisation rate of around 40-50% have been quoted, these are based on demand models and therefore considerable uncertainty exists (Delaney et al [2] and Williams et al [3]). Previous publications, such as Hoskin et al [1] have estimated utilisation based on episodes and attendances, however changing clinical practice with regards to fractionation limits the comparability of these estimates to current practise. Therefore, a knowledge gap exists about national utilisation of radiotherapy across all cancers and specific diagnostic groups with additional information needed to better understand and visualise variation in utilisation across the country. Such analyses require clear and transparent inclusion criteria and methodology.
It is also notable that this report focusses solely upon radiotherapy utilisation. Where acceptable alternative treatment strategies exist and the relative utilisation of this and radiotherapy varies (e.g. in radical treatment of prostate cancer) across the country (due to clinician or patient preference) we are not able to consider this. Data informing the relative utilisation of alternative treatment modalities is available at demographic and geography level in the NDRS Cancer Treatments dashboards Cancer treatments - NDRS which can support triangulation across modalities.. Further the study period includes the COVID19 pandemic period in which it is recognised that cancer diagnoses and treatment were significantly disrupted (Spencer et al [4]).
After careful consideration, three key measures were defined in order to assess radiotherapy utilisation in a given year (2019, 2020 or 2021). The measures consider radiotherapy activity in the context of cancer incidence (in the same period). This does not provide a cohort-based approach as the tumours treated (counted in the numerator) are not necessarily all included within the denominator set of incident tumours (for example, treatments in January may be delivered for tumours diagnosed in the prior December). This is advantageous, however, as it provides a clearer picture of all radiotherapy delivered within the observed period as treatments delivered to those diagnosed outside this window are none the less recognised. The measures are based on all malignant tumours (ICD10 C00-C97, D05 excluding C44) diagnosed in English residents from 1995 onwards and treated with radiotherapy in a given calendar year considered against all incident tumours in the same year.
The analysis results presented here will focus on NHS radiotherapy activity taking place during 2019, with selective results presented for 2020 and 2021 calendar years. At the time the report was created it was not possible to include 2020 and 2021 data for Measure 2b because an additional two years of follow-up is required was not available previously.
2.1 Methodology
The key measures presented here are Measure 1, Measure 2a and Measure 2b, representing overall, radical and palliative radiotherapy activity respectively. For context, an additional mop-up measure (Measure 2c) captured all radiotherapy activity treatment in a given calendar year that was not included in (the numerators of) the Measure 1, Measure 2a or Measure 2b. Note that the majority of the tumours will be counted both in Measure 1, and then in at least one of the Measure 2a and Measure 2b. Tumours may be counted in the denominator of both Measure 2a and Measure 2b, however radiotherapy episodes can only be included in one of these two measures (they are not exclusive).
Measure 1
A measure of overall radiotherapy utilisation for a given calendar year, capturing all radiotherapy activity for patients with a diagnosis of cancer, independently of when the diagnosis has occurred
This measure estimates the number of malignant tumours treated with radiotherapy in a given year for every 100 incident tumours in the same year
\[
\begin{align}
\text{Measure 1} = \frac{\text{Number of tumours treated with } \\
\text{radiotherapy in a given year (diagnosed anytime since 1995)}}{
\text{Number of tumours diagnosed during the same year}} {\text{ X 100}}
\end{align}
\]
Inclusion criteria for denominator
- Diagnosed since 1995
- Aged 18 and over at the time of diagnosis
- Patient gender is known
- Patients have been excluded where a sex-specific diagnosis code does not match the person-stated gender, this may have excluded some transgender and non-binary patients https://digital.nhs.uk/ndrs/our-work/ncras-work-programme/inequalities-in-cancer
- Patient resident in England at time of diagnosis and diagnosed at an English provider
Inclusion criteria for numerator
As above and:
All types of radiotherapy are included
All intents are included (intent is clinician defined and not defined based on treatment regimen)
Measure 2a
A measure of radiotherapy utilisation in the curative setting, covering only those tumours diagnosed at stage 1-3 and treated with radical radiotherapy within a calendar year from the date of diagnosis
This measure estimates the number of stage 1-3 tumours (diagnosed anytime since 1995) treated within a year of diagnosis with radical radiotherapy in a given calendar year for every 100 incident stage 1-3 tumours in the same year
\[
\text{Measure 2a} = \frac{\text{Number of stage 1-3 tumours treated with
curative RT} \\ \text{during a given year and within 1 year of
diagnosis (diagnosed anytime since 1995)}} {\text{Number of stage 1-3
tumours diagnosed during the same year}} {\text{ X 100}}
\]
Inclusion criteria for denominator
Diagnosed cases of stage 1-3 cancers from 1995
Patient gender is known
Patients have been excluded where a sex-specific diagnosis code does not match the person-stated gender, this may have excluded some transgender and non-binary patients https://digital.nhs.uk/ndrs/our-work/ncras-work-programme/inequalities-in-cancer
Aged 18 and over at the time of diagnosis
Patient resident in England at time of diagnosis and diagnosed at an English trust
Inclusion criteria for numerator
As above and:
All types of radiotherapy are included (https://bmjopen.bmj.com/content/13/6/e070699)
Intent is curative (intent is clinician defined)
Radical radiotherapy within 1 year of diagnosis
Measure 2b
A measure capturing palliative radiotherapy use, based on the number of malignant tumours treated with palliative RT during a given year where treatment is delivered within two years before the patient’s death where the patient had a cancer registration record for a diagnosis anytime since 1995 and where the underlying cause of death was cancer. These are considered against the number of tumours where the individual died in a given year with a known cancer diagnosis (diagnosis being at any time from 1995 onwards) and where the underlying cause of death was cancer
This measure estimates the number of tumours (diagnosed anytime since 1995) treated with palliative radiotherapy in a given calendar year and within two year prior to death for every 100 tumours where the individual died in the same calendar year with cancer as underlying cause of death
\[
\begin{gather*}
\text{Measure 2b} = \frac{\text{Number of tumours treated with
palliative RT during a given year} \\ \text{ and within two years before
the patient’s death (diagnosed anytime since 1995)}} {\text{Number of
tumours where the individual died in the same year with a known cancer
diagnosis}} {\text{ X 100}}
\end{gather*}
\]
Inclusion criteria for denominator
Underlying cause of death was cancer
Diagnosed cases of cancer from 1995
Patient gender is known
Patients have been excluded where a sex-specific diagnosis code does not match the person-stated gender, this may have excluded some transgender and non-binary patients https://digital.nhs.uk/ndrs/our-work/ncras-work-programme/inequalities-in-cancer
Aged 18 and over at the time of diagnosis
Patient resident in England at time of diagnosis and diagnosed at an English trust
Inclusion criteria for numerator
As above and:
Palliative radiotherapy (clinician defined intent) within 2 years of death
Measure 2c
This measure is a mop-up measure, aiming to quantify all the radiotherapy activity recorded in a given calendar year that was not already captured in (the numerator of) Measure 1, Measure 2a or Measure 2b
It is a measure based on RTDS dataset only
Inclusion criteria
Patient has received radiotherapy
Aged 18 and over at start of treatment
Patient gender is known
Patients have been excluded where a sex-specific diagnosis code does not match the person-stated gender, this may have excluded some transgender and non-binary patients https://digital.nhs.uk/ndrs/our-work/ncras-work-programme/inequalities-in-cancer
Malignant and benign neoplasms included
Patient resident in England at time of diagnosis and diagnosed at an English trust
All measure estimates are ratios, reported as the number of treated tumours per 100 incident tumours (or 100 tumours where the patient died, for Measure 2b) in a given year. The measure estimates are neither proportions nor rates.
The Cancer Registration dataset was used to identify all tumours with a cancer diagnosis between 1995 and 2019. The radiotherapy dataset RTDS was then used to select only those tumours where the patient had radiotherapy treatment for the tumour during 2019 (or 2020, 2021 respectively). This included all the tumours where an automated linkage between the cancer registration and radiotherapy treatment records existed, and those where we established a reliable link to radiotherapy treatment using a linkage algorithm (https://bmjopen.bmj.com/content/13/6/e070699). This resulting cohort formed the basis for all the numerators in the ratio of Measure 1, Measure 2a and Measure 2b.
In addition, all the tumours diagnosed in 2019 (or 2020, 2021 respectively) were identified to build the cohort that was the basis for all the denominators in the ratio of each Measure 1, Measure 2a. Similarly all the tumours diagnosed at any time from 1995 and where the patient died in 2019 with cancer as underlying cause of death were identified for the denominator of the 2019 Measure 2b. The Measure 2b estimates could not be calculated for 2021 due to follow-up data to 31st December 2023 not being available for all patients at the time of analysis.
Measure 2c was entirely based on RTDS, quantifying the radiotherapy utilisation in a given calendar year that was not captured in Measure 1, Measure 2a or Measure 2b.
Demographics
Patient demographic information is based on cancer registry data.
Five year age band at diagnosis are used
The 16+1 ethnic data categories defined in the 2001 census is the national mandatory standard for the collection and analysis of ethnicity.
Gender is self-stated at diagnosis
Socioeconomic deprivation (SED) of Lower Super Output Area (LSOA) of residential address at time of diagnosis, English indices of deprivation 2019 - GOV.UK (www.gov.uk)
Cancer groupings
Cancer site groupings are based on ICD10 codes:
Breast (C50, D05)
Head and neck (C00-C14, C30-C32)
Lung (C33, C34, C37-C39, C45)
Prostate (C61; men only)
Rectal (C19, C20)
All other codes grouped into ‘Other’ due to the small numbers included in each preventing granular analysis across demographics and geographies
Skin (C44) is excluded
3 Key findings
In England the estimated overall utilisation for 2019 was 37 tumours treated with radiotherapy for every 100 tumours diagnosed
Among stage 1-3 tumours, the estimated 2019 radiotherapy utilisation in a curative setting was 34 tumours treated with radiotherapy for every 100 tumours diagnosed
The 2019 national estimate for palliative radiotherapy utilisation in the last year of life for cancer patients was 17 tumours treated for every 100 tumours where the patient died in 2019
The tables bellow summarises the national overall, radical and
palliative radiotherapy utilisation estimates for the years 2019, 2020
and 2021.
Overall utilisation of radiotherapy across England (Measure 1):
Utilisation of radical radiotherapy across England
(Measure 2a):
Utilisation of palliative radiotherapy across England
(Measure 2b):
*Measure 2b estimates are not available for 2021. Please see the Methodology section for further details.
4 Cohort description, 2019
The Measures 1 and 2a in this report were built on the comparison of two tumour cohorts: the cohort of all cancer tumours diagnosed in 2019 (denominator) and the cohort of all tumours treated with radiotherapy in 2019 (and diagnosed anytime between 1995 and 2019) (numerator). In this section we aim to describe these two cohorts in relation to the patient’s demographic characteristics at the time of diagnosis (not at the time of radiotherapy delivery) and the cancer type.
The characteristics of 2019 treated tumours and incident tumours are presented in the bar graphs and tables below stratified by age group, gender, socioeconomic deprivation quintiles (SED) (based on the English Index of Multiple Deprivation (IMD)), ethnicity and tumour type.
335,799 tumours were diagnosed in 2019 in England (294,364 diagnosed in 2020, and 335,243 in 2021). There were 124,621 tumours (and ductal carcinoma in-situ of the breast) treated with radiotherapy during 2019 at the English NHS Trusts (among all tumours diagnosed in English residents between 1995 and 2019). (113,903 tumours treated in 2020, and 116,773 in 2021 respectively).
Five year age bands
Gender
Ethnicity
SED
Tumour Groups
5 Overall radiotherapy utilisation (Measure 1), 2019
A measure of overall radiotherapy utilisation for a given year was developed in order to capture all radiotherapy activity in patients with a diagnosis of cancer, independently of when the diagnosis occurred and whether the patient is treated as part of initial, or recurrence, management, or for symptom palliation. This measure estimates the number of tumours treated with radiotherapy in a given year for every 100 incident tumours in the same year.
\[
\begin{align}
\text{Measure 1} = \frac{\text{Number of tumours treated with } \\
\text{radiotherapy in a given year (diagnosed anytime since 1995)}}{
\text{Number of tumours diagnosed during the same year}} {\text{ X 100}}
\end{align}
\]
5.1 National measure of overall radiotherapy utilisation by patient demographic factors and cancer site
A total of 335,799 tumours were diagnosed in 2019. In the same period 124,621 tumours (and breast ductal carcinoma in-situ) were treated with radiotherapy (this latter group could have been diagnosed at any time prior to 2019). As such, 37.1 tumours were treated with radiotherapy in 2019, for every 100 tumours diagnosed in England in the same time period.
Note: The graph bars were shaded grey where the measure presented was based on a tumour count of less than 50.
Five year age bands
Gender
SED
Ethnicity
Tumour Group
5.2 Regional measure of overall radiotherapy utilisation
In 2019, the number of tumours treated with radiotherapy for every 100 tumours diagnosed varied between geographical regions. For the Integrated Care Boards (ICBs), there were between 30.5 and 46.5 treated tumours for every 100 tumours diagnosed. For Sub-ICB Locations (sub-ICBs) the measure of overall radiotherapy varied between 28.1 and 46.5.
ICBs
The maps below display the overall radiotherapy utilisation measure for each individual year.
The data for the number of tumours treated, the number of tumours diagnosed and the measure value are included in the table below.
To find your specific area please type a keyword into the
search bar. The data table can also be filtered by calendar year by
typing the year in the search box. Each of the columns can also be
sorted in ascending or descending order by clicking on the column
title.
Sub-ICBs
The maps below display the overall radiotherapy utilisation measure for each individual year.
The data for the number of tumours treated, the number of tumours diagnosed and the measure value are included in the table below.
To find your specific area please type a keyword into the search bar. The data table can also be filtered by calendar year by typing the year in the search box. Each of the columns can also be sorted in ascending or descending order by clicking on the column title.
NHS Regions
The maps below display the overall radiotherapy utilisation measure for each individual year.
The data for the number of tumours treated, the number of tumours diagnosed and the measure value are included in the table below.
To find your specific area please type a keyword into the
search bar. The data table can also be filtered by calendar year by
typing the year in the search box. Each of the columns can also be
sorted in ascending or descending order by clicking on the column
title.
5.3 Stratified regional measure of overall radiotherapy utilisation, 2019
The overall radiotherapy utilisation measure was produced for all ICB geographies and stratified by key socio-demographic factors and cancer site. The maps and data table below present the overall radiotherapy utilisation measure for selected factor levels.
Note: The geographical areas where the measure presented was based on an tumour count of less than 50 were shaded grey.
SED quintiles 1 & 5
The maps below display the overall radiotherapy utilisation
measure for the most and for the least socioeconomically deprived
groups.
The data for the number of tumours treated, the number of
tumours diagnosed and the measure value are included in the table
below.
To find your specific area please type a keyword into the
search bar. The data table can also be filtered by calendar year by
typing the year in the search box. Each of the columns can also be
sorted in ascending or descending order by clicking on the column
title.
Gender
The maps below display the overall radiotherapy utilisation
measure for the male and the female groups.
The data for the number of tumours treated, the number of
tumours diagnosed and the measure value are included in the table
below.
To find your specific area please type a keyword into the
search bar. The data table can also be filtered by calendar year by
typing the year in the search box. Each of the columns can also be
sorted in ascending or descending order by clicking on the column
title.
Age
The maps below display the overall radiotherapy utilisation
measure for the group of patients aged 18 to 70 years old and the group
of patients aged 70 years or older.
The data for the number of tumours treated, the number of
tumours diagnosed and the measure value are included in the table
below.
To find your specific area please type a keyword into the
search bar. The data table can also be filtered by calendar year by
typing the year in the search box. Each of the columns can also be
sorted in ascending or descending order by clicking on the column
title.
Ethnicity
The maps below display the overall radiotherapy utilisation
measure for each ethnicity group.
The data for the number of tumours treated, the number of
tumours diagnosed and the measure value are included in the table
below.
To find your specific area please type a keyword into the
search bar. The data table can also be filtered by calendar year by
typing the year in the search box. Each of the columns can also be
sorted in ascending or descending order by clicking on the column
title.
Tumour Group
The maps below display the overall radiotherapy utilisation
measure for each individual tumour group (with tumour group specific
value range). For each tumour group, the ICBs were ordered from the
highest value of the measure to the lowest value, allowing for the
comparative analysis across different tumour groups of each geography’s
position. The measure values and the position of each ICB for individual
tumour groups are included in the table below.
The data for the number of tumours treated, the number of tumours diagnosed and the measure value are included in the table below.
To find your specific area please type a keyword into the
search bar. The data table can also be filtered by calendar year by
typing the year in the search box. Each of the columns can also be
sorted in ascending or descending order by clicking on the column
title.
6 Radical radiotherapy utilisation (Measure 2a), 2019
This measure provides an indication of use of radiotherapy in the curative setting. It considers only those tumours diagnosed at stage 1-3 (denominator) and treated with radical radiotherapy within a year from the date of diagnosis (numerator). It is suitable for identifying variation in practice and potential unmet health need / quality improvement targets. This measure estimates the number of stage 1-3 tumours (diagnosed anytime since 1995) treated within a year of diagnosis with radical radiotherapy in a given calendar year for every 100 incident stage 1-3 tumours in the same year. Radiotherapy intent is defined by the treating clinician. Whilst algorithmic approaches can be used to the allocation of intent this approach is open to criticism. Conversely, clinician defined intent may not always be consistent despite identical clinical circumstances it is none the less felt to provide a good representation of what was intended at the point of treatment decision making.
\[
\text{Measure 2a} = \frac{\text{Number of stage 1-3 tumours treated with
curative RT} \\ \text{during a given year and within 1 year of
diagnosis (tumours diagnosed anytime since 1995)}} {\text{Number of
stage 1-3 tumours diagnosed during the same year}} {\text{ X 100}}
\]
6.1 National measure of radical radiotherapy utilisation by patient demographic factors and cancer site
Of all tumours diagnosed in 2019, 176,303 were stage 1-3 at diagnosis. 60,071 stage 1-3 tumours were treated with radical radiotherapy in 2019 within a year of their diagnosis. In 2019 34.1 stage 1-3 tumours were treated with radical radiotherapy within a year of the date of diagnosis for every 100 stage 1-3 tumours diagnosed in the same year.
Note: The graph bars were shaded grey where the measure presented was based on an tumour count of less than 50.
Five year age bands
Gender
SED
Ethnicity
Stage
Tumour Group
6.2 Regional measure of radical radiotherapy utilisation
In 2019, the number of stage 1-3 tumours treated with radical radiotherapy for every 100 stage 1-3 tumours diagnosed varied between geographical regions. For the ICBs, there were between 25.0 and 42.1 treated tumours for every 100 tumours diagnosed. For Sub-ICBs the measure of radical radiotherapy varied between 23.7 and 47.7.
ICBs
The maps below display the radical radiotherapy utilisation measure for each individual year.
The data for the number of tumours treated, the number of tumours diagnosed and the measure value are included in the table below.
To find your specific area please type a keyword into the
search bar. The data table can also be filtered by calendar year by
typing the year in the search box. Each of the columns can also be
sorted in ascending or descending order by clicking on the column
title.
Sub-ICBs
The maps below display the radical radiotherapy utilisation measure for each individual year.
The data for the number of tumours treated, the number of tumours diagnosed and the measure value are included in the table below.
To find your specific area please type a keyword into the
search bar. The data table can also be filtered by calendar year by
typing the year in the search box. Each of the columns can also be
sorted in ascending or descending order by clicking on the column
title.
NHS Regions
The maps below display the radical radiotherapy utilisation measure for each individual year.
The data for the number of tumours treated, the number of tumours diagnosed and the measure value are included in the table below.
To find your specific area please type a keyword into the
search bar. The data table can also be filtered by calendar year by
typing the year in the search box. Each of the columns can also be
sorted in ascending or descending order by clicking on the column
title.
6.3 Stratified regional measure of radical radiotherapy utilisation rates, 2019
The radical radiotherapy utilisation measure was produced for all ICB geographies and stratified by key socio-demographic factors and five major cancer sites. The maps and data table below present the radical radiotherapy utilisation measure for selected factor levels.
Note: The geographical areas where the measure presented was based on a tumour count of less than 50 were shaded grey.
SED quintiles 1 & 5
The maps below display the radical radiotherapy utilisation
measure for the most and for the least socioeconomically deprived
groups.
The data for the number of tumours treated, the number of
tumours diagnosed and the measure value are included in the table
below.
To find your specific area please type a keyword into the
search bar. The data table can also be filtered by calendar year by
typing the year in the search box. Each of the columns can also be
sorted in ascending or descending order by clicking on the column
title.
Gender
The maps below display the radical radiotherapy utilisation
measure for the male and the female groups.
The data for the number of tumours treated, the number of
tumours diagnosed and the measure value are included in the table
below.
To find your specific area please type a keyword into the
search bar. The data table can also be filtered by calendar year by
typing the year in the search box. Each of the columns can also be
sorted in ascending or descending order by clicking on the column
title.
Age
The maps below display the radical radiotherapy utilisation
measure for the group of patients aged 18 to 70 years old and the group
of patients aged 70 years or older.
The data for the number of tumours treated, the number of
tumours diagnosed and the measure value are included in the table
below.
To find your specific area please type a keyword into the
search bar. The data table can also be filtered by calendar year by
typing the year in the search box. Each of the columns can also be
sorted in ascending or descending order by clicking on the column
title.
Ethnicity
The maps below display the radical radiotherapy utilisation
measure for each ethnicity group.
The data for the number of tumours treated, the number of
tumours diagnosed and the measure value are included in the table
below.
To find your specific area please type a keyword into the
search bar. The data table can also be filtered by calendar year by
typing the year in the search box. Each of the columns can also be
sorted in ascending or descending order by clicking on the column
title.
Stage
The maps below display the radical radiotherapy utilisation
measure for each stage group.
The data for the number of tumours treated, the number of
tumours diagnosed and the measure value are included in the table
below.
To find your specific area please type a keyword into the
search bar. The data table can also be filtered by calendar year by
typing the year in the search box. Each of the columns can also be
sorted in ascending or descending order by clicking on the column
title.
Tumour Group
The maps below display the radical radiotherapy utilisation
measure for each individual tumour group.
The data for the number of tumours treated, the number of
tumours diagnosed and the measure value are included in the table
below.
To find your specific area please type a keyword into the
search bar. The data table can also be filtered by calendar year by
typing the year in the search box. Each of the columns can also be
sorted in ascending or descending order by clicking on the column
title.
7 Palliative radiotherapy utilisation (Measure 2b), 2019
This measure is intended as a means of capturing palliative radiotherapy use. Like Measure 2a, it is suitable for identifying variation in practice and potential unmet health needs or quality improvement targets. This measure is based on the number of malignant tumours treated with palliative RT during a given year and within two years before the patient’s death where the patient had a cancer registration record for a diagnosis anytime since 1995 and where the underlying cause of death was cancer (numerator). These are considered against the number of tumours where the individual died in a given year with a known cancer diagnosis (diagnosis being at any time from 1995 onwards) and where the underlying cause of death was cancer (denominator).
\[
\begin{gather*}
\text{Measure 2b} = \frac{\text{Number of tumours treated with
palliative RT during a given year} \\ \text{ and within two years before
the patient’s death (diagnosed anytime since 1995)}} {\text{Number of
tumours where the individual died in the same year with a known cancer
diagnosis}} {\text{ X 100}}
\end{gather*}
\]
7.1 National measure of palliative radiotherapy utilisation by patient demographic factors and cancer site
There were 159,312 registered tumours where the patient died in 2019 (with cancer the recorded underlying cause of death). 26,697 tumours were treated with palliative radiotherapy in 2019 and within two years before the patient’s death. In 2019 16.8 tumours were treated with palliative radiotherapy within two years before the patient’s death for every 100 tumours where the patient died in the same year.
Note: The graph bars were shaded grey where the measure presented was based on a tumour count of less than 50.
Five year age bands
Gender
SED
Ethnicity
Tumour Group
7.2 Regional measure of palliative radiotherapy utilisation
The number of tumours treated with palliative radiotherapy in 2019 and within two year before the patient’s death for every 100 tumours where the patient died in 2019 varied between geographical regions. For the ICBs, there were between 6.9 and 21.6 treated tumours for every 100 tumours where the patient died in 2019. For Sub-ICBs the measure of palliative radiotherapy varied between 6.9 and 23.2.
The 2021 data for the palliative radiotherapy utilisation measure is not included here due to incomplete vital status (death) for a small number of patients at the point of analysis (leading to a possible underestimation of the measure’s values).
ICBs
The maps below display the palliative radiotherapy utilisation measure for each individual year.
The data for the number of tumours treated, the number of tumours diagnosed and the measure value are included in the table below.
To find your specific area please type a keyword into the
search bar. The data table can also be filtered by calendar year by
typing the year in the search box. Each of the columns can also be
sorted in ascending or descending order by clicking on the column
title.
Sub-ICBs
The maps below display the palliative radiotherapy utilisation measure for each individual year.
The data for the number of tumours treated, the number of tumours diagnosed and the measure value are included in the table below.
To find your specific area please type a keyword into the
search bar. The data table can also be filtered by calendar year by
typing the year in the search box. Each of the columns can also be
sorted in ascending or descending order by clicking on the column
title.
NHS Regions
The maps below display the palliative radiotherapy utilisation measure for each individual year.
The data for the number of tumours treated, the number of tumours diagnosed and the measure value are included in the table below.
To find your specific area please type a keyword into the
search bar. The data table can also be filtered by calendar year by
typing the year in the search box. Each of the columns can also be
sorted in ascending or descending order by clicking on the column
title.
7.3 Stratified regional measure of palliative radiotherapy utilisation, 2019
The palliative radiotherapy utilisation measure was produced for all ICB geographies and stratified by key socio-demographic factors and cancer site. The maps and data table below present the palliative radiotherapy utilisation measure for selected factor levels.
Note: The geographical areas where the measure presented was based on an tumour count of less than 50 were shaded grey.
SED quintiles 1 & 5
The maps below display the palliative radiotherapy utilisation
measure for the most and for the least socioeconomically deprived
groups.
The data for the number of tumours treated, the number of
tumours diagnosed and the measure value are included in the table
below.
To find your specific area please type a keyword into the
search bar. The data table can also be filtered by calendar year by
typing the year in the search box. Each of the columns can also be
sorted in ascending or descending order by clicking on the column
title.
Gender
The maps below display the palliative radiotherapy utilisation
measure for the male and the female groups.
The data for the number of tumours treated, the number of
tumours diagnosed and the measure value are included in the table
below.
To find your specific area please type a keyword into the
search bar. The data table can also be filtered by calendar year by
typing the year in the search box. Each of the columns can also be
sorted in ascending or descending order by clicking on the column
title.
Age
The maps below display the palliative radiotherapy utilisation
measure for the group of patients aged 18 to 70 years old and the group
of patients aged 70 years or older.
The data for the number of tumours treated, the number of
tumours diagnosed and the measure value are included in the table
below.
To find your specific area please type a keyword into the
search bar. The data table can also be filtered by calendar year by
typing the year in the search box. Each of the columns can also be
sorted in ascending or descending order by clicking on the column
title.
Ethnicity
The maps below display the palliative radiotherapy utilisation
measure for each ethnicity group.
The data for the number of tumours treated, the number of
tumours diagnosed and the measure value are included in the table
below.
To find your specific area please type a keyword into the
search bar. The data table can also be filtered by calendar year by
typing the year in the search box. Each of the columns can also be
sorted in ascending or descending order by clicking on the column
title.
Tumour Group
The maps below display the palliative radiotherapy utilisation
measure for each individual tumour group.
The data for the number of tumours treated, the number of
tumours diagnosed and the measure value are included in the table
below.
To find your specific area please type a keyword into the
search bar. The data table can also be filtered by calendar year by
typing the year in the search box. Each of the columns can also be
sorted in ascending or descending order by clicking on the column
title.
8 Other radiotherapy activity (Measure 2c)
Through Measure 1 we aimed to quantify the overall radiotherapy treatment delivered in a single calendar year for the treatment of cancer in adults resident in England. There is additional radiotherapy activity for adult patients delivered in a calendar year that is not captured by Measure 1, for example radiotherapy for non-cancer conditions, for patients not resident in England or where linkage to cancer registration was not possible. For context, the mop-up Measure 2c was defined to capture all the radiotherapy activity for adult patients (aged 18 or older at the time of starting radiotherapy treatment) taking place at English NHS providers during a calendar year which was not already accounted for in (the numerators of) Measure 1. Unlike in Measure 1, Measure 2a and Measure 2b, this additional activity can only be quantified in terms of radiotherapy episodes, but not in terms of tumours treated as many of the episodes were delivered for the treatment of non-cancer conditions.
Based on the available data recorded in the RTDS dataset, in 2019 there were 135,518 adult patients treated with 146,191 episodes of radiotherapy in England (133,152 in 2020 and 137,037 in 2021). 133,081 (91%) of these episodes were accounted for in Measure 1 (i.e. treatment for patients diagnosed with cancer (ICD 10 C00-C97 excl.C44) who at the time of their diagnosis were 18 or older and resident in England). The remaining 13,110 (9%) of radiotherapy episodes delivered in 2019 (8% in 2020 and 9% in 2021) represent radiotherapy for in-situ, benign or uncertain behaviour tumours, treatment for non-melanoma skin cancer (ICD10 C44) or non-cancer conditions, treatment for patients not resident in England or patients younger than 18 at the time of diagnosis, or radiotherapy records where a linkage to a a cancer registration could not be established.
9 Data Quality
In all of the maps, the geographical areas where the measure presented was based on an tumour count of less than 50 the area was shaded grey.
The following Trusts had low or missing RTDS data submissions in the time period covered by the report:
- Guy’s and St Thomas’ NHS Foundation Trust - Missing data submissions in September and October 2021
- North Cumbria Integrated Care NHS Foundation Trust - Missing data for August 2021 (As of August 2021 North Cumbria Integrated Care NHS Foundation Trust’s (RNN) radiotherapy service merged with The Newcastle upon Tyne Hospital NHS Foundation Trust (RTD). Data for RNN is reported separately up to April 2023 at which point all data is included in RTD.)
- The Christie NHS Foundation Trust - missing Proton Beam Theraoy (PBT) data between June 2019 and November 2021
- Only a small and incomplete amount of Molecular Radiotherapy (MRT) data is available for the time period included in the report
10 References
- Hoskin, P. J. et al. Variations in radiotherapy delivery in England - Evidence from the national radiotherapy dataset. Clin. Oncol. 25, 531–537 (2013).
- Delaney GP, Jacob S, Featherstone C, Barton NB. The role of radiotherapy in cancer treatment: estimating optimal utilisation from a review of evidence-based clinical guidelines. Cancer 2005; 104: 1129-37.
- Williams, M. V. & Drinkwater, K. J. Radiotherapy in England in 2007: Modelled Demand and Audited Activity. Clin. Oncol. 21, 575–590 (2009).
- Spencer, K. et al. the impact of the COVID-19 pandemic on radiotherapy services in England, UK: a population-based study. Lancet Oncol. 2021 Mar; 22(3):309-320.
11 About NDRS
The National Disease Registration Service (NDRS) is part of NHS England (NHSE). Its purpose is to collect, collate and analyse data on patients with cancer, congenital anomalies, and rare diseases. It provides robust surveillance to monitor and detect changes in health and disease in the population. NDRS is a vital resource that helps researchers, healthcare professionals and policy makers make decisions about NHS services and the treatments people receive.
The NDRS includes:
- the National Cancer Registration and Analysis Service (NCRAS)
and
- the National Congenital Anomaly and Rare Disease Registration Service (NCARDRS)
Healthcare professionals, researchers and policy makers use data to better understand population health and disease. The data is provided by patients and collected by the NHS as part of their care and support. The NDRS uses the data to help:
- understand cancer, rare diseases, and congenital anomalies
- improve diagnosis
- plan NHS services
- improve treatment
- evaluate policy
- improve genetic counselling
Contacts and Resources at NDRS
The National Disease Registration Service (NDRS) are making every effort to support each NHS Trust in achieving the highest levels of data quality in their RTDS submission. To support this aim, the following resources are available:
Your NDRS Data Liaison Manager
Your Data Liaison Manager can provide extensive support to improve the quality of data submitted to the National Disease Registration Service. Please contact the RTDS Helpdesk: rtds.helpdesk@nhs.net for further details.
NDRS Data Hub and Website
A single point of access for all NDRS related information including cancer data collection, datasets, supporting tools, training materials and guidance documents: NDRS Data Hub.
CancerStats2
CancerStats2 is a secure reporting platform that is only available to organisations with a HSCN connection. The platform hosts a variety of RTDS dashboards, including the radiotherapy quality metrics dashboard, the dose and fractination dashboard and weekly updated operational data. In addition to RTDS data, the platform features dashboards reporting for cancer incidence and mortality, molecular and genetics and systemic anti-cancer therapy. CancerStats2 platform enables key stakeholders to generate reports using NDRS data on a self-service basis.
If you do not currently have access please contact the RTDS Helpdesk (rtds.helpdesk@nhs.net).
12 Appendix
Overall Radiotherapy Utilisation in 2019 by Ethnicity (ungrouped)
12.1 Radiotherapy populations report
Derived England and Wales radiotherapy centre populations. The reporting period is 01 April 2021 - 31 March 2022 and the populations are based on all radiotherapy episodes delivered and collected from radiotherapy providers in the Radiotherapy Dataset (RTDS). An estimated UK value is provided. https://digital.nhs.uk/ndrs/data/data-sets/rtds#rtds-data-outputs