Radiotherapy in the management of high-grade gliomas diagnosed in Western Australia: a patterns of care study.

PURPOSE: Radiotherapy (RT) plays an integral role in the management of high-grade glioma (HGG). However, there is little information on the patterns of care in unselected Australian patients with HGG. PATIENT AND METHODS: This prospective cohort study collected information on patients with a diagnosis of HGG managed in Western Australia over a 25-month period from 2006 to 2008. RT treatment and survival data were analysed. RESULTS: 86% of Western Australian patients with HGG were treated at the study site over this period. Of these, 80% were reviewed by a radiation oncologist with RT recommended in 88% of cases. One hundred eighty-seven patients proceeded to have RT, with most receiving 60 Gy in 30 fractions with limited field external beam radiotherapy (LFRT). Median survival from diagnosis was 13.6 months for all patients and 15.4 months for those planned for treatment with 60 Gy in 30 fractions. The median time from surgery to the start of RT was 41 days. Longer waiting times were not predictors of poor survival. Failure to receive all planned treatment (13% of patients) predicted for poor survival (hazard ratio 0.38). CONCLUSION: Dose and fractionation practices show concordance with published data and guidelines. Survival is also consistent with clinical trial data for patients planned for aggressive therapy. Nevertheless, a substantial number of patients are not suited to aggressive therapy or fail to complete planned therapy, and these patients have poor outcomes. Treatment delays did not affect survival outcomes but are confounded by earlier treatment of those unsuited to LFRT.

The trajectory of lung cancer patients in Western Australia--a data linkage study: still a grim tale.

OBJECTIVE: To plot the trajectory of lung cancer patients by linking multiple data sources in Western Australia. DESIGN: Database survey, data linkage and postal survey. SETTING: Western Australia. PARTICIPANTS: Lung cancer patients registered on the cancer registry database of Western Australia, April 2006 to March 2007. MAIN OUTCOME MEASURES: Morbidity, mortality, and medical procedures. RESULTS: 950 lung cancer patients were registered on the cancer registry database from April 2006 to March 2007. Sixty five percent were male with a mean age at diagnosis of 70 years (SD 11 years). Approximately 30% were from regional and remote areas of Western Australia. 76% reported a history of smoking, with a mean of 41 pack-years per smoker. One in four cases had metastases at diagnosis. 18% of cases from a tertiary hospital received no active treatment. The median time from the first visit to GP with recognized cancer symptoms until consultation with a specialist was 2 weeks. One in five cases presented directly to the hospital Emergency Department. For 16% of all cases, no symptoms were recorded in the hospital administrative records at the time of presentation. Fifty-two percent of patients had chemotherapy, 49% received radiotherapy and 21% had surgery. 13% of treated patients were readmitted to hospital with complications of therapy. Median survival was 33 weeks (95% CI 30-40). CONCLUSION: Data linkage offers limited prospects for exploring the trajectory of patients with lung cancer in Western Australia. The available data indicate that the prognosis of lung cancer remains very poor and that a high proportion of patients are still diagnosed with advanced disease. There is no evidence to suggest that a greater proportion of patients are being offered surgical treatment compared to more than a decade ago. However a greater proportion of cases now receive adjuvant therapies and overall median survival has improved by a matter of weeks.