The Availability of Radiotherapy to All Patients for whom it is Clinically Appropriate that can be Accessed in a Timely Manner
Importance of ensuring access
Radiation oncology’s contribution to the fight against cancer is significant. The impact of radiotherapy in cancer survival has been estimated at 40%, compared to 49% of patients being cured by surgery and 11% of patients for systemic treatments9. Cancer is a leading cause of death in Australia10. The 2012 report on cancer incidence projections by the Australian Institute of Health and Welfare (AIHW)11 highlights just how significant the age related increase in cancer incidence across Australia will become. The AIHW report projects that the number of cases of cancer diagnosed in Australia will rise over the next decade for both males and females and is expected to reach about 150,000 in 2020—an increase of almost 40% from 2007. Increases in the number of cases diagnosed are due primarily to the ageing and increasing population and are expected to be most evident in older populations. In this context, enabling patient access to a quality radiotherapy service across Australia that is integrated with the other cancer services becomes paramount to cancer management.
The current average radiotherapy utilisation rate for Australian cancer patients is estimated at 38.1%, while the agreed target level is 52.3%12. This means that:
On average, 14.2% of Australian cancer patients miss out on a clinically appropriate radiotherapy treatment (which is understood to be a conservative estimation);
This equates to at least around 18,000 cancer patients not receiving potentially beneficial radiotherapy treatment in 2012;
In 2022, if the current under-utilisation rate is maintained, this would equate to around 24,000 cancer patients will miss out on radiotherapy13.
The matter of access to services is dependent on multiple interrelated factors. These include patterns of referrals, level of implementation of MDTs and other factors. Nonetheless, research in the area of access to radiotherapy14 as well as anecdotal evidence from across Australia strongly suggests that the single most important barrier to access is the proximity of patients to radiation oncology services15. This observation supports the case that patient access to radiation oncology severely limits the impact of other facility level initiatives aimed at increasing productivity to improve access.
Waiting time for radiotherapy is an important quality indicator for oncology services16. Several different lines of evidence support the conclusion that a delay in initiating radiotherapy has an adverse effect on outcomes17. The risk of local cancer recurrence increases with increasing waiting times for radiotherapy. The increase in local recurrence rate translates into decreased survival in some clinical situations. Waiting times for radiotherapy treatments should be as short as reasonably achievable18.
Maximum acceptable delays in radiotherapy
|Category||Definition||Maximum Acceptable Waiting Time|
|Emergency Care||Medical emergency||24 hours|
|High Priority Care||Patients for whom delay in starting will have a significant adverse effect on outcome||14 calendar days|
|Planned Care||All others||28 calendar days|
Data from 2008 in New South Wales shows that the percentage of patients who were treated within target times improved overall: with 57% of priority one patients, 72% of priority two patients and 82% of priority three patients treated within the maximum acceptable times recommended by the Royal Australian and New Zealand College of Radiologists19. These same data can be interpreted to say that 43% of priority one patients and 28% of priority two patients were not treated within the maximum acceptable times within New South Wales in 2008.
The National Health and Hospital Reform Commission concluded in 2009 that national access targets are needed in Australia to continuously measure and report on whether people are accessing the health services they need in a timely manner. Targets for access to radiotherapy were included on the priority list and the preliminary targets were aligned with those set by the RANZCR20.
Financial impact on patients, families and carers
The financial impact of accessing cancer treatments on the patients, their families and carers can mean that the optimal treatment option is unaffordable. For remote and rural patients who may need to travel to a metropolitan centre to receive treatment and be away from home for many weeks, the financial impact can be significant and prohibitive. Their ability to access childcare, replace lost income or continue their business, access the emotional and physical support provided by family and carers, as well as fund travel and accommodation costs, can determine whether the optimal treatment option is chosen. This issue is discussed in greater detail in the Supporting Regional and Rural Access to Radiation Oncology Services section, however the quality of service provided to a patient is strongly influenced by this issue.
In the 2002 Baume Inquiry report, a recommendation was made that the Commonwealth legislation should be revised to allow out-patient radiation oncology to qualify for private health insurance. Ten years on and patients receiving radiotherapy still do not qualify for private health insurance. Financial issues that inhibit patient access to radiation oncology services have a significant impact on the quality of care offered to patients.