Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

Lower radiotherapy utilisation in patients with cutaneous T-cell lymphomas (CTCL) living in highly accessible areas (#328)

Belinda A Campbell 1 2 , Gabriel Gabriel 3 4 5 , Geoffrey P Delaney 3 4 5 , Miles Prince 1 2 , Sandro V Porceddu 1 6 7 , Karin Thursky 1 2 8
  1. Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  2. The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
  3. Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Liverpool, New South Wales, Australia
  4. Ingham Health and Medical Research Institute, Liverpool, New South Wales, Australia
  5. South-Western Sydney Clinical School, University of New South Wales, Liverpool, New Sauth Wales, Australia
  6. Department of Radiology, University of Melbourne, Parkville, Victoria, Australia
  7. Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
  8. Royal Melbourne Hospital, Parkville, Victoria, Australia

Aims:  CTCL are rare malignancies with increasing incidence.  Typically incurable and highly morbid, patients with CTCL frequently require multi-lined therapies, over decades. Radiotherapy achieves high response rates, and constitutes the historical cornerstone of CTCL treatment. Total skin electron therapy (TSE) is a highly technical form of radiotherapy, with proven quality-of-life benefits for CTCL patients.  However, with the advent of newer skin-directed and systemic therapies, no consensus exists on optimal treatment sequencing.  International reports demonstrate wide variation in patterns of care and suggest declining radiotherapy-utilisation first-line. Herein, we investigated the incidence of CTCL and geographical patterns of radiotherapy-utilisation in a state-wide, population-based registry.

 

Methods: A retrospective study of NSW Cancer Registry dataset for all patients newly diagnosed with CTCL from 2009-2018, with data linkage to the NSW Outpatients Radiotherapy database.  Patients with dual malignancies and/or whose closest radiotherapy centre (calculated by ArcGIS) was across NSW borders, were excluded from radiotherapy analyses.  Radiotherapy-utilisation included all treatment lines.

 

Results: 553 patients were newly diagnosed with CTCL in NSW, with incidence of 7.1/million/year (<1 in 14,000 people). Median age at diagnosis was 64 (range, 11-98) years; 61% were men; 1.6% identified as Aboriginal.  33% of all CTCL patients lived in the 2 most disadvantaged Index of Relative Socio-economic Disadvantage quintiles. 13% resided in remote or moderately accessible locations; 16% resided >50km from the nearest radiotherapy centre.

Over 10 years, the radiotherapy-utilisation rate was 29%.  Patients residing in highly accessible areas had lowest radiotherapy-utilisation (24%).  Regional variation in radiotherapy-utilisation existed between local health districts (range, 9-50%).  No pattern was observed between radiotherapy-utilisation and distance to the nearest radiotherapy centre.  TSE-utilisation was only 1.8%, over 10 years. 

 

Conclusion: CTCL incidence in NSW was 7.1 per million/year. Overall radiotherapy-utilisation rate was 29%; TSE-utilisation was extremely low.  Curiously, radiotherapy-utilisation was lowest in patients living in highly accessible areas, possibly suggesting that referral bias may be a contributing factor.

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