The purpose of this study is to estimate the clinical status of radiation therapy (RT) in Korea.
We analyzed open claims data from the Health Insurance Review and Assessment Service (HIRA). The subjects were patients with malignant neoplasms who had procedure codes concerning RT in 2009 and 2013.
The total numbers of patients who underwent RT in 2009 and 2013 were 42,483 and 56,850, respectively. The numbers of men and women were 20,012 and 22,471 in 2009 and 26,936 and 29,914 in 2013, respectively. The five most frequent RT sites were metastatic, breast, gastrointestinal, thoracic, and gynecologic cancers in 2009, and metastatic, breast, gastrointestinal, thoracic and head and neck cancers in 2013. The three leading types of cancer among men were metastatic, gastrointestinal, and thoracic, and breast, metastatic, and gynecologic among women. According to age, the most common treatment site was the central nervous system for those aged 20 years or less, the breast for those in their 30s to 50s, and metastatic sites for those in their 60s or older.
Data from this study provide an overview of the clinical status of RT in Korea.
As in many other parts of the world, cancer is the leading cause of death and is a major public health problem in Korea. According to the annual report of the Korea Central Cancer Registry, 224,177 patients were newly diagnosed with cancer in 2012, and overall incidence rates have increased by 3%-4% per year [
In addition to surgery and chemotherapy, radiation therapy (RT) is one of the three primary modalities for modern cancer treatment. As the market and clinical demand for RT grow in importance, providing accurate, nationally based databases concerning the clinical status of RT has become important for understanding the status and development of cancer treatment in Korea. Official records concerning the clinical status of RT were reported from 1999 to 2006 in Korea [
In this study, we analyzed the clinical status of RT in 2009 and 2013 in Korea using open claims data from the Health Insurance Review and Assessment Service (HIRA).
The claims data from the HIRA are open access to approved researchers who submit a profile of their work and R&D plan. The claims data from the HIRA contain information on 46 million patients per year who account for 90% of the total population in Korea; the claims data include information regarding patients’ diagnoses, treatment, procedures, surgical history, and prescription drugs, which provide a valuable resource for healthcare research [
The customized source population criteria for this study are shown in
The site of RT category classification was based on the annual reports from the KOSRO, except for the breast and thyroid, which were classified independently rather than as part of the thoracic category.
The total numbers of patients who underwent RT in 2009 and 2013 were 42,483 and 56,850, respectively. The total numbers of male and female patients who received RT were 20,012 and 22,471 in 2009, 26,936 and 29,914 in 2013, respectively (
This study was conducted to analyze the clinical status of RT in 2009 and 2013 in Korea using claims data from the HIRA. Using the annual reports of KOSRO, we determined that the total number of patients who received RT increased by 33% every 4 years (
Breast, gastrointestinal, and genitourinary cancers have shown the steepest increase in number and proportion (
This approach, using claims data from the HIRA, could reduce the amount of time required to obtain data from participants from each RT facility and eliminate the possible recall bias associated with questionnaire-based studies. In addition, claims data from the HIRA can be analyzed easily by age group, as shown in
However, this study had several limitations. Because the claims data from the HIRA only include the insured cases, uninsured treatments, such as intensity modulated RT, cannot be analyzed. In addition, we included patients with the ‘C’ code and excluded benign disease. Therefore, patients who had a ‘D’ diagnostic code, which is expected to be a somewhat large portion of patients with ductal carcinoma in situ of the breast treated by RT, were excluded from this analysis. As a result, the actual number of patients who received RT is expected to be more than what is reported. To the contrary, because the patients who received RT on multiple sites including primary or metastatic sites throughout the treated years could be re-counted as annual new patients, the actual total number of patients who received RT is expected to be less than what we reported. Therefore, the annual number of patients who received RT should be considered under these limitations. In addition, the ‘metastasis’ category, which accounts for the largest proportion of patients in this study, may reduce the number of patients who received RT to each primary cancer site. Because we cannot distinguish whether the patients actually received RT to a metastatic site or to a primary site in cases with a metastatic diagnostic code, we assumed that the patients with metastatic diagnostic codes received RT to a metastatic site. As a result, the proportions of patients who received RT to metastatic sites were high in this study. According to the RT statistics data published in KOSRO, the portion of the ‘metastasis’ category for all patients receiving RT was 15%-18% between 1999 and 2006 [
In conclusion, the number of patients who received RT in Korea has shown a steady increase; however, the percentages of cancer patients who underwent irradiation were expected to still be below 30%. Although the use of claims data from the HIRA has some limitations, it provided useful cumulative clinical data supporting RT as one of the main modalities for cancer treatment in Korea.
Conflict of interest relevant to this article was not reported.
This work was supported by the National Nuclear R & D program of the Ministry of Education, Science and Technology, Republic of Korea.
Total number of patients who underwent radiation therapy in 2009 and 2013 in Korea.
Cancer incidence and total number of patients who received radiation therapy through 2001 to 2013 in Korea. The cancer incidence for 2013 is the value predicted by Jung et al. [
Time course of the number of patients who received radiation therapy at seven main sites.
The customized source population
List | Criterion |
---|---|
Treatment period | 2009 Jan 1-2009 Dec 31, 2013 Jan 1-2013 Dec 31 |
Type of healthcare facility | Tertiary, secondary |
Diagnostic code | C00-C97 |
Type of insurance | Health insurance, medical aid |
Hospital region | National |
Sex | Male, female |
Age | All ages |
Procedure codes related to radiation therapy
Procedure code | Name of procedure codes |
---|---|
HD051 | Teletherapy-Low energy-Single port |
HD052 | Teletherapy-Middle energy-Single port |
HD053 | Teletherapy-High energy-Single port |
HD054 | Teletherapy-Low energy-Paralleled opposed ports |
HD055 | Teletherapy-Middle energy-Paralleled opposed ports |
HD056 | Teletherapy-High energy-Paralleled opposed ports |
HD058 | Rotational irradiation-Middle energy radiation therapy |
HD059 | Rotational irradiation-High energy radiation therapy |
HD061 | 3-Dimensional conformal therapy |
HD080 | External radioisotope therapy |
HD081-HD082 | Intracavitary therapy-High dose rate |
HD083-HD084 | Intracavitary therapy-Low dose rate |
HD085-HD086 | Interstitial, intraluminal therapy-High dose rate |
HD088 | Interstitial, intraluminal therapy-Low dose rate |
HD089 | Brachytherapy |
HD091 | Total body irradiation |
HD092 | Total body lymph node irradiation |
HD093 | Total skin electron beam therapy |
HD110 | Fractionated stereotactic radiotherapy |
HD111-HD112 | Body stereotactic radiosurgery-Using linear accelerator |
HD113 | Cranial stereotactic radiosurgery-Gamma knife |
HD114 | Cranial stereotactic radiosurgery-Cyber knife |
HD115 | Cranial stereotactic radiosurgery-Linear accelerator |
HD121 | Proton therapy |
HD211-HD212 | Stereotactic body radiosurgery-Using cyber knife |
HZ271 | Intensity modulated radiation therapy |
Distribution of patients who received radiation therapy according to tumor site and sex in 2009 and 2013
Site | Sub-site (diagnostic code) | No. of patients in 2009 |
No. of patients in 2013 |
||||
---|---|---|---|---|---|---|---|
Male | Female | Total | Male | Female | Total | ||
Metastasis | (C77-C79) | 7,435 | 6,280 | 13,715 | 8,529 | 6,894 | 15,423 |
Breast | (C50) | 11 | 8,731 | 8,742 | 17 | 13,480 | 13,497 |
Gastrointestinal | Colorectum (C18-C20) | 2,129 | 1,109 | 3,238 | 2,416 | 1,203 | 3,619 |
Hepatobiliary (C22-C24) | 1,706 | 566 | 2,272 | 2,329 | 746 | 3,075 | |
Esophagus (C15) | 737 | 43 | 780 | 992 | 79 | 1,071 | |
Pancreas (C25) | 226 | 147 | 373 | 397 | 275 | 672 | |
Stomach (C16) | 232 | 108 | 340 | 290 | 133 | 423 | |
Anus (C21) | 49 | 72 | 121 | 62 | 109 | 171 | |
Small bowel (C17) | 13 | 5 | 18 | 17 | 12 | 29 | |
Other (C26) | 2 | 0 | 2 | 1 | 0 | 1 | |
Subtotal | 5,094 | 2,050 | 7,144 | 6,504 | 2,557 | 9,061 | |
Thoracic | Lung (C34) | 2,576 | 551 | 3,127 | 4,073 | 1,045 | 5,118 |
Thymus (C37) | 86 | 70 | 156 | 115 | 80 | 195 | |
Mediastinum (C38) | 20 | 4 | 24 | 31 | 7 | 38 | |
Trachea (C33) | 6 | 7 | 13 | 6 | 8 | 14 | |
Other (C39) | 1 | 0 | 1 | 1 | 0 | 1 | |
Subtotal | 2,689 | 632 | 3,321 | 4,226 | 1,140 | 5,366 | |
Head and neck | Larynx (C32) | 575 | 32 | 607 | 832 | 36 | 868 |
Oral cavity (C02-C06) | 183 | 89 | 272 | 304 | 178 | 482 | |
Oropharynx (C01, C09-C10) | 193 | 35 | 228 | 395 | 66 | 461 | |
Nasopharynx (C11) | 125 | 42 | 167 | 271 | 92 | 363 | |
Salivary gland (C07-C08) | 127 | 77 | 204 | 163 | 116 | 279 | |
Hypopharynx (C12-C13) | 181 | 14 | 195 | 248 | 17 | 265 | |
Paranasal sinus (C31) | 57 | 27 | 84 | 82 | 39 | 121 | |
Nasal cavity (C30) | 48 | 19 | 67 | 64 | 34 | 98 | |
Eye and orbit (C69) | 17 | 16 | 33 | 23 | 16 | 39 | |
Lip (C00) | 8 | 2 | 10 | 5 | 5 | 10 | |
Other (C14) | 4 | 1 | 5 | 15 | 0 | 15 | |
Subtotal | 1,518 | 354 | 1,872 | 2,402 | 599 | 3,001 | |
Gynecologic | Uterine cervix (C53) | - | 1,942 | 1,942 | - | 2,095 | 2,095 |
Uterine corpus (C54-C55) | - | 521 | 521 | - | 618 | 618 | |
Ovary and tubes (C56) | - | 72 | 72 | - | 111 | 111 | |
Vagina and vulva (C51-C52) | - | 87 | 87 | - | 84 | 84 | |
Other (C57-C58) | - | 3 | 3 | - | 5 | 5 | |
Subtotal | - | 2,625 | 2,625 | - | 2,913 | 2,913 | |
Genitourinary | Prostate (C61) | 847 | - | 847 | 2,097 | - | 2,097 |
Ureter and bladder (C66-C67) | 178 | 52 | 230 | 291 | 69 | 360 | |
Kidney (C64-C65) | 47 | 17 | 64 | 77 | 38 | 115 | |
Penis and testis (C60, C62-C63) | 34 | - | 34 | 53 | - | 53 | |
Other (C68) | 0 | 4 | 4 | 0 | 7 | 7 | |
Subtotal | 1,106 | 73 | 1,179 | 2,518 | 114 | 2,632 | |
Central nervous system | Brain (C70-C71) | 700 | 557 | 1,257 | 815 | 656 | 1,471 |
Spinal cord (C72) | 20 | 12 | 32 | 17 | 24 | 41 | |
Other (C47) | 11 | 7 | 18 | 23 | 18 | 41 | |
Subtotal | 731 | 576 | 1,307 | 855 | 698 | 1,553 | |
Lymphoma | Hodgkin's disease (C81) | 58 | 23 | 81 | 61 | 26 | 87 |
Non-Hodgkin's lymphoma (C82-C88) | 541 | 398 | 939 | 676 | 542 | 1,218 | |
Other (C96) | 2 | 2 | 4 | 9 | 7 | 16 | |
Subtotal | 601 | 423 | 1,024 | 746 | 575 | 1,321 | |
Soft tissue | (C46, C49) | 177 | 140 | 317 | 295 | 219 | 514 |
Myeloma and plasmacytoma | (C90) | 132 | 125 | 257 | 179 | 163 | 342 |
Leukemia | (C91-C95) | 159 | 115 | 274 | 170 | 132 | 302 |
Skin | (C44) | 84 | 83 | 167 | 123 | 102 | 225 |
Thyroid | (C73) | 57 | 122 | 179 | 72 | 134 | 206 |
Malignant melanoma | (C43) | 38 | 34 | 72 | 68 | 61 | 129 |
Primary bone and cartilage | (C40-C41) | 69 | 42 | 111 | 59 | 38 | 97 |
Endocrine | (C74-C75) | 26 | 14 | 40 | 37 | 22 | 59 |
Others | (C45, C48, C76, C80, C97) | 85 | 52 | 137 | 136 | 73 | 209 |
Total | 20,012 | 22,471 | 42,483 | 26,936 | 29,914 | 56,850 |
The number of patients who received radiation therapy by site and age group in 2013
Treatment site | Age group |
Total | |||||
---|---|---|---|---|---|---|---|
20s or under | 30s | 40s | 50s | 60s | 70s or older | ||
Metastasis | 150 | 614 | 2,150 | 4,351 | 4,240 | 3,918 | 15,423 |
Breast | 137 | 1,411 | 4,976 | 4,412 | 1,872 | 689 | 13,497 |
Gastrointestinal | 15 | 178 | 880 | 2,605 | 2,753 | 2,630 | 9,061 |
Respiratory | 18 | 60 | 300 | 989 | 1,774 | 2,225 | 5,366 |
Head and neck | 54 | 132 | 343 | 816 | 867 | 789 | 3,001 |
Gynecologic | 45 | 257 | 611 | 911 | 529 | 560 | 2,913 |
Genitourinary | 13 | 20 | 58 | 289 | 854 | 1,398 | 2,632 |
Central nervous system | 227 | 159 | 285 | 343 | 300 | 239 | 1,553 |
Lymphoma | 126 | 127 | 215 | 333 | 243 | 277 | 1,321 |
Soft tissue | 61 | 53 | 75 | 99 | 105 | 125 | 518 |
Myeloma and plasmacytoma | 0 | 8 | 34 | 87 | 118 | 95 | 342 |
Leukemia | 118 | 66 | 47 | 45 | 23 | 3 | 302 |
Skin | 3 | 11 | 25 | 32 | 42 | 112 | 225 |
Thyroid | 7 | 10 | 26 | 60 | 42 | 61 | 206 |
Malignant melanoma | 0 | 8 | 17 | 36 | 37 | 31 | 129 |
Primary bone and cartilage | 25 | 5 | 12 | 26 | 16 | 13 | 97 |
Endocrine | 18 | 5 | 10 | 8 | 10 | 8 | 59 |
Others | 9 | 6 | 24 | 51 | 53 | 62 | 205 |
All cancer | 1,026 | 3,130 | 10,088 | 15,493 | 13,878 | 13,235 | 56,850 |