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Abstract
Introduction:
In Australia there is widespread underutilization of some cancer treatments and socioeconomic disparity in cancer outcomes. The aims of this study were to develop an evidence-based model to estimate the optimal proportion of new cases of cancer that should be treated with brachytherapy (BT), the optimal brachytherapy utilization rate (BTU); to conduct a comprehensive Patterns of Care Study (POCS) of BT for NSW to assess BT quality and to calculate actual BTU in NSW; and to compare optimal and actual BTU.
Methods & Materials:
Evidence-based guidelines were used to construct optimal BTU trees for prostate and gynaecological malignancies. Searches of the epidemiological literature were performed to ascertain the proportion of patients with indications for BT. The robustness of the models was tested by sensitivity analyses and by an external court of reviewers. Actual practice was used to estimate the optimal BTU rate for tumour sites in which BT is only rarely indicated. Data on all NSW patients treated with BT in 2003 were collected from all nine radiation oncology departments in NSW that treat patients with BT, as well as limited data from interstate departments that treated NSW residents. The actual BTU in NSW in 2003 was determined by dividing the number of NSW residents treated with BT by the incidence for each cancer.
Results:
Optimal BTU was 2.8% (95%CI 2.7-3.5%), compared to Actual BTU of 1.5%. European BTU averaged 1.9% and in the SEER areas 3.4%. On multivariate analysis, patients were more likely to be treated with BT if resident in an Area Health Service equipped with BT (OR 1.64, p<0.001) or in a high socioeconomic status postcode (OR 1.11, p=0.002), but accessibility of postcode of residence was not significant. Non-prostate BT treatment in NSW was dispersed amongst a large number of treating departments often treating small numbers of patients with sub-optimal treatment quality.
Conclusions:
BT was underutilized in NSW in 2003. Non-medical factors were important determinants of access to BT treatment, and non-prostate BT was dispersed with impaired quality.