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Radiation Therapy Utilization for Primary Cutaneous T-Cell Lymphoma Is Lowest Among Patients Living in the Most
Belinda A Campbell1, Gabriel Gabriel2, Geoff P Delaney3
1Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia; Department of Clinical Pathology, University of Melbourne, Parkville, Victoria, Australia.
Purpose:
Cutaneous T-cell lymphomas (CTCL) are rare with increasing incidence. Most patients have skin-confined mycosis fungoides: a typically indolent, highly morbid, incurable disease requiring multi-lined treatment. For these patients, radiation therapy (RT) is efficacious, well-tolerated, and cost-effective; total skin electron beam therapy (TSEBT) is a specialized technique with proven quality-of-life benefits. Consensus on optimal treatment sequencing is lacking, creating heterogeneity in care. International data suggest declining RT-utilization. Using a state-wide, population-based, Australian cancer registry with linked data sets, we investigated RT-utilization for CTCL, examining for geographically based disparities. Correlations between dermatologist-availability and linac-density on incidence and RT-utilization rates were also explored.
Methods And Materials:
Retrospective analysis of New South Wales Cancer Registry data set of all patients diagnosed with CTCL from 2009 to 2018, with data linkage to the Outpatient Radiation Oncology Database. Actual RT-utilization rates included all treatment lines, calculated per person.
Results:
A total of 553 patients were diagnosed with CTCL; age-standardized incidence was 7.19/million/year. Geographically, 35% resided in regional/rural local health districts (LHDs); 13% in underaccessible locations; 15% >50 km road distance from the nearest RT center. RT-utilization and TSEBT-utilization rates were 29.0% and 1.8%, respectively. Variation existed between LHDs, with greater RT-utilization in regional/rural over metropolitan LHDs (odds ratio: 1.66; P = .01). Patients residing in major cities had lower RT-utilization than those in inner regional areas (odds ratio: 2.12; P = .001). Shortest road distance to the nearest RT center did not predict for greater RT-utilization. Disparities in access to specialist services existed between LHDs. Dermatologist-availability significantly predicted for diagnosis rates (R2 = 0.34; F(1,11) = 5.58; P = .04). The absence of RT facilities was associated with poor RT-utilization rates.
Conclusions:
Over 10 years, only 29% of patients with CTCL received RT across all treatment lines, with significant geographic-based heterogeneity observed. Contrary to expectation, residence in major cities and proximity to RT facilities were associated with lower RT-utilization rates. Further advocacy is encouraged to overcome diagnostic and treatment disparities for patients with CTCL.
