Foreword

The European Society for Radiotherapy and Oncology (ESTRO) seeks to improve cancer patients’ outcomes by promoting innovation, research, and dissemination of science and by developing initiatives to increase awareness and understanding of radiotherapy treatment, and therefore facilitate its access.
 
After cardiovascular diseases, cancer is the main cause of death in Europe, worldwide.¹ In 2012, there were 3.45 million new cases of cancer and 1.75 million deaths from cancer across the European Member States at that time.²
 
A cornerstone of modern cancer treatment
Radiation oncology is a cornerstone of modern cancer treatment; it plays an important role in the treatment of most cancers. Research is continuing to refine radiation oncology technologies, techniques and processes, including proton therapy and SBRT among others, to allow even more patients to benefit from effective, precise and safe treatment, while at the same time aiming to optimise the cost-effectiveness of therapy.
 
Access to radiation therapy is therefore central: optimally, around half of all cancer patients in Europe should receive radiotherapy at some point during their disease.³
 
Moreover, the need for radiation oncology services will rise with the increasing number of cancer patients in Europe: about 4 million new patients are predicted for 2025 based on demographic changes. Therefore the need for radiotherapy in Europe on average is expected to increase by 16% from 2012 to 2025.
 
Variations and deficiencies in access exist
However, there are important variations and deficiencies in access to radiation oncology services,^3–5 and many patients who should receive radiotherapy do not receive it. On average, across European countries with available data, radiotherapy is given to only 74.3% of patients who optimally should receive it:³ a quarter of cancer patients do not receive the treatment they need, and in almost half of the countries, radiation oncology did not reach 70% of the patients who should receive it.³
 
Cancer cost the EU €126 billion in 2009. Healthcare delivery accounted for €51 billion (40%) of this cost, with the rest being indirect costs of lost productivity through early death, lost working days and informal care.⁶ Investment in radiation oncology services is vital to optimise the efficiency and sustainability of high-quality cancer care services. The GTFRCC (Global Task Force on Radiotherapy for Cancer Control) recently concluded that, from a global perspective, scaling up radio-oncology services to meet demand is not only feasible and affordable, but should offer a positive return on investment by 2035.⁷
 
The economics of health care is an increasingly important topic with competing demands on limited financial resources and there is a need to demonstrate cost effectiveness and value in order to secure limited resources. In order to provide a knowledge base and a model for health economic evaluation of radiation treatments at the European level, ESTRO launched the HERO project (Health Economics in Radiation Oncology). The HERO project supports the radiotherapy community by addressing different dimensions. First it addressed the provision and accessibility of radiotherapy in Europe, then the demand for radiotherapy across Europe(www.estro.org/about-us/health-economics-in-radiation-oncology—hero/hero). The next step of the project will be to develop a cost-accounting programme for radiotherapy at the European level, in order to engage in economic evaluations of radiotherapy. 
 
Radiation oncology is a low-cost, high-quality treatment modality, and through its vision for 2020, which states, “Every cancer patient in Europe will have access to state of the art radiation therapy, as part of a multidisciplinary approach where treatment is individualised for the specific patient’s cancer, taking account of the patient’s personal circumstances”, ESTRO is committed to making a significant contribution to treatment access as one of its priorities.
 
References
1 Global Burden of Disease Study 2015. www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30818-8/fulltext?elsca1=tlpr
2 Ferlay J et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 2013;49(6):1374–403.
3 Borras JM et al. The optimal utilization proportion of external beam radiotherapy in European countries: An ESTRO-HERO analysis. Radiother Oncol 2015;116:38–44. 
4 Grau C et al. Radiotherapy equipment and departments in the European countries: Final results from the ESTRO-HERO survey. Radiother Oncol 2014;112:155–64.
5 Lievens Y et al. HERO (Health Economics in Radiation Oncology): a pan-European project on radiotherapy resources and needs. Clin Oncol (R Coll Radiol) 2015;27(2):115–24.
6 Luengo-Fernandez R et al. Economic burden of cancer across the European Union: a population-based cost analysis. Lancet Oncol 2013;14(12):1165–74.
7 Atun R et al. Expanding global access to radiotherapy. Lancet Oncol 2015;16(10):1153–86.