1. (1) Discussion.  Radiation therapy, surgery, and medical oncology-chemotherapy combined are often the most effective treatment for cancer.  Specific planning for these modes of treatment is necessary to insure proper cost and quality of care for the citizens of Alabama.  Surgery is often a “one-time” service and may or may not be offered close to the patient’s home.  Radiation therapy and chemotherapy are generally provided on a daily basis for an extended period of time, and so are often more accessible if provided close to a patient’s residence.

2. (2) Definition.

   1. (a) “Radiation Therapy” is a clinical specialty in which ionizing radiation is used for treatment of cancer.  The predominant form of radiation therapy involves an external source of radiation focused on the diseased area.
   2. (b) “Oncology” is the discipline devoted to the delivery of specialized care to those patients afflicted with cancer.  The delivery of care to these patients involves the diagnosis of cancer, the staging and determining the distribution of cancer, and the treatment of cancer.  Treatments involve coordination of care often with radiation oncologists and surgeons.  The primary modes of treatment for these patients are hormonal therapy and immunotherapy.
3. (3) Surgery for cancer is usually provided in a hospital setting and may be done on an outpatient and/or inpatient basis.
4. (4) Medical oncology/chemotherapy is the introduction of certain chemical agents into a patient’s body to inhibit or prevent the growth of cancerous cells and may be done on an inpatient or outpatient basis.

5. (5)  Planning Policies

   1. (a) Planning Policy:  A megavoltage radiation therapy unit (which is a single megavoltage machine or energy source) shall serve a population of at least 150,000 persons and perform 6,000 treatments/patient visits annually within three (3) years of initiation.
   2. (b) Planning Policy:  No additional megavoltage units shall receive approval unless each existing megavoltage unit in the county is performing at least 6,000 treatments/patient visits per year.
   3. (c) Planning Policy:  When applying the standard of 6,000 treatments per year, the limited specialized use of special purpose (i.e. radiosurgery, stereotactic body radiation therapy, proton therapy) and extra high energy machines shall also receive consideration.  Furthermore, if existing equipment does not offer integrated kilovoltage image guidance and multi-leaf collimator-based intensity modulated radiation therapy, existing equipment will not be considered in applying the 6,000 treatment per year rule as long as the competing or replacement equipment includes these features.

   4. (d) Preference for new radiation therapy services shall be given to those applicants who combine/locate co-existent with chemotherapy treatment modalities, as these services are most accessible when provided in a single location.

      Note:  The numerical standards contained in the above Planning Policies were obtained from Radiation Oncology in Integrated Cancer Management Report of the Inter-Society Council for Radiation Oncology, November 1986.

6. (6)  Data on Oncology services is available from the State Health Planning and Development Agency.

Author: Statewide Health Coordinating Council (SHCC)

Statutory Authority: Code of Ala. 1975, §22-21-260(4).

History: Effective March 8, 1996. Amended: Filed June 19, 1996; effective July 25, 1996. Repealed and New Rule: Filed October 18, 2004; effective November 22, 2004. Amended (SHP Year Only): Filed December 2, 2014; effective January 6, 2015. Repealed and New Rule: Published March 31, 2020; effective May 15, 2020. Repealed and New Rule: Published April 30, 2024; effective June 14, 2024.