NTCN Radiotherapy provision and equity of access

1. NTCN Radiotherapy provision and equity of access David Meechan Carolynn Gildea Trent Cancer Registry

2. Overview Preliminary results from RCIG/NATCANSAT on radiotherapy uptake by cancer network Latest results from Trent Cancer Registry analysis of inequalities in RT treatment rates within N Trent (lung, rectal & breast)

3. RT Attendances per million pop by network 2009/10 (Source RCIG/NATCANSAT)

4. Unadjusted Cancer Incidence per 100,000 population by Cancer Network 2008 (Source NATCANSAT)

5. Radiotherapy attendances per thousand cancer incident cases (source: NATCANSAT)

6. Radiotherapy Attendances per Patient (Source: NATCANSAT)

7. Radiotherapy Patients per thousand cancer incident cases (Source: NATCANSAT)

8. Breast Cancer Radiotherapy Patients per thousand Breast Cancer Incident Cases (source: NATCANSAT)

9. Summary Comparisons (source: NATCANSAT)

10. Treatment Inequalities Work – Radiotherapy 2007 diagnosed patients Non-small cell lung, rectal and breast cancer Include radiotherapy within 12 months of diagnosis Percentage of tumours receiving radiotherapy Adjusted for multiple factors, including stage, age, deprivation, co-morbidities etc.

11. Stage NSCLC – radiotherapy variations with stage

12. Co-Morbidity Patients with multiple or more serious co-morbidities less likely to receive radiotherapy

13. Deprivation For radiotherapy, no statistically significant differences with deprivation

14. Travel Time NSCLC and Breast – radiotherapy less likely for patients living further from WPH

15. Age Radiotherapy less likely for elderly patients (particularly those aged 70+)

16. Ethnicity NSCLC and Breast - patients with from non-white ethnic groups less likely to receive radiotherapy

17. Sex Radiotherapy less likely for female rectal cancer

18. Conclusions • Apparent low uptake of RT in N Trent compared with other networks • Initial evidence of lower RT treatment rates for: • older patients • those with co-morbidities • female patients • those living further away from Weston Park • No evidence of differences in RT treatment rates between deprivation groups

19. Modelling Future Radiotherapy Provision in NTCN David Meechan, John Langley, Stuart Gray, TrCR/EMPHO

20. Please note These models are based on (sometimes unrealistic) assumptions (eg patients will be treated at the centre to which they can travel to most quickly) They won’t tell you where to locate additional linacs But they should help inform your decision

21. Stage NSCLC – radiotherapy variations with stage

22. Co-Morbidity Patients with multiple or more serious co-morbidities less likely to receive radiotherapy

23. Deprivation For radiotherapy, no statistically significant differences with deprivation

24. Travel Time NSCLC and Breast – radiotherapy less likely for patients living further from WPH

25. Age Radiotherapy less likely for elderly patients (particularly those aged 70+)

26. Ethnicity NSCLC and Breast - patients with from non-white ethnic groups less likely to receive radiotherapy

27. Sex Radiotherapy less likely for female rectal cancer

28. Conclusions • Apparent low uptake of RT in N Trent compared with other networks • Initial evidence of lower RT treatment rates for: • older patients • those with co-morbidities • female patients • those living further away from Weston Park • No evidence of differences in RT treatment rates between deprivation groups

29. Modelling Future Radiotherapy Provision in NTCN David Meechan, John Langley, Stuart Gray, TrCR/EMPHO

30. Please note These models are based on (sometimes unrealistic) assumptions (eg patients will be treated at the centre to which they can travel to most quickly) They won’t tell you where to locate additional linacs But they should help inform your decision