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

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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.

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