Blood cancers

Underuse of radiotherapy in blood cancers linked to poor outcomes

Radiotherapy is significantly underutilised in cancer care with likely adverse impacts on patient outcomes across a range of solid and haematological cancers.

A study of radiotherapy utilisation in all NSW patients diagnosed with cancer between 2009 and 2011 found 25% received radiotherapy within one year of diagnosis.

However the optimal radiotherapy utilisation rate was calculated to be 44.5%.

In a population of 110,645 cancer cases, the underutilisation of radiotherapy potentially compromised local control of the cancer in 5,062 patients or survival in 1,162 patients.

The study found a gap between actual versus optimal use of radiotherapy was widespread across tumour sites but particularly in breast (61% v 86%), prostate (23% v 86%), lung (41% v 73%), head and neck cancers (51% v 70%) and lymphoma (22% v 65%).

Not surprisingly, increasing distance to the nearest radiotherapy centre was one of the factors associated with underuse of radiotherapy.

Other factors were older age, male gender, localised disease, Australian country of birth and socioeconomic disadvantage.

Senior author Professor Geoff Delaney, director of the Liverpool Cancer Therapy Centre, told the limbic that distance to treatment centres was improving although it could never fully match patient expectations in a big country.

“The one good news story I guess is that in NSW, and in most states in fact, there has been an investment in regional cancer centres. And I think it is something like 83% of patients in NSW live within 50 km of a treatment centre.”

However other issues also needed urgent attention, he said.

While not every patient was suitable for or wanted radiotherapy, there were probably a lot of patients who don’t ever get to see a radiation specialist for advice.

He said some of the problems included low awareness of radiotherapy – currently being addressed in the Targeting Cancer campaign, outdated misinformation about radiotherapy, and clinician or patient nihilism.

“We’ve already shown before that people don’t get radiation. What we have shown this time though is that that gap is in areas of medicine where there has been a survival benefit identified in clinical trials.”

“We are aware of some situations where there are definite guidelines and definite evidence of survival and yet those patients are not getting radiation. As Australians, we should be really concerned about this. ”

The study suggested that mandating multidisciplinary team discussion for patients and the use of clinical decision-support tools could improve practice.

Professor Delaney said there was evidence that patients discussed at a MDT were more likely to get evidence-based care than those not referred to a MDT.

“Ideally a radiation oncologist should be in every MDT but particularly in rural settings that can be difficult although not impossible with technology.”

“But what we think needs to happen is if there isn’t a radiation doctor sitting in the MDT room, someone needs to prompt them to think about radiation as a possibility.”

He added that patients will often be influenced by hearing stories about radiation therapy delivered 10, 15 or 20 years.

However radiotherapy side effects had improved dramatically due to better CT, MRI and PET imaging and better targeting of tumours.

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