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Radiation in Medicine: A Need for Regulatory Reform
All other and unspecified
a Data are rough estimates of how many new cases may receive radiation therapy. Although the number of estimated new cases is fairly reliable, the distribution of therapy cases is more difficult to predict, owing to its dependence on practice patterns.
SOURCE: American Cancer Society (see Wingo et al., 1995).
treated with radiation therapies. The actual frequency distribution by site is quite variable, because it depends on local patterns of care, the initiation of new treatment protocols, and the retirement of old ones.
Patterns of Care Studies. The ACR, through the Patterns of Care Studies (POCS), has conducted periodic surveys of the status of radiation oncology in the United States. The relatively small number of centers and physicians involved in the specialty of radiation oncology (and the field's exclusive focus on cancer) facilitate in-depth surveys of the patterns of care in clinical radiation therapy. The POCS measure the size and composition of the radiation oncology care delivery system in the United States and document both the process of care and patient outcomes. Over time, the POCS also contribute information leading to changes in process and improvements in outcomes.
The POCS data are valuable in placing radiation oncology in perspective among the cancer treatment modalities. Based as they are on statistically valid samples of the total spectrum of practice in the United States, the numbers can be relied upon to demonstrate what is experienced in the community in terms of tumor response, survival, and complications. Some of these outcomes data are presented later in this section.
Table 2.12 summarizes the results of those surveys that tracked facilities and work load, showing data for selected years between 1975 and 1990. Between 1975 and 1990, for example, the total number of facilities increased by just under 300 while treatment machines rose by more than 1,000. In the same period, the number of new patients rose by nearly 180,000 persons (or about 12,000 a year on average).
Much of the growth in machines and new patients in this period occurred between 1986 and 1990, and most of this can be attributed to the expansion of freestanding (nonhospital-based) radiation oncology centers. In 1986, approximately 20 percent of facilities were freestanding, whereas just four years later the figure had increased to 27 percent.