The purpose of this study was to estimate the clinical utilization of radiation therapy (RT) in Korea between 2011 and 2015.
We analyzed the claims data from the Health Insurance Review and Assessment Service to estimate the clinical utilization of RT. The source population consisted of all patients who had any of the International Classification of Diseases 10th revision cancer diagnoses (C00-C97) and those with diagnostic codes D00-D48, who were also associated with at least one of the procedure codes related to RT.
The total number of patients who received RT in 2011, 2012, 2013, 2014, and 2015 were 54,810, 59,435, 61,839, 64,062, and 66,183, respectively. Among them, the total numbers of male and female patients were 24,946/29,864 in 2011, 27,211/32,224 in 2012, 28,111/33,728 in 2013, 29,312/34,750 in 2014, and 30,266/35,917 in 2015. The utilization rate of RT in cancer patients has also increased steadily over the same period from 25% to 30%. The five cancers that were most frequently treated with RT between 2011 and 2012 were breast, lung, colorectal, liver, and uterine cervical cancers. However, the fifth most common cancer treated with RT that replaced uterine cervical cancer in 2013 was prostate cancer. More than half of cancer patients (64%) were treated with RT in the capital area (Seoul, Gyeonggi, and Incheon).
The total number of patients who underwent RT increased steadily from 2011 to 2015 in Korea. The utilization rate of RT in cancer patients is also increasing.
Because of the decreases in the incidence of thyroid cancer, the annual cancer incidence has decreased in Korea after 2011 following a steady increase [
In the present study, we analyzed the claims data from the Health Insurance Review and Assessment Service (HIRA) to estimate the clinical utilization of RT in the 2011-2015 period.
We analyzed open claims data from the HIRA. The analysis methods using claims data from the HIRA are described in detail in a previous study [
We analyzed the claims data from the HIRA in order to identify the total number of patients who underwent RT, and the number of patients who received RT by primary cancer diagnosis, sex, and age group between 2011 and 2015 in Korea. In addition, through the classification of the procedure codes related to RT [
The total number of patients who received RT in 2011, 2012, 2013, 2014, and 2015 were 54,810, 59,435, 61,839, 64,062, and 66,183, respectively (
The distribution of patients who received RT by cancer diagnosis between 2011 and 2015 is shown in
Breast cancer and carcinoma
The utilization rates of RT in the 10 most common cancers in Korea [
The distribution of patients who received RT in 2015 based on cancer diagnosis and age group is shown in
The distribution of patients who received RT with specific modalities is shown in
We analyzed the clinical utilization of RT between 2011 and 2015 in Korea using claims data from the HIRA. The total number of patients who underwent RT has increased by 3%-8% per year between 2011 and 2015 (
While the numbers of breast, lung, and prostate cancers being treated with RT has increased every year, the numbers of colorectal and uterine cervix cancer treated with RT have not shown any increase (
Although the percentage of cancer patients who underwent RT increased from 25% to 30% during these 5 years (
There is an overlap in years between the present and a previous study [
In terms of RT modalities, the number of cases receiving SRT has steadily increased over the last 5 years and it was notably increased especially in 2015. In 2015, the national health insurance coverage of SRT was expanded from only cranio-spinal tumors and inoperable lung cancer to whole body tumors. Similar to SRT, notable increases in the use of IMRT and proton therapy are expected in 2016 because national health insurance coverage of IMRT and proton therapy has been expanded in the second half of 2015. In addition, a second proton therapy center in Korea started operating in 2016 [
In 2015, the population of Seoul was 19.5% of Korea’s population; however, nearly half of the patients (43.9%) treated with RT were treated in Seoul (
The total number of patients who underwent RT increased steadily from 2011 to 2015 in Korea. The utilization rate of RT in cancer patients is also increasing. These trends are expected to continue because the incidences of breast and lung cancers with treatment heavily dependent on RT are also experiencing a rising trend in Korea.
Conflict of interest relevant to this article was not reported.
This study was supported by a grant of the Korea Institute of Radiological and Medical Sciences (KIRAMS), funded by Ministry of Science, ICT and Future Planning, Republic of Korea (1711045544; 1711042677; 1711045548; 1711045553; 1711045555/50534-2017).
The total number of patients who underwent radiation therapy between 2011 and 2015 in Korea.
The total numbers of male and female patients who received radiation therapy between 2011 and 2015 in Korea.
Cancer incidence and the total number of patients who received radiation therapy between 2009 and 2013 in Korea.
The fifth most common cancer treated with radiation therapy (RT) between 2011 and 2015 in Korea. (A) All patients. (B) Male patients. (C) Female patients.
The utilization rate of radiation therapy (RT) in the 10 most common cancer between 2011 and 2014 in Korea. NHL, non-Hodgkin’s lymphoma.
Customized source population
List | Criteria |
---|---|
Treatment period | 1 Jan 2011-31 Dec 2015 |
Type of healthcare facility | Tertiary, secondary, primary, sanatorium |
Diagnostic code | C00-C97, D00-D48 |
Type of insurance | Health insurance, medical aid, patriots and veterans affairs’ insurance expenditure by government |
Hospital region | National |
Sex | Male, female |
Age | All ages |
Distribution of cancer patients who underwent radiation therapy based on primary diagnosis between 2011 and 2015 in Korea
Category | Primary diagnosis (diagnostic code) | Year |
||||
---|---|---|---|---|---|---|
2011 | 2012 | 2013 | 2014 | 2015 | ||
Breast | (C50) | 13,765 | 15,059 | 15,766 | 16,549 | 17,302 |
Gastrointestinal | Colorectum (C18-C20) | 5,054 | 5,048 | 4,920 | 4,901 | 4,898 |
Liver (C22) | 3,027 | 3,446 | 3,641 | 3,679 | 4,112 | |
Esophagus (C15) | 1,250 | 1,335 | 1,380 | 1,397 | 1,472 | |
Stomach (C16) | 1,070 | 1,048 | 1,026 | 992 | 1,013 | |
Pancreas (C25) | 782 | 942 | 906 | 948 | 998 | |
Gallbladder and biliary (C23-C24) | 778 | 856 | 879 | 954 | 985 | |
Anus (C21) | 193 | 213 | 211 | 203 | 199 | |
Small bowel (C17) | 42 | 39 | 43 | 35 | 32 | |
Other (C26) | 4 | 5 | 3 | 3 | 3 | |
Subtotal | 12,200 | 12,932 | 13,009 | 13,112 | 13,712 | |
Thoracic | Lung (C34) | 8,991 | 9,425 | 10,187 | 10,846 | 10,863 |
Thymus (C37) | 258 | 238 | 249 | 307 | 323 | |
Mediastinum (C38) | 41 | 44 | 48 | 47 | 54 | |
Trachea (C33) | 16 | 18 | 16 | 22 | 25 | |
Other (C39) | 4 | 3 | 2 | 1 | 1 | |
Subtotal | 9,310 | 9,728 | 10,502 | 11,223 | 11,266 | |
Head and neck | Larynx (C32) | 773 | 884 | 964 | 912 | 903 |
Oropharynx (C01, C09-C10) | 509 | 615 | 595 | 621 | 619 | |
Oral cavity (C02-C06) | 500 | 601 | 588 | 605 | 632 | |
Nasopharynx (C11) | 414 | 489 | 488 | 488 | 516 | |
Salivary gland (C07-C08) | 298 | 346 | 347 | 398 | 374 | |
Hypopharynx (C12-C13) | 354 | 394 | 352 | 437 | 395 | |
Paranasal sinus (C31) | 149 | 166 | 145 | 179 | 166 | |
Nasal cavity (C30) | 93 | 129 | 110 | 128 | 142 | |
Eye and orbit (C69) | 44 | 54 | 51 | 41 | 58 | |
Lip (C00) | 11 | 8 | 13 | 9 | 18 | |
Other (C14) | 19 | 20 | 14 | 16 | 17 | |
Subtotal | 3,164 | 3,706 | 3,667 | 3,834 | 3,840 | |
Gynecologic | Uterine cervix (C53) | 2,453 | 2,481 | 2,540 | 2,425 | 2,466 |
Uterine corpus (C54-C55) | 635 | 724 | 741 | 810 | 813 | |
Ovary and tube (C56) | 217 | 204 | 247 | 248 | 258 | |
Vagina and vulva (C51-C52) | 111 | 111 | 100 | 90 | 122 | |
Other (C57-C58) | 15 | 14 | 12 | 9 | 11 | |
Subtotal | 3,431 | 3,534 | 3,640 | 3,582 | 3,670 | |
Genitourinary | Prostate (C61) | 1,952 | 2,451 | 2,577 | 2,634 | 2,778 |
Ureter and bladder (C66-C67) | 498 | 484 | 531 | 608 | 602 | |
Kidney (C64-C65) | 443 | 422 | 445 | 454 | 525 | |
Penis and testis (C60, C62-C63) | 65 | 57 | 66 | 57 | 62 | |
Other (C68) | 11 | 14 | 12 | 18 | 19 | |
Subtotal | 2,969 | 3,428 | 3,631 | 3,771 | 3,986 | |
CNS | Brain (C70-C71) | 1,388 | 1,513 | 1,567 | 1,623 | 1,605 |
Spinal cord (C72) | 60 | 61 | 52 | 48 | 47 | |
Other (C47) | 45 | 36 | 52 | 32 | 46 | |
Subtotal | 1,493 | 1,610 | 1,671 | 1,703 | 1,698 | |
Lymphoma | Non-Hodgkin's lymphoma (C82-C88) | 1,169 | 1,322 | 1,321 | 1,389 | 1,493 |
Hodgkin's disease (C81) | 98 | 108 | 91 | 93 | 100 | |
Other (C96) | 22 | 23 | 21 | 30 | 33 | |
Subtotal | 1,289 | 1,453 | 1,433 | 1,512 | 1,626 | |
Soft tissue | (C46, C49) | 545 | 581 | 631 | 648 | 715 |
Mesothelioma | (C45) | 14 | 19 | 18 | 19 | 29 |
Myeloma and plasmacytoma | (C90) | 316 | 414 | 442 | 450 | 459 |
Thyroid | (C73) | 354 | 381 | 357 | 360 | 309 |
Leukemia | (C91-C95) | 359 | 353 | 351 | 411 | 396 |
Skin | (C44) | 244 | 287 | 264 | 284 | 279 |
Malignant melanoma | (C43) | 215 | 209 | 225 | 244 | 241 |
Primary bone and cartilage | (C40-C41) | 213 | 219 | 170 | 206 | 223 |
Endocrine | (C74-C75) | 56 | 72 | 93 | 101 | 104 |
Unknown primary | (C48, C76-C80, C97) | 878 | 1,070 | 1,239 | 1,287 | 1,420 |
Total No. of cancer patients | - | 50,815 | 55,055 | 57,109 | 59,296 | 61,275 |
Carcinoma |
(D05) | 1,388 | 1,653 | 1,918 | 1,912 | 2,062 |
Benign neoplasm of meninges | (D32) | 1,022 | 960 | 1,041 | 1,112 | 1,032 |
Benign neoplasm of CNS | (D33) | 726 | 750 | 744 | 694 | 713 |
Benign neoplasm of endocrine | (D34-D35) | 229 | 283 | 304 | 319 | 308 |
Other D code diseases | (D00-D04, D06-D31, D36-D48) | 630 | 734 | 723 | 729 | 793 |
Total D code patients | - | 3,995 | 4,380 | 4,730 | 4,766 | 4,908 |
Total | - | 54,810 | 59,435 | 61,839 | 64,062 | 66,183 |
CNS, central nervous system.
Number of patients who received radiation therapy.
The number of patients who underwent radiation therapy by cancer diagnosis and age group in Korea (2015)
Category | Primary diagnosis | Age group |
||||||
---|---|---|---|---|---|---|---|---|
20s or under | 30s | 40s | 50s | 60s | 70s or older | Total | ||
Breast | Breast (C50) | 114 | 1,614 | 5,949 | 5,908 | 2,761 | 956 | 17,302 |
Gastrointestinal | Colorectum (C18-C20) | 13 | 140 | 563 | 1,330 | 1,376 | 1,476 | 4,898 |
Liver (C22) | 10 | 89 | 447 | 1,332 | 1,326 | 908 | 4,112 | |
Esophagus (C15) | 0 | 2 | 50 | 328 | 498 | 594 | 1,472 | |
Stomach (C16) | 9 | 66 | 151 | 279 | 258 | 250 | 1,013 | |
Pancreas (C25) | 2 | 16 | 65 | 273 | 340 | 302 | 998 | |
Gallbladder and biliary (C23-C24) | 0 | 8 | 58 | 237 | 347 | 335 | 985 | |
Anus (C21) | 3 | 0 | 16 | 52 | 49 | 79 | 199 | |
Small bowel (C17) | 0 | 3 | 0 | 10 | 12 | 7 | 32 | |
Other (C26) | 0 | 0 | 0 | 1 | 2 | 0 | 3 | |
Subtotal | 37 | 324 | 1,350 | 3,842 | 4,208 | 3,951 | 13,712 | |
Thoracic | Lung (C34) | 14 | 124 | 571 | 2,232 | 3,632 | 4,290 | 10,863 |
Thymus (C37) | 9 | 26 | 71 | 86 | 79 | 52 | 323 | |
Mediastinum (C38) | 14 | 4 | 8 | 10 | 11 | 7 | 54 | |
Trachea (C33) | 1 | 1 | 5 | 4 | 7 | 7 | 25 | |
Other (C39) | 0 | 0 | 0 | 0 | 1 | 0 | 1 | |
Subtotal | 38 | 155 | 655 | 2,332 | 3,730 | 4,356 | 11,266 | |
Head and neck | Larynx (C32) | 0 | 5 | 32 | 204 | 344 | 318 | 903 |
Oropharynx (C01, C09-C10) | 2 | 7 | 58 | 229 | 211 | 112 | 619 | |
Oral cavity (C02-C06) | 15 | 36 | 77 | 172 | 166 | 166 | 632 | |
Nasopharynx (C11) | 21 | 44 | 109 | 162 | 112 | 68 | 516 | |
Salivary gland (C07-C08) | 21 | 23 | 52 | 100 | 103 | 75 | 374 | |
Hypopharynx (C12-C13) | 0 | 1 | 11 | 85 | 140 | 158 | 395 | |
Paranasal sinus (C31) | 3 | 3 | 28 | 42 | 43 | 47 | 166 | |
Nasal cavity (C30) | 4 | 15 | 20 | 37 | 26 | 40 | 142 | |
Eye and orbit (C69) | 7 | 3 | 7 | 15 | 11 | 15 | 58 | |
Lip (C00) | 0 | 0 | 2 | 5 | 3 | 8 | 18 | |
Other (C14) | 1 | 1 | 0 | 3 | 6 | 6 | 17 | |
Subtotal | 74 | 138 | 396 | 1,054 | 1,165 | 1,013 | 3,840 | |
Gynecologic | Uterine cervix (C53) | 24 | 274 | 539 | 702 | 440 | 487 | 2,466 |
Uterine corpus (C54-C55) | 9 | 24 | 129 | 339 | 213 | 99 | 813 | |
Ovary and tube (C56) | 1 | 13 | 40 | 98 | 69 | 37 | 258 | |
Vagina and vulva (C51-C52) | 0 | 2 | 12 | 28 | 21 | 59 | 122 | |
Other (C57-C58) | 0 | 1 | 1 | 3 | 5 | 1 | 11 | |
Subtotal | 34 | 314 | 721 | 1,170 | 748 | 683 | 3,670 | |
Genitourinary | Prostate (C61) | 1 | 0 | 18 | 257 | 918 | 1,584 | 2,778 |
Ureter and bladder (C66-C67) | 1 | 4 | 31 | 94 | 145 | 327 | 602 | |
Kidney (C64-C65) | 11 | 14 | 56 | 141 | 156 | 147 | 525 | |
Penis and testis (C60, C62-C63) | 12 | 14 | 7 | 12 | 7 | 10 | 62 | |
Other (C68) | 0 | 2 | 2 | 1 | 4 | 10 | 19 | |
Subtotal | 25 | 34 | 114 | 505 | 1,230 | 2,078 | 3,986 | |
CNS | Brain (C70-C71) | 250 | 186 | 264 | 391 | 304 | 210 | 1,605 |
Spinal cord (C72) | 15 | 5 | 7 | 6 | 8 | 6 | 47 | |
Other (C47) | 9 | 12 | 7 | 7 | 6 | 5 | 46 | |
Subtotal | 274 | 203 | 278 | 404 | 318 | 221 | 1,698 | |
Lymphoma | Non-Hodgkin's lymphoma (C82-C88) | 78 | 128 | 220 | 361 | 331 | 375 | 1,493 |
Hodgkin's disease (C81) | 36 | 19 | 10 | 15 | 5 | 15 | 100 | |
Other (C96) | 5 | 8 | 8 | 8 | 1 | 3 | 33 | |
Subtotal | 119 | 155 | 238 | 384 | 337 | 393 | 1,626 | |
Soft tissue | (C46, C49) | 75 | 73 | 103 | 157 | 135 | 172 | 715 |
Mesothelioma | (C45) | 0 | 0 | 3 | 8 | 12 | 6 | 29 |
Myeloma and plasmacytoma | (C90) | 1 | 5 | 43 | 113 | 163 | 134 | 459 |
Thyroid | (C73) | 3 | 3 | 24 | 75 | 82 | 122 | 309 |
Leukemia | (C91-C95) | 138 | 54 | 85 | 69 | 34 | 16 | 396 |
Skin | (C44) | 5 | 11 | 14 | 40 | 53 | 156 | 279 |
Malignant melanoma | (C43) | 3 | 8 | 31 | 60 | 73 | 66 | 241 |
Primary bone and cartilage | (C40-C41) | 58 | 23 | 28 | 39 | 34 | 41 | 223 |
Endocrine | (C74-C75) | 50 | 11 | 4 | 24 | 7 | 8 | 104 |
Unknown primary | (C48, C76-C80, C97) | 20 | 53 | 168 | 377 | 429 | 373 | 1,420 |
Total No. of cancer patients | 1,068 | 3,178 | 10,204 | 16,561 | 15,519 | 14,745 | 61,275 | |
Carcinoma |
(D05) | 18 | 184 | 799 | 661 | 323 | 77 | 2,062 |
Benign neoplasm of meninges | (D32) | 10 | 36 | 161 | 319 | 266 | 240 | 1,032 |
Benign neoplasm of CNS | (D33) | 53 | 65 | 136 | 208 | 148 | 103 | 713 |
Benign neoplasm of endocrine | (D34-D35) | 19 | 41 | 71 | 84 | 60 | 33 | 308 |
Other D code diseases | (D00-D04, D06-D31, D36-D48) | 88 | 75 | 124 | 189 | 176 | 141 | 793 |
Total D code patients | 188 | 401 | 1,291 | 1,461 | 973 | 594 | 4,908 | |
Total | 1,256 | 3,579 | 11,495 | 18,022 | 16,492 | 15,339 | 66,183 |
CNS, central nervous system.
Number of patients who received radiation therapy.
Distribution of patients who received radiation therapy according to specific radiation therapy modalities between 2011 and 2015 in Korea
Radiation therapy modality | Year |
||||
---|---|---|---|---|---|
2011 | 2012 | 2013 | 2014 | 2015 | |
Brachytherapy | 1,421 (2.6) | 1,421 (2.4) | 1,404 (2.3) | 1,255 (2.0) | 1,247 (1.9) |
Intensity-modulated radiation therapy | 6,250 (11.4) | 6,372 (10.7) | 6,698 (10.8) | 7,022 (11.0) | 8,397 (12.7) |
Stereotactic radiation therapy | 3,122 (5.7) | 6,670 (11.2) | 6,772 (11.0) | 7,648 (11.9) | 12,228 (18.5) |
Proton radiation therapy | 25 (0.0) | 50 (0.1) | 33 (0.1) | 34 (0.1) | 158 (0.2) |
Values are presented as number (%).
Percentage of the number of specific radiation therapy modalities over the total number of radiotherapy in each year.
Demographic data of patients who received radiation therapy between 2011 and 2015 in Korea for each prefecture
Prefecture | Population (2015) [ |
Year |
||||
---|---|---|---|---|---|---|
2011 | 2012 | 2013 | 2014 | 2015 | ||
Seoul | 9,860 (19.5) | 24,713 (45.1) | 26,996 (45.4) | 27,458 (44.4) | 28,303 (44.2) | 29,085 (43.9) |
Gyeonggi, Incheon | 15,284 (30.2) | 10,651 (19.4) | 11,543 (19.4) | 12,228 (19.8) | 12,859 (20.1) | 13,680 (20.7) |
Gangwon | 1,506 (3.0) | 1,308 (2.4) | 1,422 (2.4) | 1,365 (2.2) | 1,406 (2.2) | 1,501 (2.3) |
Chungbuk | 1,561 (3.1) | 654 (1.2) | 684 (1.2) | 683 (1.1) | 696 (1.1) | 742 (1.1) |
Chungnam, Daejeon | 3,822 (7.5) | 2,548 (4.6) | 2,822 (4.7) | 3,029 (4.9) | 3,047 (4.7) | 3,166 (4.8) |
Jeonbuk | 1,798 (3.5) | 1,299 (2.4) | 1,334 (2.2) | 1,366 (2.2) | 1,466 (2.3) | 1,393 (2.1) |
Jeonnam, Gwangju | 3,274 (6.5) | 2,812 (5.1) | 3,024 (5.1) | 3,119 (5.0) | 3,195 (5.0) | 3,359 (5.1) |
Gyeongbuk, Daegu | 5,097 (10.1) | 4,062 (7.4) | 4,388 (7.4) | 4,702 (7.6) | 4,922 (7.7) | 4,926 (7.4) |
Gyeongnam, Busan, Ulsan | 7,827 (15.5) | 6,393 (11.7) | 6,774 (11.4) | 7,429 (12.0) | 7,652 (11.9) | 7,802 (11.8) |
Jeju | 587 (1.1) | 420 (0.7) | 448 (0.8) | 460 (0.8) | 516 (0.8) | 529 (0.8) |
Total | 50,616 (100) | 54,810 (100) | 59,435 (100) | 61,839 (100) | 64,062 (100) | 66,183 (100) |
Values are presented as number (%).