Colorectal cancer radiotherapy utilization rate in a low-middle income country - a multicenter study in Indonesia.

Introduction: Despite the rising application of radiotherapy for cancer in Indonesia, no known radiotherapy utilization rate (RUR) figure has been produced for colon and rectal cancer in Indonesia. This study aims to depict the actual and optimal RUR for colon and rectal cancer in Indonesia. Material and methods: Secondary data was obtained from hospitals providing radiotherapy services in Indonesia, and descriptive analysis was conducted in April-September 2022. Results: Actual RUR (aRUR) of colon cancer was 5.3%, yet the calculated optimal RUR (oRUR) was 3.3% (3-3.7%) with an unmet need percentage of -60.6% [-76.7-(-43.2)%]. Actual RUR of rectal cancer in Indonesia was 19.5%, while calculated oRUR was 41% (28-66%) with an unmet need percentage of 52.4% (30.4-70.5%). In combination, 26.21% and 14.9% were the final calculation of colorectal cancer oRUR and aRUR, resulting in 45.5% (21.4-65.6%) unmet need. A substantial difference was also observed when sensitivity analysis was incorporated, with the percentage of unmet needs for colon and rectal cancer ranging from -76.7 to 86.5% and 2.2-94.2%, respectively. Conclusions: There is a gap between aRUR and oRUR of colorectal cancer. Although oRUR of colon cancer seems to have been met, a significant gap persisted between oRUR and aRUR in rectal cancer. However, when sensitivity analysis was incorporated, notable disparity persisted for both colon and rectal cancer. Patient, clinician, and bureaucratic factors should be considered in increasing the RUR of colon and rectal cancer.