Does travel time for SABR treatment, impact upon the management of early-stage inoperable NSCLC?

Abstract

Introduction: SABR for early lung cancer is the standard of care for patients unsuitable for surgery. SABR is not commissioned in 30% of English radiotherapy centres [1]. Compared to the Netherlands, numbers of patients who receive suboptimal conventional radiotherapy or no treatment (26% vs 9%) are unacceptably high [2]. This could be related to excess patient travel-time to a SABR centre [3]. The aim of this study is to simulate demand for lung SABR in England, based on aspirational Dutch treatment rates, and compare this to the provision of SABR and the relationship to patient traveltime. Methods: The Malthus model (a local-level radiotherapy demand prediction tool) [4] was used to simulate current SABR treatment at a local-level using 2015–2016 English SABR treatment rates (12%) [2].This was then repeated based on Dutch treatment rates (41%) and mapped against English radiotherapy centres identified as SABR or non-SABR centres. 45min travel-time isochrones based on SABR centre postcodes were then generated. Results: There is an imbalance of lung SABR provision. For large parts of England (e.g. the South West and North West) patients are located over 45 minutes from a SABR centre (Fig. 1). If England matched Dutch treatment rates, patient numbers with a travel-time over 45 minutes would greatly increase. Overall, patient numbers could increase from ~725 to ~2500 patients/year. Conclusion: Geographical disparity of lung SABR services exists in England. This will subject some patients, who are typically elderly with multiple co-morbidities, to long travel-times. This may contribute to high rates of suboptimal radiotherapy or no treatment in England. Improvements in SABR provision and commissioning are urgently needed to address this.