Volume 195 - Issue 11
Distance to the closest radiotherapy facility and survival after a diagnosis of rectal cancer in Queensland
Authors: Sean A Bydder and Nigel A Spry
Med J Aust 2011; 195 (11): 661-662. || doi: 10.5694/mja11.11271
Published online: 12 December 2011
Published online: 12 December 2011
To the Editor: We find ourselves in the curious position of criticising an article that supports improving access to radiotherapy. Baade and colleagues looked at cause-specific survival in all patients aged 20–79 years diagnosed with rectal cancer in Queensland.1 They found a 6% increase in cause-specific mortality risk for each 100 km increment in distance from the nearest radiotherapy facility. They concluded that the apparent poorer outcomes were due to a failure to receive radiotherapy.
However, we suggest that their approach was significantly flawed in a number of ways. We have difficulty in understanding why, when information about the use of radiotherapy is available, this key explanatory factor was not actually measured. The size of the benefit they attribute to greater use of radiotherapy exceeds the expected improvements attributable to adjuvant radiotherapy compared with none at all.2 The authors state that pathological staging, another factor central to their analysis, is a reliable surrogate for clinical staging. However, they appear not to have made any allowance for the fact that neoadjuvant treatment leads to pathological down-staging. Finally, the main outcome, cause-specific survival, was taken from death certificates and is likely to be inaccurate.
Use of radiotherapy is suboptimal in Australia.3 If the authors could identify the impact of distance on access to radiotherapy, this would be very valuable for cancer service planning. Clinical input is desirable in future investigations in this area.
Competing interests
No relevant disclosures.
References
- Baade PD, Dasgupta P, Aitken JF, Turrell G. Distance to the closest radiotherapy facility and survival after a diagnosis of rectal cancer in Queensland. Med J Aust 2011; 195: 350-354. 0_CHDBGGEA
- Wong RK, Tandan V, De Silva S, Figueredo A. Pre-operative radiotherapy and curative surgery for the management of localized rectal carcinoma. Cochrane Database Syst Rev 2007; (2): CD002102. 0_i1142862
- Morgan G. Why has radiotherapy utilisation not improved since 1999? J Med Imaging Radiat Oncol 2011; 55: 347-350. 0_i1142865