Factors affecting radiotherapy utilisation in geriatric oncology patients in NSW, Australia

Background and Purpose

Large non-age-specific radiotherapy utilisation rate (RTU) studies have demonstrated that actual RTU is below the optimal recommended utilisation rate for both curative and palliative intent radiotherapy indications. The optimal utilisation rate for the geriatric oncology cohort of patients has not yet been determined. The purpose of this research was to examine the actual RTU for patients treated in New South Wales (NSW), Australia as a function of increasing age, and the relationship between RTU and tumour site, travelling distance and socio-economic status.

Materials & Methods

NSW Central Cancer Registry data (2009-2011) were linked to the NSW Radiotherapy Dataset (2009-2012). RTU was calculated for patients aged <80 years and ≥80 years. RTU was defined as the proportion of patients receiving at least a single course of radiotherapy within 12 months of a cancer diagnosis.

Results

110,645 patients were diagnosed with cancer, of whom 27,721 received at least one course of radiotherapy. The overall RTU was 25%. RTU for patients aged <80 years was 28% compared to 14% for patients aged 80+ years (p < 0.001). On both univariate and multivariate analysis, increasing age, residential address in disadvantaged socioeconomic areas and increasing distance to the nearest radiotherapy department were associated with a reduction in RTU.

Conclusion

Geriatric oncology patients are less likely to receive radiotherapy than their younger counterparts. Some of the reduction in RTU may be justifiable on the basis of limited life expectancy and co-morbidity. Further research is required to determine the co-morbidity adjusted optimal RTU in older patients.

International patterns of radiotherapy practice for non-small cell lung cancer

Radiotherapy is an important treatment modality for non-small cell lung cancer (NSCLC). There are models of radiotherapy utilization that estimate the proportion of patients with NSCLC who have an evidence-based indication for radiotherapy. These estimates range from 46%-68% for radiotherapy utilization at diagnosis and 64%-75% overall. However, actual radiotherapy utilization throughout much of the world is lower than this, ranging from 28%-53%, with the largest differences between actual and estimated radiotherapy utilization seen in stage III NSCLC. Some of this discrepancy is attributable to the assumptions in the models that are based on broad factors such as stage and performance status. Characteristics of the population with underlying lung cancer that often has comorbidities or compromised respiratory function also influence the ability to deliver radiotherapy safely. Sociodemographic factors such as race and income have been found to affect access to radiotherapy in certain jurisdictions. The type of clinician or medical setting the patient presents to initially can also influence radiotherapy use in NSCLC. Potential solutions to improve appropriate radiotherapy utilization for NSCLC include restructuring models of care to ensure that all patients with lung cancer are managed within a multidisciplinary team including a radiation oncologist.