Cancer treatment and services: Radiotherapy treatment services in NSW
What is radiotherapy?
Radiotherapy is a common treatment for people with many cancers.
Most radiotherapy cancer treatment is given as external beam radiotherapy (EBRT). Radiation is produced by a machine called a linear accelerator, and given from outside the body to the area where the cancer is.
What is hypofractionated radiotherapy?
When patients have EBRT, the total dose of radiation they need is divided into a number of smaller doses, known as fractions.
Compared with non‑hypofractionated EBRT, hypofractionation uses a smaller number of fractions, each providing a slightly higher dose of radiation. This means people need fewer visits to complete their course of radiotherapy.
Radiotherapy treatment for early‑stage breast cancer
Hypofractionated radiotherapy for early‑stage breast cancer is recommended as the standard of care for the majority of women, both in Australia and internationally.[52–54] Studies have shown benefits, including improved patient choice, health outcomes and patient experience.
Studies have shown benefits, including improved patient choice, patient experience, health outcomes and better cosmesis.[52–54] Increased use of hypofractionation could also allow more people to be treated with existing radiotherapy resources.
Despite these outcomes, there is variation in the use of hypofractionation across NSW facilities and LHDs.
Radiotherapy treatment for cancer‑related bone pain
EBRT is the recommended treatment for cancer that has spread (metastasised) to the bone and was causing pain without other complications.
Long‑term evidence shows radiotherapy treatment using a single fraction (dose) is as effective as using multiple fractions for relieving bone pain for most people with pain and no complications.[55] However, for a small number of people, multiple fractions can help reduce the need for retreatment.[56]
Despite evidence supporting the use of single fractions for most people with pain from secondary spread of cancer to bones, estimates indicate most cancer centres continue to use multiple fractions to treat cancer that has spread to the bone and is causing pain.
Overall key findings:
For early‑stage breast cancer
- Across public facilities in NSW, hypofractionation was the most common radiotherapy treatment used for early‑stage breast cancer, with 73% of patients receiving this treatment between 2015 and 2018.
- Between 2015 and 2018, the use of hypofractionation varied widely across public facilities, ranging from 29% to 97% of patients.
- Patients receiving hypofractionated radiotherapy tended to be older than those receiving non‑hypofractionated treatment.
For bone metastases
- Across public facilities in NSW, multiple‑fraction radiotherapy treatments (multiple doses of a smaller amount of radiotherapy) were most commonly used to treat patients with cancer that had spread to the bone and was causing pain. Only 34% of patients received single‑fraction treatments (single doses) between 2015 and 2018.
- The use of single fractions varied widely across public facilities between 2015 and 2018, ranging from 20% to 54% of patients.
Proportion of early‑stage breast cancer* patients who received hypofractionated or non‑hypofractionated regimens of external beam radiotherapy in NSW public facilities, with median age, by selected local health districts (LHDs)** (ranked), 2015-2018
Key findings:
- In NSW public facilities, 73% of treatment for early stage breast cancer was hypofractionated radiotherapy.
- The proportion of early-stage breast cancer patients who received hypofractionated regimens ranged from 29% to 97% across LHDs, in 2015–2018.
N= Number of treatments.
* Early-stage breast cancer is defined as TNM Stage I or IIA. Refer to the 'Technical document' in the appendices for full definitions.
** LHDs with TNM staging completeness greater than 60% were reported for this indicator. 'NSW public' includes 16 out of 17 facilities. Refer to the appendices for the list of public facilities included in this indicator.
Notes:
1. Data source: NSW Outpatient Radiation Oncology Dataset. Data were extracted from the NSW Cancer Registry (NSWCR) staging database, between April and May 2019. Data available from radiotherapy source systems were incomplete for 2018.
2. Fractions were estimated using an operational definition. The programming logic to estimate fractions is complex owing to differences in the recording of treatment across individual radiotherapy centres.
3. Non-hypofractionation: Radiotherapy dose is between 1.8 and 2.0 Gy per fraction.
4. Hypofractionation: Radiotherapy dose is above 2.0 Gy per fraction.
Proportion of early‑stage breast cancer* patients receiving hypofractionated or non‑hypofractionated regimens of external beam radiotherapy in selected local health districts (LHDs)** in NSW public facilities, with median age, by facility, 2015-2018
Key finding:
Between 2015 and 2018, the proportion of patients receiving hypofractionated radiotherapy ranged from 29% to 97% in the reported NSW public cancer centres providing radiotherapy.
N= Number of treatments.
* Early-stage breast cancer is defined as TNM Stage I or IIA. Refer to the 'Technical document' in the appendices for full definitions.
** LHDs with TNM staging completeness greater than 60% were reported for this indicator. 'NSW public' includes 16 out of 17 facilities. Refer to the appendices for the list of public facilities included in this indicator.
ᴧ Mid North Coast Cancer Institute.
ᴧᴧ North Coast Cancer Institute, Lismore Cancer Care and Haematology Unit.
Notes:
1. Data source: NSW Outpatient Radiation Oncology Dataset. Data were extracted from the NSW Cancer Registry (NSWCR) staging database, between April and May 2019. Data available from radiotherapy source systems were incomplete for 2018.
2. Fractions were estimated using an operational definition. The programming logic to estimate fractions is complex owing to differences in the recording of treatment across individual radiotherapy centres.
3. Non-hypofractionation: Radiotherapy dose is between 1.8 and 2.0 Gy per fraction.
4. Hypofractionation: Radiotherapy dose is above 2.0 Gy per fraction.
Proportion of patients with bone metastases receiving single or multiple fractions of external beam radiotherapy with palliative treatment intent in NSW public facilities, with median age, by local health district (LHD) and specialty health network (ranked), 2015-2018
Key findings:
- Between 2015 and 2018, of all treatment courses provided to patients with bone metastases (cancer that has spread to the bone) with palliative intent (for pain relief) in NSW public facilities, 34% were received in a single fraction.
- The proportion of patients with bone metastases receiving a single fraction ranged from 21% to 54%, in 2015–2018.
N= Number of treatments.
Notes:
1. Data source: NSW Outpatient Radiation Oncology Dataset. Data were extracted from the NSW Cancer Registry (NSWCR) staging database, between April and May 2019. Data available from radiotherapy source systems were incomplete for 2018.
2. Fractions were estimated using an operational definition. The programming logic to estimate fractions is complex owing to differences in the recording of treatment between individual radiotherapy centres.
3. New centres and closures in the reporting period: St Vincent's Hospital services transitioned to St Vincent's Private Hospital in August 2015; and Blacktown Cancer and Haematology Centre became operational in April 2016.
4. Bone metastases: Cancer invasion of the bone from another part of the body.
5.Palliative treatment: Given primarily for the purpose of pain relief or other symptom control.
Proportion of patients with bone metastases receiving single or multiple fractions of external beam radiotherapy with palliative treatment intent in NSW public facilities, with median age, by facility (ranked), 2015-2018
Key finding:
- Between 2015 and 2018, the use of single fraction radiotherapy for bone metastases varied widely across the reported NSW public cancer centres ranging from 20% to 54% of patients.
N= Number of treatments.
* Mid North Coast Cancer Institute.
** North Coast Cancer Institute, Lismore Cancer Care and Haematology Unit.
Notes:
1. Data source: NSW Outpatient Radiation Oncology Dataset. Data were extracted from the NSW Cancer Registry (NSWCR) staging database, between April and May 2019. Data available from radiotherapy source systems were incomplete for 2018.
2. Fractions were estimated using an operational definition. The programming logic to estimate fractions is complex owing to differences in the recording of treatment between individual radiotherapy centres.
3. New centres and closures in the reporting period: St Vincent's Hospital services transitioned to St Vincent's Private Hospital in August 2015; and Blacktown Cancer and Haematology Centre became operational in April 2016.
4. Bone metastases: Cancer invasion of the bone from another part of the body.
5. Palliative treatment: Given primarily for the purpose of pain relief or other symptom control.
Why are different time periods and dates reported?
Cancer information is collected from many different sources, so it takes time to review and analyse the data. Different pieces of information may be collected over different time periods, or reported at different times. This means not all the measures reported here have the same dates.
The information presented is the most recent available for each measure at the time this report was written.
Why are confidence intervals reported here?
Confidence intervals are included when a small sample is used to represent the overall population, because there is a chance of an error due to this scaling.
In this report, a 95% confidence interval is presented only on charts where a sample of the population is used. This interval can be thought of as a margin of error.
The larger the sample size, the smaller the confidence interval range. The smaller the sample size, the larger the confidence interval range.