Examining determinants of “access” to radiotherapy – Does the introduction of a local publicly funded radiotherapy service to regional NSW impact on the uptake of breast conserving treatment for early breast cancer here?  — ASN Events
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Examining determinants of “access” to radiotherapy – Does the introduction of a local publicly funded radiotherapy service to regional NSW impact on the uptake of breast conserving treatment for early breast cancer here?  (#272)

Johnson Lam 1 , Stephanie Foster 1 , Theresa Cook 1 , Puma Sundaresan 1 2
  1. Central Coast Cancer Centre, Gosford Hospital, Gosford, NSW, Australia
  2. The University of Sydney, Sydney, NSW, Australia

Background and Aims

The uptake of radiotherapy (RT) or combined approaches that include RT may be affected by multiple factors including availability of local RT services. Adjuvant RT is integral to breast conserving treatment (BCT) for early breast cancer. BCT offers equivalent disease outcomes as mastectomy. We aimed to compare uptake of BCT in the Central Coast Local Health district (CCLHD), NSW over 3 sequential 1 year time periods when patients and referrers had variable access to RT services: Period 1 = Access to local private RT facility (at cost) or daily commute / relocation to publicly funded RT outside CCLHD (cost + inconvenience); Period 2 = Free transport to publicly funded RT outside CCLHD available (Cost minimised but inconvenience remained); Period 3 = local publicly funded RT available (no cost and inconvenience minimised).

Methods

Female patients with T1-2N0M0 invasive or in-situ (< 5cm) breast cancer were retrospectively identified from multidisciplinary team records and databases maintained by clinical nurse consultants. Demographic data, tumour characteristics and treatment details were checked against hospital records and reports of imaging, pathology and operations.

Results

BCT rates for early invasive and in-situ breast cancer in periods 1, 2 and 3 were 61.5% (n=120/195), 60.5% (n=106/175) and 69.1% (n=163/236) respectively.  Mastectomy rates for early invasive and in-situ breast cancer in periods 1, 2 and 3 were 38.5% (n = 75/195), 39.5% (n = 69/175) and 30.9% (n = 73/236) respectively.

Conclusions 

There was an increase in the use of BCT for early breast cancer with the introduction of local, publicly funded RT to a region already serviced by the private sector and non-local public RT services. Although local availability and cost have been recognised as important determinants of “access” to RT, our findings suggest that factors such as service convenience may also be important.

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