Two in Three Patients with Curable Rectal Cancer Not Referred for Radiotherapy

A study of patients with curable rectal cancer has found that only 35 per cent are being referred for radiotherapy, even though it has been proven to reduce local recurrence of the disease.

The study found that surgeons who saw low numbers of patients with rectal cancer were much less likely to refer patients for radiotherapy than surgeons treating high numbers of patients.Commenting on the study, published online in the Asia Pacific Journal of Clinical Oncology, the Clinical Oncological Society of Australia (COSA) said today it was concerned the poor referral rate meant many patients were missing out on vital treatment that could prevent their cancer returning following surgery. “More than 4000 Australians are diagnosed with rectal cancer each year and more than 1300 die from the disease,” said COSA President Professor David Goldstein. “We know radiotherapy can prevent local recurrence, but patients who should be getting the treatment may be missing out because they are not being referred.”Lead author Dr Fiona Hegi-Johnson, said the study showed referrals by surgeons for either pre-operative or post-operative radiotherapy varied depending on the number of cases they managed. “While surgeons with high numbers of patients refer significantly more for radiotherapy, it is a different story for surgeons who treat small numbers, of which there are many in Australia,” said Dr Hegi-Johnson. “Surgeons treating less than four cases a year refer just 23 per cent of patients, compared to surgeons treating 20 or more cases who refer 41 per cent of patients. We also found that patients over 70 years of age were only half as likely to receive radiotherapy treatment as those under 70.”The study, which covered the South-Western, Wentworth and Western Area Health Services, assessed patients with a curable diagnosis of rectal cancer. The area is home to 9.4 per cent of the Australian population.Professor Goldstein said that while the problem was serious, the study used data from 2001 and further research was required to validate the current level of referral. “There may be a need to better inform surgeons, particularly those with small numbers of patients with rectal cancer,” he said. “If we are seeing such a low referral rate in urban areas, it is important to investigate this in regional and rural areas where there are fewer specialist colorectal surgeons.” “It is also concerning that a significant number of patients over the age of 70 aren’t getting radiotherapy. We aren’t sure exactly why – it may be under caution on behalf of surgeons – but the evidence clearly shows people over 70 can tolerate radiotherapy.”(Source: Clinical Oncological Society of Australia : June 2007)