Radiation therapy utilization for primary cutaneous T-cell lymphoma is lowest amongst patients living in the most geographically accessible areas; an Australian study: Disparate RT-utilization in patients with CTCL
- Author(s)
- Campbell, BA; Gabriel, G; Delaney, GP; Porceddu, SV; Smee, R; Barton, M; Prince, HM; Thursky, K;
- Journal Title
- International Journal of Radiation Oncology, Biology, Physics
- Publication Type
- Online publication before print
- Abstract
- AIMS: Cutaneous T-cell lymphomas (CTCL) are rare with increasing incidence. Most patients have skin-confined mycosis fungoides (MF): a typically indolent, highly morbid, incurable disease requiring multi-lined treatment. For these patients, radiotherapy (RT) is efficacious, well-tolerated and cost-effective; total skin electron beam therapy (TSEBT) is a specialised 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 datasets, 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: Retrospective analysis of New South Wales Cancer Registry dataset of all patients diagnosed with CTCL from 2009-2018, with data linkage to the Outpatient Radiation Oncology Database. Actual RT-utilization rates included all treatment lines, calculated per person. RESULTS: 553 patients were diagnosed with CTCL; age-standardized incidence was 7.2/million/year. Geographically, 35% resided in regional/rural local health districts (LHD); 13% in under-accessible locations; 16% >50km road-distance from the nearest RT center. RT-utilization and TSEBT-utilization rates were 29.0% and 1.8%, respectively. Variation existed between LHD, with greater RT-utilization in regional/rural over metropolitan LHD (OR 1.7, p=0.01). Patients residing in major cities had lower RT-utilization than those in inner regional areas (OR 2.1, p=0.001). Shortest road-distance to the nearest RT center did not predict for greater RT-utilization. Disparities in access to specialist services existed between LHD. Dermatologist-availability significantly predicted for diagnosis rates (R(2)=0.336, F(1-11)=5.577, p=0.038). Absence of RT facilities was associated with poor RT-utilization. CONCLUSION: Over 10 years, only 29% of patients with CTCL received RT across all treatment-lines, with significant geographically-based heterogeneity observed. Contrary to expectation, residence in major cities and proximity to RT facilities were associated with lower RT-utilization. Further advocacy is encouraged to overcome diagnostic and treatment disparities for patients with CTCL.
- Department(s)
- Radiation Oncology; Haematology; Health Services Research
- Publisher's Version
- https://doi.org/10.1016/j.ijrobp.2025.07.054
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- Refer to copyright notice on published article.
Creation Date: 2025-08-19 07:56:59
Last Modified: 2025-08-19 07:57:15