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Radiation Oncology

Radiation Oncology Single Machine Unit Trial

The National Single Machine Unit (SMU) Radiotherapy Trial was jointly funded by the Commonwealth and Victorian Governments and commenced in 1999. The aim of the trial was to improve access to, and utilisation of, radiotherapy services for Victorian rural patients, while maintaining acceptable standards of care.

Radiotherapy services have typically involved facilities with at least two linear accelerators (linacs) located in metropolitan areas. This approach has been considered essential for the continuity of patient care and to ensure the availability of the required specialist workforce and engineering support. The SMU trial was undertaken in response to concerns about significantly lower radiotherapy treatment rates in regional areas and associated poorer survival outcomes for patients with cancer. The challenge was to provide comparable service quality with a single linac where two linacs could not be justified because of low patient throughput.

Under the trial, SMU radiotherapy facilities were established in Ballarat and Bendigo in 2002 and a third unit was opened in Traralgon in 2006. The trial was undertaken using a hub and spoke model, with major metropolitan radiotherapy providers operating and managing the facilities as satellite services.

The primary aim of the evaluation of the SMU trial was to measure the impact of the SMUs on access to, and utilisation of, radiotherapy in rural Victoria. In addition, the evaluation compared the performance of the SMU ‘spokes’ with their ‘hub’ sites in terms of the cost of providing the service, the overall activity levels of each service and the quality of the service.

The Minister for Health and Ageing, the Hon Nicola Roxon MP, released the report entitled the Evaluation of the National SMU Radiotherapy Trial (PDF 1520 KB) on 12 November 2009.

An update on the trial has been provided by the Victorian Department of Health SMU Addendum 2009 (PDF 127 KB)

For post trial documentation, please refer to the Establishing Radiation Oncology Services in Regional Areas - Experiences of the National Radiotherapy Single Machine Unit Trial and other regional radiation oncology models report below.

The key findings of the report are summarised below:

• SMUs can be operated in a relatively cost effective manner and meet (and possibly exceed) the service quality of their respective hubs.
• the hospitals/towns in which the SMUs were located already provided significant cancer services and had access to a broad range of hospital services – a significant factor in their success.
• the proximity of the spoke to the hub enabled a significant level of support from the hubs (the SMUs were located within 2-2.5 hours by road from their hubs in metropolitan Melbourne). Satellite radiotherapy services located at considerably greater distances may face significantly greater challenges and/or costs – depending on available transport corridors.
• the speed of growth in services was unexpected and reflected the potential for a new radiation oncology service to capture unmet demand and provide a focus for regional cancer referrals.
• site capacity for, and timing of, expansion from one to two linacs should be considered as part of the initial planning and design stages.
• some patients with complex cancers could be treated at the spoke facility after consultation and assessment at the hub.

A comprehensive analysis of the findings of the report can be accessed using the link above.

Establishing Radiation Oncology Services in Regional Areas

Valuable lessons were learnt from the National SMU Radiotherapy trial about the planning, implementation and ongoing management of regional radiotherapy services.

The Department of Health and Ageing (DoHA) and the then Victorian Department of Human Services (DHS), in consultation with the Radiation Oncology Reform Implementation Committee (RORIC) Service Planning Forum (SPF), has developed a document entitled Establishing Radiation Oncology Services in Regional Areas – Experiences of the National Radiotherapy Single Machine Unit Trial and other regional radiation oncology models (PDF 93KB).
The aim of this document is to provide policy makers and health planners with information based on the insights gained through conducting the SMU trial as well as drawing on the experiences of other states in establishing radiation oncology services in regional Australia.

While this document focuses on the delivery of regional radiation oncology services, it is recognised that radiotherapy is provided in conjunction with other cancer related services such as surgical oncology, medical oncology, haematology, palliative care and supportive care services. This document predominantly focuses on the radiation oncology component of cancer services.

If you are having difficulty downloading the PDF document/s, please email mbd.web@health.gov.au for an alternative format or a copy to be sent to you.