Factors affecting radiotherapy utilization in NSW and ACT 2004-06: a data linkage and geographical information system study

BACKGROUND Delaney et al estimated that more than half of all cancer patients should receive radiotherapy (RT) at some point during the course of the disease if every appropriate patient were treated according to the recommendations of evidence-based treatment guidelines. Actual RTU rates are usually lower than the optimal rates. AIMS: 1) To calculate actual RTU rates for NSW and ACT residents directly from patient records. 2) To identify factors affecting RTU with special emphasis on the effect of geographic variation on RTU METHODS Data were collected from all radiotherapy departments (RTD) in NSW and ACT for years 2004-2006. Follow up for death status used for survival time was for a minimum of 2 years. RT data and Central Cancer Registries records were linked by the Centre for Health Record Linkage to create a database of patients with cancer who received and did not receive RT. All patients residential addresses were geocoded. Patients were excluded from the study if their nearest RTD was outside NSW. The actual RTU rates were calculated and then compared with the recommended optimal rates by tumour site. Univariate and multivariate analyses were performed to examine reasons for differences in RTU. GIS software was used to calculate road distance between patients residence and the closest RTD. RESULTS The overall RTU rate was 26%. This represents 54% of the estimated optimal RTU of 48%. Multivariate regression showed that males, younger age and shorter travel distance were significantly associated with receiving RT. Patient diagnosed with regional or distant stage were more likely to receive RT than unknown stage (p<0.001). Survival analysis shows higher survival for patients receiving radiotherapy. RTU rates decreased with increasing distance from patient residence to the nearest RTD (p <0.001). RTU ranged from 27% for those who lived <100 km from the nearest RTD to 21% for those who lived 300+ km. CONCLUSIONS RTU in the first two years after diagnosis is less than guidelines suggest. Increasing road distance between patient residence and the nearest RT facility is significantly associated with decreasing RTU. There is an association between receiving radiotherapy and higher survival.

Grantor dc:publisher

UNSW, Sydney

Year dc:date

2014

Author dc:creator

• Gabriel, Gabriel Sam

• Geographical information system
• Radiotherapy
• Data linkage

Statement dc:rights

• open access
• CC BY-NC-ND 3.0
• free_to_read

Licence

• https://purl.org/coar/access_right/c_abf2
• https://creativecommons.org/licenses/by-nc-nd/3.0/au/

Language dc:language

EN

Identifier

https://doi.org/10.26190/unsworks/17067

OAI identifier oai:identifier

oai:unsworks.library.unsw.edu.au:1959.4/53884