Comparative analysis of radiation therapy in the treatment of cancer

Two important new methods of treating cancer are examined (a) conformal RT (Radiation Therapy) technologies, an intensity-modulated radiation therapy (IMRT); and (b) high-dose-rate brachytherapy, enhanced by the use of remote afterloaders. They have the ability to reduce both side effects and treatment time for patients. These new treatments have resulted in less in-patient hospital stays and have greatly improved the survivability of cancer patients. They are not widely used because of high equipment cost. This paper discusses methods to implement their use by analyzing cost to benefit issues. Radiation oncology has also progressed in picture archiving and communications systems where reliance on heavy negatives has been replaced by digital technology leading to TeleRadiation Oncology. This allows remote consulting for diagnosis and treatment strategies. Computed tomography and magnetic resonance imaging have transformed Radiation Oncology from a two-dimensional to a three-dimensional science. This makes precise planned treatment possible and these treatment strategies are discussed. Costs associated with these technologies are reviewed comparing in-patient versus out-patient care, free-standing care units and mobile RT units. Conformal RT and high-dose rate brachytherapy reduce in-patient time thus reducing patient costs. Conversely, equipment costs are high where mobile RT units and regional treatment centers are used to control costs. Issues that affect RT are discussed such as HMO cost containment, equipment costs versus patient load, funding of research, and the quality of care imposed by these issues. There is a movement away from hospitals and in-patient services, towards managed care, out-patient services, and freestanding clinics. This is discussed as it impacts RT patient care and the radio-oncology profession. The socioeconomic demographics of RT oncology is discussed where lower economic groups are not receiving optimal care because they are not receiving timely diagnosis and treatment. Strategies to improve high quality cancer care are discussed in light of all of the issues discussed in this paper. Recommendations are made to improve RT care treatment in light of cost containment strategies.