Despite evidence of the benefits of radiotherapy (RT) in the treatment of cancer patients, its underutilisation has been reported for various tumour sites. The aim of this study was to estimate survival shortfall, ‘years of potential life lost’ (YPLL) and ‘disability-adjusted life years’ (DALY) to demonstrate the impact of radiotherapy underutilisation in Australia.
Methods and Materials:
Optimal and actual RT utilisation (RTU) was compared to assess RT underutilisation to estimate 5-year overall survival shortfall using 2006 data from NSW. 5-year overall survival shortfall is defined as number of people not surviving for 5-years due to RT underutilisation [calculated as benefit proportion X shortfall (optimal-actual RTU) proportion X no. of new cases]. This was assessed for 26 common tumour sites. YPLL = survival shortfall X estimated life lost per person (overall life expectancy – median age at death for specific cancer). DALY = (Years lived with disability + Years of life lost) X survival shortfall.
The total number of new cases with cancer in 2006 in NSW was 20,741. Optimal RTU was 52% while actual RTU was 24%, resulting in estimated of 261 deaths due to underutilisation. It was estimated RT underutilisation resulted in a total of 2,910 YPLL and 4,584 DALY overall. Each death due to underutilization of radiotherapy resulted in an average of 11.1 YPLL and 17.6 DALY.
Using the YPLL and DALY parameters to estimate population burden from RT underutilisation has added value in demonstrating the effect on the population for overall and individual tumour sites that RT underutilization has. This study illustrates the value of considering different mortality and disability statistics, which include measures of the burden of cancer deaths on the population. Key area for further research includes health economic analysis and impact of RT underutilisation on productivity cost.