The changes of radiotherapy in Lithuania: infrastructure, utilization rate, and cost.

Background. The aim of this study was to evaluate radiation therapy (RT) productivity, capacity, and cost in Lithuania. Materials and methods. An electronic questionnaire was prepared and sent to the country's RT centres. The data was collected for the years 2011-2014. The early data of the RT infrastructure was obtained from the QUARTS Project (2001). Results. In Lithuania the external beam RT was applied to 32.6% of new cancer cases (non-melanomatous skin cancer and benign conditions were excluded). In 2014, RT was more frequently applied for breast and prostate carcinomas, 23 and 20%, respectively. The country owned 11 units of linear accelerators (linacs) and this accounts for 3.7 linacs per one million population. 3D conformal RT is the standard approach in all four RT centres in Lithuania. IMRT practices were established in three centers and VMAT or stereotactic RT in two of them. 73% of linacs were capable of IGRT, while only 27% were equipped with CBCT. The average linac workload was 567 patients per year and showed a 10% decrease compared with the 2011 data. During a ten-year period, the average cost per patient for RT treatment increased 7.6 times - from EUR 129 to 974. The reimbursement system in Lithuania is not favourable for application of RT. Conclusions. During the recent thirteen years, RT services in Lithuania have dramatically improved, but we are still behind the average of European countries and benchmark rates. It is important to continue optimising the efficiency of RT services, and further evidence-based studies on RT infrastructure assessment and planning are needed.

Postgraduate Cancer Education and Training in Lithuania: Harmonization According to the EU Rules.

The purpose of this article is to discuss Lithuanian postgraduate cancer education according to the data of 2013. In Lithuania, a specialization in an area called clinical oncology is absent; as independent specialities in oncology, there are both medical oncologists and radiation oncologists. These types of oncologists complete rigorous residency training in the clinics. Separate courses are provided in different residency programmes. Currently, there are two medical oncology and radiation oncology programmes for 3rd-, 4th- and 5th-year residents, one at the National Cancer Institute and another at the Lithuanian University of Health Sciences and Kaunas Clinics. Today, there are only 45 radiation oncologists and 56 medical oncologists licensed in Lithuania. This means that each radiation oncologist and medical oncologist is providing for 397 and 319 new cancer cases per year, respectively, or there are 0.3 practising in the major specialties of oncology per 10,000 population. Most other medical residency programmes expose their trainees to oncology for only 1 month either in the 1st or the 2nd year of residency. Due to the growing number of new cancer cases worldwide, these programmes have to be extended, especially for family and internal medicine residents. Lithuanian postgraduate cancer education and training is in the process of harmonization according to the EU rules. All the Lithuanian residency programmes are certificated by an independent public agency and are recognized by a number of countries, including all the countries of the EU.

Cancer education in Lithuania.

The aim of this article is to describe cancer education in Lithuania according to the data of 2013. In Lithuania, there are the following stages of education for physicians: basic education through integrated studies of medicine (six years), postgraduate education through residency studies (four to five years), and continuing professional development. In recent years, integrated studies of medicine have been the most popular specialty. Oncology is incorporated into the teaching courses in medicine programmes. In each university, an oncology course is mandatory during these studies. In Lithuania, there are two types of specialists related to oncology: medical oncologists and radiation oncologists. These oncologists complete multidisciplinary residency study programmes in the clinics. To receive a doctoral degree, specialists may join PhD programmes at any of the accredited universities. In recent years the number of dissertations in oncology has grown. Notably, oncology is chosen not only by students in the field of medicine. It also becomes the choice of those seeking a doctorate in the fields of nursing, public health, biochemistry, and physics. The professional development of oncologists is a lifelong commitment. In Lithuania, continuing specialist medical training is mandatory. This requirement is ensured with the process of licensing of medical practice. All Lithuanian study programmes are certificated by an independent public agency and are recognised by a number of other countries as well.