PQA 02 - Pediatric Cancer, Sarcoma and Cutaneous Tumors, Medical Education & Professional Development, and Health Services Research
Presenter(s)
A. O’Donovan1, A. Brennan2, E. D. Rodrigues Pinto3, R. Joyce4, A. U. Flavin5, B. McClean6, P. Mackenzie7, A. Horgan8, A. Lavan9, and A. Barry10; 1Trinity College Dublin, Dublin, Ireland, 2National Cancer Registry of Ireland, Cork, Ireland, 3Universidade do Porto, Porto, Portugal, 4University Hospital Galway, Galway, Ireland, 5Cork University Hospital, Cork, Ireland, 6St. Luke’s Radiation Oncology Network, Dublin, Ireland, 7FRANZCR, The University of Queensland, The Royal Brisbane and Women's Hospital, Brisbane, Australia, Brisbane, Ireland, 8University Hospital Waterford and National Cancer Control Programme, Waterford, Ireland, 9St James's Hospital and National Cancer Control Programme, Dublin, Ireland, 10University College Cork, Cork, Ireland
Purpose/Objective(s):
Radiotherapy (RT) is a core component of cancer care, with evidence-based models demonstrating that approximately 50% of cancer patients have an indication for RT. Underutilisation may adversely affect outcomes, particularly in older adults who represent a growing proportion of cancer patients. National RT utilisation (RTU) in Ireland was quantified, age-related disparities were evaluated, and observed utilisation was benchmarked against evidence-based optimal utilisation estimates.
Materials/Methods:
All invasive cancers diagnosed in Ireland between 2018 and 2022 were analysed using National Cancer Registry Ireland data. RTU was defined as receipt of RT within 12 months of diagnosis (primary course), whereas optimal utilisation benchmarks reflect lifetime indications. Utilisation was analysed by age (=70 vs <70 years), cancer site, and stage. Multivariable logistic regression using weighted aggregated data assessed the independent association between age and RT receipt, adjusting for site, stage, and sex.
Results:
Among 123,750 cancers diagnosed, 39,184 received RT (RTU 31.7%), substantially below optimal utilisation (~48–52%). Older patients (=70 years) had significantly lower RTU than younger patients (26.1% vs 36.2%). After adjustment for site, stage and sex, RT use declined markedly with advancing age (age 80–84: OR 0.57, 95% CI 0.53–0.61; =85: OR 0.23, 95% CI 0.21–0.25 vs <70). Large age-related disparities (=70 vs <70 years) in observed RTU were found in the following sites: brain (43.6% vs 75.6%), breast (52.5% vs 76.9%), head and neck (57.4% vs 73.4%), and lung cancer (31.8% vs 42.6%). Observed utilisation was also substantially below optimal utilisation benchmarks, including lung (36.4% vs 77%), prostate (32.6% vs 58%), and lymphoma (17.4% vs 73%).
Conclusion:
This national analysis demonstrates substantial underutilisation of radiotherapy in Ireland relative to evidence-based benchmarks, with disproportionately lower use in older adults independent of cancer site and stage. These findings identify potential inequities in access to radiotherapy at a population level. Addressing barriers to RT delivery in older patients represents an important opportunity to improve equity and optimise cancer care delivery
