Quantifying the Travel Undertaken by Cancer Patients Receiving Radiotherapy in Victoria, Australia

PURPOSE/OBJECTIVE(S)

This study aimed to investigate the travel distance for cancer patients treated with radiotherapy in Victoria, Australia, during a 9-year period relative to their home address. Additionally, the study aimed to quantify 'excess' travel distance where patients travelled to treatment centers that were not their closest.

MATERIALS/METHODS

The PRedicting the health economic IMPact of new and current CAncer Treatments (PRIMCAT) dataset was used for the study. PRIMCAT is a multi-institution research initiative taking a data-driven modelling approach to understand and forecast cancer treatment utilization in Australia. The PRIMCAT dataset is a comprehensive linked dataset including a retrospective cohort of patients 18 years and over, diagnosed with cancer included in the Victorian Cancer Registry between January 2010 to December 2019. For each patient in the cohort, data linkage includes a range of datasets managed by state and federal health departments including the Victorian Radiotherapy Minimum Dataset. A distance matrix was constructed using the Google Distance Matrix API that included driving distance between postcodes of selected patients and the postcodes of radiotherapy facilities. The centroid of each post-code was used for driving distance measurements. We first analyzed the realized travel distances of patients followed by the excess travel by patients. The excess travel was further quantified separately for public and private radiotherapy facilities.

RESULTS

There were 86,408 unique patient-radiotherapy courses available and of sufficient data quality to analyze. Patients travelled an average of 42.5km (s.d. = 72.2km) one-way, with a median travel distance of 16.5km. The largest distance travelled was 723km with 95% of patients travelling between 0km and 257km. Of the patients who received radiotherapy in a public facility, 44.3% travelled to a facility that was not their closest public facility. The average excess travel of these patients was 26.8km, with the median excess travel being 13.6km. Additionally, of patients who received care in a public facility, 47.4% travelled past a closer private facility. The average excess travel distance of these patients was 23.1km and the median excess travel was 11.5km. In the case of patients who received radiotherapy at a private facility, 92.8% travelled to a clinic that was not their closest. The average excess of these patients was 36.6km with a median excess travel distance of 15.6km.

CONCLUSION

Access to radiotherapy facilities remains unequal in Victoria with some patients having to travel significantly greater distances than average. This significant travel may require patients to take time off work or live away from home presenting additional financial challenges. The reasons for the large travel distances and any excess travel have not yet been identified but will be the subject of further study.

Minimising critical organ irradiation in limited stage Hodgkin lymphoma: a dosimetric study of the benefit of involved node radiotherapy

BACKGROUND

Chemotherapy plus radiotherapy is the standard of care for patients with limited stage Hodgkin lymphoma (HL). Radiotherapy is evolving from involved field radiotherapy (IFRT) to involved node radiotherapy (INRT) to decrease radiotherapy-related morbidity. In the absence of long-term toxicity data, dose-volume metrics of organs at risk (OAR) provide a surrogate measure of toxicity risk.

PATIENTS AND METHODS

Ten female patients with stage I-IIA supradiaphragmatic HL were randomly selected. All patients had pre-chemotherapy computerised tomography (CT) and CT-positron emission tomography staging. Using CT planning, three radiotherapy plans were produced per patient: (i) IFRT, (ii) INRT using parallel-opposed beams and (iii) INRT using volumetric modulated arc therapy (VMAT). Radiotherapy dose was 30.6 Gy in 1.8 Gy fractions. OAR evaluated were lungs, breasts, thyroid, heart and coronary arteries.

RESULTS

Compared with IFRT, INRT significantly reduced mean doses to lungs (P < 0.01), breasts (P < 0.01), thyroid (P < 0.01) and heart (P < 0.01), on Wilcoxon testing. Compared with conventional INRT, VMAT improved dose conformality but increased low-dose radiation exposure to lungs and breasts. VMAT reduced the heart volume receiving 30 Gy (V30) by 85%.

CONCLUSIONS

Reduction from IFRT to INRT decreased the volumes of lungs, breasts and thyroid receiving high-dose radiation, suggesting the potential to reduce long-term second malignancy risks. VMAT may be useful for patients with pre-existing heart disease by minimising further cardiac toxicity risks.

Parotid-sparing radiotherapy: does it really reduce xerostomia?

AIMS

Parotid-sparing radiotherapy (PSRT) was introduced for patients with selected head and neck cancer requiring bilateral upper-neck irradiation at our centre in 2000. The aim of this study was to compare the subjective degree of xerostomia in patients treated with PSRT between January 2000 and June 2003 with patients treated using conventional techniques (radiotherapy) over the same period.

MATERIALS AND METHODS

Eligible patients were required to have completed treatment 6 months previously and be recurrence-free at the time of interview. PSRT was defined as conformal radiotherapy, in which the mean dose to at least one parotid gland was 33 Gy or less, as determined by the dose-volume histogram. Patients receiving radiotherapy were treated with standard parallel-opposed fields, such that both parotids received a minimum of 40 Gy. Xerostomia was assessed using a validated questionnaire containing six questions with a rating between 0 and 10. Lower scores indicated less difficulty with xerostomia.

RESULTS

Thirty-eight eligible patients treated with PSRT were identified: 25 with oropharyngeal cancer and 13 with nasopharyngeal cancer (NPC). The mean overall questionnaire score (Q1-5) for this group was 4.20 (standard error = 0.33). Forty-four patients (24 oropharyngeal, 21 NPC) treated with radiotherapy over the same period were eligible. The mean overall questionnaire score (Q1-5) for this group was 5.86 (standard error = 0.35). The difference in mean overall scores between the two groups of patients was statistically significant (P < 0.001), as were the scores for four of the six individual questions.

CONCLUSION

These results suggest that PSRT offers improved long-term xerostomia-related quality of life compared with conventional radiotherapy.

Quality assurance in a Radiation Oncology Unit: the Chart Round experience

Quality assurance ensures that planned treatments eventuate. Programmes must include feedback loops to promptly correct any shortfall in predetermined standards. In March 1999, a weekly Chart Round was introduced to verify that certain items relevant to quality care were being completed for patients of the Head and Neck Radiotherapy Unit at the Peter MacCallum Cancer Institute. The experience was reviewed after 1 year and it was found that the initiation of Chart Rounds has assisted in raising the level of item completion from 80% to 99% in similar groups of patients treated before and after the initiation of the Chart Round. Initiation of the Chart Round has also provided a useful forum for in-house peer-review, education and effective real-time communication between medical and allied health personnel, all of which has further added to the quality of patient care.