Session Item

Cancer services in Australia and radiotherapy specifically prioritize access, safety and quality for all patients, and where possible, care close to home. Ongoing expansion of treatment facilities, combined with pre-existing referral pathways, are key enablers to meeting this need across vast geographical expanses. At the height of the COVID-19 pandemic in 2020, jurisdictional government enforced restrictions were imposed to limit disease transmission in Victoria, Australia. Restrictions included significant barriers on movement in and out of regional Victoria into metropolitan Melbourne- often a necessity to meet complex radiotherapy needs. The restrictions only allowed essential, permitted travel to traverse the physical greater Melbourne boundary. The aim of this review was to investigate recent Victorian radiotherapy patient pathways and determine the impact (if any) of pandemic restrictions on radiotherapy referrals.

All patients treated with radiotherapy in Victoria from January 2018 to December 2020 were included in this analysis. Each radiotherapy department was classified as metropolitan or regional, according to the metropolitan Melbourne geographical boundary. Patients were categorized into geographic rings (10km, 25km, 50km, 75km, 100km, 150+km) from the radiotherapy department where they received their care. Anatomical treatment site for each patient was also captured to assess disease-specific referral impact.

Between January 2018 and December 2020, 60,930 patients received radiotherapy in Victoria. Treatment <50km from place of residence occurred in 79.7% (2018), 80.2% (2019) and 82.7% (2020) of patients. While in parallel, treatment >150km from home was seen in 6.8% (2018), 6.2% (2019) and 4.9% (2020) of patients. In metropolitan radiotherapy departments, treatment >150km from home decreased from 7.0% (2018) and 6.3% (2019), to 4.7% (2020). Comparatively, regional patients traveling >150km for radiotherapy remained relatively stable (2018: 6.4%; 2019: 6.1%; 2020: 6.2%). Metropolitan radiotherapy declined 8.6%, 2.7%, 9.5%, 12.2% and 9.9% for breast, lung, brain, lower GI and head and neck radiotherapy courses from 2019 to 2020, respectively. Regional providers experienced mixed referral pathway fluctuations in the same cohorts (breast: -3.7%; lung: +6.7%; brain: +19.0%; lower GI: 0.6%; head and neck: +13.4%). These findings are indicative of the heightened movement restrictions and physical boundary that were put in place in metropolitan Melbourne, compared to regional Victoria.

Pandemic restrictions had varying impacts on Victorian radiotherapy patients accessing treatment in 2020. Further investigation is required to understand the decreased travel to metropolitan radiotherapy hubs from regional Victoria, and whether adopted pathways are sustainable long term to enable treatment closer to home, where possible, without compromising optimal cancer care.