Colorectal cancer is a leading cause of cancer in the world, and in Indonesia, there were over 24,000 cases in 2022. Radiotherapy is an essential treatment for this cancer. The radiotherapy utilisation rate (RUR) is the proportion of patients who have received radiotherapy at least once in their lives. Currently, RUR in Indonesia is calculated without using real-world data from Indonesia. Therefore, this study was designed to compare the optimal and actual RURs (oRUR and aRUR) for colon and rectal cancer in Indonesia.

The aRUR is the proportion of colorectal patients who have received radiotherapy treatment. The oRUR is the proportion of colorectal patients who have met the requirements to receive radiotherapy treatment. Then, the percentage of unmet needs was calculated to determine the gap between the aRUR and the oRUR.

This was a cross-sectional study of cancer registry/medical records for those hospitals with radiotherapy equipment across Indonesia. This research was part of a project funded by the International Atomic Energy Agency through its Regional Cooperative Agreement Regional Office. We collected all colon and rectal cancer data for 2019 to estimate and calculate the RURs. Sensitivity was analysed to calculate the estimated RURs through the use of Global Cancer Observatory (GLOBOCAN) data and the previous Indonesian Radiation Oncology Society (IROS) survey.

For the study, the data for 3,330 colon and rectal cancer patients were collected from 34 hospitals and analysed after filtering for data duplication. Most patients were male (51.5%), 55-64 years old, and originated from North Sumatra, Central Java and Jakarta. Most patients had presented with cancer of locally advanced or advanced stages.

Based on the calculations from the survey data, the oRURs for colon and rectal cancers were 3.3% and 41%, respectively. In comparison, the aRURs for colon and rectal cancers were 5.3% and 19.5%. In combination, the oRUR and aRUR for colorectal cancer were 26.21% and 14.9%, which meant that 45.5% (21.4-65.6%) of patients’ needs for radiotherapy were unmet. There seems to be no obstacle to the provision of the treatment for colon cancer, but for rectal cancer there is a clear obstacle to the receipt of radiotherapy.

These numbers are worse if we extrapolate the data into a bigger perspective through the use of sensitivity analysis (incorporating GLOBOCAN and IROS data). This calculation produces aRURs for colon and rectal cancer of 0.5-5.3% and 4.4-22.5% respectively. From this data, we can see that there is a substantial unmet demand for radiotherapy to treat colon and rectal cancers, which ranges from -76.7% to 86.6% and 19.5% to 93.3%, respectively.

Several factors may affect the RUR in one country. These can be patient or clinician factors, cancer characteristics and bureaucracy. Despite this caveat, this result highlights the urgent need of a national cancer control plan in Indonesia in order to increase access to radiation therapy, especially for colorectal cancer management. Further study is also required to better understand factors that affect RURs in each centre across Indonesia.