Utilisation patterns of radiotherapy among older patients: Insights from Portuguese National Cancer Registry data

Radiation therapy (RT) will be required by millions of those aged 70 or older by 2040 based on European growth in cancer incidence among this age group.

This study evaluates the use of external radiotherapy (EBRT) using data from the Portuguese National Cancer Registry (RON), analysing various cancer locations and age groups. A comparative analysis was conducted between actual EBRT utilization and comorbidity-adjusted optimal rates.

Based on RON's data, cancer diagnoses from January to June 2018 were analysed. Optimal Utilization Proportions (OUP) of EBRT were obtained from European SocieTy for Radiotherapy and Oncology (ESTRO), Health Economics in Radiation Oncology (HERO) project. Actual utilization percentages (AUP) were calculated using national cancer registry data, and a comparative analysis adjusting for comorbidities was conducted.

For most cancer locations and age groups, the actual EBRT utilisation fell below the ESTRO-HERO recommendations, with potential untreated patients estimated at 22 % of all new cancer cases across all age groups. Disparities were observed for older patients, such as breast cancer EBRT actual utilisation declining from 68 % to 25 % for patients aged under 70 and 85 or older, respectively. Also, cervix cancer patients aged 75 or older exhibited nearly 100 % optimal EBRT utilisation. Conversely, older patients with bladder and colon cancer had significantly lower RT actual utilisation rates. Comorbidity-adjusted EBRT utilisation rates for lung, rectal, cervix, and breast cancers in patients aged 70-79 did not reached ESTRO-HERO task force recommended rates. The actual EBRT usage in Portugal failed to meet the comorbidity-adjusted optimal utilisation rate for all cancer locations and age groups. Nevertheless, Portuguese actual EBRT for rectal and prostate cancer, exceeded the actual rates in Australian cohort.

While EBRT is essential for older adults with cancer, disparities and suboptimal utilization highlight opportunities for improving cancer care provision.