Actual versus optimal utilization of radiotherapy in lung cancer: Where is the shortfall?

Abstract

Background: Estimates of ideal radiotherapy utilization in lung cancer range from 61% to 74%. Actual utilization rates are lower than this. The aim of the present study was to identify those groups where there was the greatest discrepancy between actual and ideal utilization. Methods: The study population consisted of South-Western Sydney Area Health Service residents who were diagnosed with lung cancer in 1993 or 1996. A clinical audit of medical records was performed to collect details on patient demographics, tumor factors, treatment details and outcome. Results: There were 527 patients diagnosed with lung cancer. Treatment data were available for 499 (95%) patients of which 279 (56%) received radiotherapy. Radiotherapy utilization declined with increasing age and decreasing performance status. When comparing actual with ideal utilization, the greatest shortfall in radiotherapy was seen in small cell lung cancer (55% vs 79%) followed by stage I (35% vs 50%) and IV non-small cell lung cancer (65% vs 83%). There was under-utilization of chest radiotherapy (79% vs 88%) and definitive radiotherapy (14% vs 50%). Conclusions: Definitive chest radiotherapy is underutilized in lung cancer, particularly in patients with limited stage small cell lung cancer and stage I non-small cell lung cancer. This is partly due to non-referral of patients but also a palliative approach by radiation oncologists. These factors have to be addressed in order to optimize survival and quality of life for lung cancer patients.

Management of stages I and II non‐small‐cell lung cancer in a New Zealand study: divergence from international practice and recommendations

“…Comparison with international data indicates surgical resection rates for stages I/II NSCLC in NZ (49%) were similar to those in the UK (46%), 32 but were low compared with Australia (72%), 33 USA (79%) 34 and Italy (84%) (Table 4). 32 Similarly the rate for definitive RT (2.9%) was similar to that in the UK (1.4–2.7%) 38,39 but lower that in the Australia (7%) 33 .…”

“…Comparison with international data indicates surgical resection rates for stages I/II NSCLC in NZ (49%) were similar to those in the UK (46%), 32 but were low compared with Australia (72%), 33 USA (79%) 34 and Italy (84%) (Table 4). 32 Similarly the rate for definitive RT (2.9%) was similar to that in the UK (1.4–2.7%) 38,39 but lower that in the Australia (7%) 33 . Although surgical resection rates in NZ were similar to the USA and Netherlands for younger patients (<60 years) and for patients without relevant comorbidity, as age and comorbidity increased, surgical resection rates in NZ fell more rapidly than in the other two countries, resulting in substantially lower resection rates overall (Table 5).…”

“…This is because of improved case selection by cardiopulmonary assessment and improved surgical techniques and perioperative care 12 . Overseas, these measures have resulted in increased numbers of elderly undergoing surgical resection with improved 5‐year survivals 12,33 . In this study, age together with general frailty was cited as the reason for palliative management in 10% (six cases).…”

“…Although surgery is the treatment of choice for early‐stage NSCLC, only 54% of the patients were referred to CTS and there was discussion at a multidisciplinary meeting for only 82 (58%). Although it is difficult to ascertain the appropriateness of decisions from retrospective records, it is of concern that the surgical resection rate (49%) was substantially lower than for countries with superior survival outcomes (72–84%) 32–34 …”

Do multidisciplinary team meetings make a difference in the management of lung cancer?

“…The under use of radiotherapy in this cohort has been noted previously. 27 We did consider the possibility that the MDT group may have received over treatment in terms of radiotherapy. We previously assigned guideline indications for treatment to our MDT cohort from 2005 to 2007.…”