Changes in the use of radiotherapy in Ontario 1984-1995

Purpose: To describe changes in the use of radiotherapy in the management of cancer in Ontario between January 1, 1984 and December 31, 1995, Methods: A retrospective review of prospectively gathered electronic records of all radiotherapy for cancer at nine provincial cancer treatment centres, Results: Over the 12 years of the study, the incidence of cancer increased by 33%, The number of curative and adjuvant courses per incident case increased by 39.3% and the number of palliative courses per incident case decreased by 15.8%. The mean number of fractions per curative and adjuvant course increased by 13%, and the mean number of fractions per palliative course decreased by 22%. The number of curative fractions per incident case increased by 63%, and the number of palliative fractions per incident case decreased by 32%. The increase in curative workload was mainly due to an increase in the incidence of prostate cancer, to an increase in the number of courses per incident case in breast and prostate cancer, and to an increase in the number of fractions per curative course in every disease group. The decrease in palliative workload was due to a decrease in the number of courses per incident case in most disease groups, and to a decrease in the number of fractions per course in most disease groups. Conclusions: In Ontario, between 1984 and 1995, there was a large shift in workload from palliative radiotherapy to curative radiotherapy. Potential causes for this phenomenon are discussed. (C) 1999 Elsevier Science Inc.