Retrospective study on the intensification of hypofractionated radiotherapy: The organizational change

Purpose: External radiotherapy process is a chain of steps in which each of them is carried out only if the previous one has been completed. The development of hypofractionation practices in recent years tends to increase the workload of the stages of preparation for irradiation and to decrease the number of fractions per patient. The purpose of this retrospective study is to analyze the evolution of these practices in a single centre and to assess the organizational issues involved. Material and methods: All radiation therapy records management data were extracted from the Radiation Therapy Information System. Radiotherapy sessions were identified by patient and by ICD (International Classification of Diseases) code. The filling rate of the treatment equipment was calculated using actual data from the radiotherapy department. Results: From 2015 to 2019, there was an increase in the number of scans (+16%), the number of patients treated (+11.6%) and the volume of hours available for treatment (+12%). Also, there was a decrease in the total number of fractions (−5%), in the average number of fractions performed per treatment sequence (−19%), in the occupancy rate of the machines (−7%) and in the average number of fractions performed per patient treated for malignant tumours of the bronchi and lung (−38%), digestive organs (−37%), secondary (−19%) breast (−15%) and prostate (−15%). The number of fractions administered per treatment sequence between 2015 and 2019 decreased significantly for patients in age groups [20–69] (P < 0.001) and [> 70] (P < 0.001). Conclusion: A paradox appears between the increase in the total number of patients treated and the decrease in the loading rate of linacs. This shift of workload has an impact on the quality and safety of care and on the organizational and investment strategies. It also has an economic impact where the model of reimbursement is based on per fraction pricing. A reorganization of radiotherapy services is inevitable.