DAta Linkage to Enhance Cancer Care (DaLECC): Protocol of a Large Australian Data Linkage Study.

Cancer is a leading cause of global morbidity and mortality, accounting for 250 Disability-Adjusted Life Years and 10 million deaths in 2019. Minimising unwarranted variation and ensuring appropriate cost-effective treatment across primary and tertiary care to improve health outcomes is a key health priority. There are few studies that have used linked data to explore healthcare utilisation prior to diagnosis in addition to post-diagnosis patterns of care. This protocol outlines the aims of the DaLECC project and key methodological features of the linked dataset. The primary aim of this project is to explore predictors of variations in pre- and post-cancer diagnosis care, and to explore the economic and health impact of any variation. The cohort of patients includes all South Australian residents diagnosed with cancer between 2011 and 2020, who were recorded on the South Australian Cancer Registry. These cancer registry records are being linked with state and national healthcare databases to capture health service utilisation and costs for a minimum of one-year prior to diagnosis and to a maximum of 10 years post-diagnosis. Healthcare utilisation includes state databases for inpatient separations and emergency department presentations and national databases for Medicare services and pharmaceuticals. Our results will identify barriers to timely receipt of care, estimate the impact of variations in the use of health care, and provide evidence to support interventions to improve health outcomes to inform national and local decisions to enhance the access and uptake of health care services.

What is multidisciplinary cancer care like in practice? a protocol for a mixed-method study to characterise ambulatory oncology services in the Australian public sector.

INTRODUCTION: An understanding of the real-world provision of oncology outpatient services can help maintain service quality in the face of escalating demand and tight budgets, by informing the design of interventions that improve the effectiveness or efficiency of provision. The aims of this study are threefold. First, to develop an understanding of cancer services in outpatient clinics by characterising the organisation and practice of multidisciplinary care (MDC). Second, to explore the key areas of: (a) clinical decision-making and (b) engagement with patients' supportive needs. Third, to identify barriers to, and facilitators of, the delivery of quality care in these settings. METHODS AND ANALYSIS: A suite of mixed-methods studies will be implemented at six hospitals providing cancer outpatient clinics, with a staged roll-out. In Stage One, we will examine policies, use unstructured observations and undertake interviews with key health professionals to characterise the organisation and delivery of MDC. In Stage Two, observations of practice will continue, to deepen our understanding, and to inform two focused studies. The first will explore decision-making practices and the second will examine how staff engage with patients' needs; both studies involve interviews, to complement observation. As part of the study of supportive care, we will examine the implications of an introduction of patient-reported measures (PRMs) into care, adding surveys to interviews before and after PRMs roll-out. Data analysis will account for site-specific and cross-site issues using an adapted Qualitative Rapid Appraisal, Rigorous Analysis approach. Quantitative data from clinician surveys will be statistically analysed and triangulated with the related qualitative study findings. ETHICS AND DISSEMINATION: Ethical approval was granted by South Eastern Sydney Local Health District Human Research Ethics Committee (no. 18/207). Findings will be shared with participating hospitals and widely disseminated through publications and presentations.

Testing criterion-based benchmarking for the appropriate use of radiotherapy.

INTRODUCTION: Planning for radiotherapy (RT) services requires information on the proportion of patients who should be given radiotherapy. Criterion-Based Benchmark (CBB) has been proposed in Canada to estimate the proportion of cancer patients who should be treated with radiotherapy. The aim of this study was to assess CBB in a health system outside of Canada. METHODS: Radiotherapy data for all new cases of cancer in New South Wales (NSW), and the Australian Capital Territory (ACT) Australia in 2004-06 and were linked to Central Cancer Registry records. Road distances between patient residence and the nearest RT centre were calculated. Local Government Areas (LGAs) with public radiotherapy departments were selected as CBB LGAs if they met the following criteria: 1. Patients make no direct payment for radiotherapy. 2. All RT is provided by site-specialised radiation oncologists in multi-disciplinary centres. 3. Radiation oncologists receive salary for their service. 4. More than 75% of patients live within 30 km from the nearest RT, and 5. Patients' waiting times were <4 weeks. RESULTS: 25,383 (26%) out of 98,000 eligible patients in NSW and ACT received radiotherapy in the study period as part of their initial treatment. An average of 31% of patients in the CBB LGAs received radiotherapy compared to an average of 26% in all LGAs during the study period. DISCUSSION: NSW-ACT RT utilisation for selected tumour sites was 7-16% higher in the CBB LGAs than in all LGAs, but was still 30-65% below the estimated optimal radiotherapy utilisation rates and differed significantly from Canadian CBBs. CBB is based on the assumption that there is perfect service delivery in some parts of the health service that can be used to benchmark the whole service. It may be applicable in well-resourced publicly-funded services in Canada, but the CBB approach may not be reproducible in other jurisdictions.