innovations conference 2014 dr gabriel gabriel does travel distance affect radiotherapy...

Does travel distance affectradiotherapy utilisation in NSW & ACT?

Gabriel Gabriel, MBBS, MPH, FAFPHM

Michael Barton, MBBS, MD, FRANZCR

Geoff Delaney, MBBS, MD, PhD, FRANZCR

• Calculate actual Radiotherapy utilisation (RTU) in

NSW & ACT

• Identify factors affecting RTU

• Quantify the effect of geographic variations on RTU

What is new in this study?

This is the first time ever to perform the following together:

1) Collect patient treatment data directly from all NSW & ACT radiotherapy

departments (RTD)

2) Match each RT record to all records in CCRs

3) Use GIS to

• Geocode the street address of patient residence and radiotherapy departments

• Calculate the road distance between patient residence and nearest RTD

• Determine the magnitude of cross-border treatment

• Collect/organise data from all RTDs in NSW/ACT

• Link RT data with CCRs (CHeReL)

• Geocode patient addresses & RTD

• Calculate the road distance between patients’

residence and the nearest RTD

• Analyse the data to identify factors affecting RTU

Flowchart of RT and

CCR data linkage

• 16 NSW and 1 ACT Radiotherapy Departments (RTD)

• 2 Central Cancer Registries (NSW & ACT)

• RT and CCR data were inconsistently recorded among departments/registries

• To geocode means to use a software program to convert street address into coordinates [longitude & latitude]

• GIS is a Geographic Information System that manages and presents data that are linked to one or more locations.

• GIS software is used to calculate the road distance between 2 or more coordinates

No Format Latitude Longitude

1 Decimal degrees (DD) -33.918357000 150.930010900

2Degrees and decimal minutes (DDM)

-33° 55.101420' 150° 55.800654'

3Degrees, minutes and decimal seconds (DMS)

33° 55' 6.0852" S 150° 55' 48.0392" E

Street address: 1 Campbell Street, Liverpool, NSW 2170, Australia

Example of coordinates

A map of NSW and ACT

A map of NSW and ACT showing all patients diagnosed with cancer 2004-06

A map of NSW and ACT showing patients diagnosed with cancer and patients who received RT 2004-06

John Flynn Hospital

Murray Valley RO Centre

No

rth

Ad

elai

de

On

colo

gyA map of NSW and ACT showing patients diagnosed with

cancer and patients who received RT 2004-06

A showing all patients diagnosed with cancer and patients who received RT 2004-06

Road distance between patient residence to the nearest RTD

Road distance between patient residence to the nearest RTD

NameCCR data

(NSW cancer patients who lived nearer to the

State border)

RT received in NSW

RTU for patients who received RT

in NSW/ACT

Tugun (QLD) 7,767 508 6.5%

Wodonga (VIC) 1,778 13 0.7%

Adelaide (SA) 463 2 0.4%

Total 10,008 523 5.2%

NSW Patients residing nearerto QLD, VIC and SA RTD

Comparison between actual radiotherapy utilisation in

NSW & ACT, South Australia and other countries

0%

5%

10%

15%

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25%

30%

Rad

ioth

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uti

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Distance in kilometres

Proportion of patients who received radiotherapy by distance from patient's residence to the nearest radiotherapy facility

NSW & ACT 2004-06

P<0.001

0%

5%

10%

15%

20%

25%

30%

35%

0

25

50

75

10

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15

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25

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32

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35

0

% o

f p

atie

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RT

Distance in kilometres

Radiotherapy utilisation by distance (km) showing trend line, NSW & ACT, 2004-06

Proportion of patients who received radiotherapyby distance and age group

0

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35

<50 50-69 70+

Prp

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RT

Age of patient (years)

<100km

100-199km

200-299km

300+km

0%

5%

10%

15%

20%

25%

30%

35%

40%

In-situ Localised Regionalised Distant Unknown

<100km

100-199km

200-299km

300+km

Radiotherapy utilisation by tumour stage and distance to the closest radiotherapy department, NSW & ACT 2004-06

DistanceIRSD-1

(Lowest)IRSD-2 IRSD-3 IRSD-4

IRSD-5

(Highest)Total

<100 km 29% 28% 28% 27% 22% 27%

100-199 km 22% 23% 24% 18% 36%* 23%

200-299 km 23% 20% 21% 22%

300+ km 19% 20% 19%

Total 27% 26% 28% 27% 22% 26%

*: Total number of patients in this cell is small (50 out of 21,535 for IRSD-5)

Proportion of patients who received radiotherapy by distance and index of relative socioeconomic disadvantage (IRSD)

*: Total number of patients in this cell is small (50 out of 21,535 for IRSD-5)

Proportion of patients who received radiotherapy by distance and index of relative socioeconomic disadvantage (IRSD)

0%

5%

10%

15%

20%

25%

30%

35%

40%

IRSD-1 (Lowest) IRSD-2 IRSD-3 IRSD-4 IRSD-5 (Highest)

<100 km

100-199 km

200-299 km

300+ km

*

<100 km

300+ km100-199 km

200-299 km

Survival analysis by distance to the nearest radiotherapy facility, NSW and ACT, 2004-06

1. Year of diagnosis (p=0.1)

2. Patient age group (p<0.001)

3. Patient age in years (continuous) (p<0.001)

4. Patient Gender (P<0.001): F 30% >RT M

5. Tumour stage (p=0.007)

6. Primary site of cancer

7. Travel distance (distance categories) (p<0.001)

8. Travel distance (continuous) (p<0.001)

9. Accessibility Remoteness Index of Australia (ARIA) (p<0.001)

10. Index of Relative Socioeconomic Disadvantage (IRSD) (p=0.9)

UNIVARIATE LOGISTIC REGRESSION

MULTIVARIATE LOGISTIC REGRESSION

Variable name Details P value Odds Ratio95% CI

Lower Upper

Gender Female 1.00

Male 0.000 1.19 1.14 1.25

Age groups < 50 years 0.000 2.88 2.70 3.07

50-59 years 0.000 2.83 2.67 3.01

60-69 years 0.000 2.65 2.51 2.81

70-79 years 0.000 2.25 2.13 2.38

80+ years 1.00

Distance <100 km 0.000 1.89 1.55 2.13

100-199 km 0.000 1.47 1.24 1.74

200-299 km 0.004 1.30 1.09 1.55

300+ km 1.00

Tumour Stage In-situ 0.000 0.42 0.37 0.47

Localised 0.000 0.81 0.78 0.85

Regional 0.000 1.60 1.52 1.69

Distant 0.000 1.50 1.42 1.59

Unknown 1.00

ARIA Highly Accessible 0.902 0.99 0.87 1.13

Accessible 0.586 1.06 0.91 1.17

(Moderately Accessible, Remote and Very Remote)

1.00

1) Radiotherapy utilization in NSW & ACT was low compared to optimal and other countries.

2) The study showed that the following factors predict low utilization:

a) Age

b) Gender

c) Travel distance

37

ACT

Queensland

New South Wales

South

Australia

Victoria

A map of NSW and ACT showing the location of radiotherapy departments 2004-2006

Lismore

Coffs Harbour

Tamworth

Port Macquarie

Orange

Nowra

ACT

Queensland

New South Wales

South

Australia

Victoria

A map of NSW and ACT showing the location of the new 6 radiotherapy departments

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Orange

CoffsHarbour

Lismore

Tamworth

PortMacquarie

New South Wales

ACT

Queensland

SouthAustralia

Victoria

A map of NSW and ACT showing the location of the new 6 radiotherapy departments

Proportion of cancer patients diagnosed (2004-06) by road distanceto the nearest RTD during the study period and with current RTD

<50km <99km <149km <199km <249km <299km <349km <399km 400+km

RTD: 2004-06 79% 84% 88% 91% 95% 97% 99% 99% 100%

RTD: current 83% 91% 95% 97% 99% 99% 99% 99% 100%

0%

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It is planned for this study to be repeated to look at the impact

these new departments

might have on radiotherapy utilization.

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Estimated optimal RTU Actual RTU

Comparison between estimated optimal RTU and Actual RTU in NSW & ACT 2004-06

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