Radiotherapy Utilisation and Geriatric Oncology: Lung, Rectal, Prostate and Cervical Cancer
Penny Mackenzie,
Australia
OC-0755
Abstract
Radiotherapy Utilisation and Geriatric Oncology: Lung, Rectal, Prostate and Cervical Cancer
Authors: Penny Mackenzie1, Claire Vajdic2, Geoff Delaney3, Tracy Comans4, Meera Agar5, Gabriel Gabriel3, Michael Barton3
1The University of New South Wales and CCORE (Collaboration for Cancer Outcomes, Research and Evaluation), Ingham Insitute, Liverpool Hospital, Sydney, Australia; 2The University of New South Wales, The Kirby Institute, Sydney, Australia; 3The University of New South Wales and CCORE (Collaboration for Cancer Outcomes, Research and Evaluation), Ingham Institute, Liverpool Hospital, Sydney, Australia; 4The University of Queensland, Centre for Health Services Research, Brisbane, Australia; 5The University of Technology, Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Liverpool Hospital, Sydney, Australia
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Purpose or Objective
Optimal radiotherapy utilisation (RTU) modelling estimates the proportion of people with cancer who would benefit from radiotherapy. With technological advancements in treatment the side effect profile of radiotherapy is low. Therefore, it is important that chronological age alone does not limit treatment recommendations. Assessment of medical comorbidities is an important component for the assessment of treatment suitability. These have not been considered in previous optimal RTU models.
We aimed to develop an age- and comorbidity- adjusted optimal RTU model for patients, with a particular focus on those aged 80+ years, with lung, rectal cancer, prostate and cervical cancer, and compare them to actual RTU rates.
Material and Methods
New South Wales (NSW) Cancer Registry data (2010-2014) linked to radiotherapy data (2010-2015) and hospitalisation data (2008-2015) were used to determine the number of patients diagnosed with lung, rectal, prostate and cervical cancer. The Cancer Specific C3 ‘all sites’ comorbidity index was calculated from hospital diagnosis data for each patient to determine suitability for radiotherapy. The index was then incorporated into a tumour site-specific decision tree model. The actual RTU was also calculated using the linked datasets.
Results
14696 patients were diagnosed with non-small cell lung cancer (NSCLC), 1839 with small cell lung cancer (SCLC), 5551 with rectal cancer, 30935 with prostate cancer and 1216 with cervical cancer in New South Wales from 2010-2014.
The proportion of patients aged 80+ years at cancer diagnosis was 25% (3603 patients), 15% (279 patients), 17% (943 patients), 12% (3745 patients), and 7% (88 patients) respectively.
The age- and comorbidity- adjusted optimal RTU rates for patients aged 80+ years using the C3 index were 49% (NSCLC), 49% (SCLC), 43% (rectal), 51% (prostate) and 40% (cervical).
The corresponding actual RTU rates for patients aged 80+ years were 25%, 32%, 27%, 16%, and 56%.
Conclusion
Even after adjusting for age and comorbidities, the actual radiotherapy utilisation rates were lower than optimal radiotherapy utilisation rates in patients aged 80+ years except for patients with cervical cancer. This warrants further assessment and research into reasons and solutions.