Palliative radiotherapy fractionation schedules prescribed are dependent on the distance a patient travels to receive treatment

Geographical distance and reduced access to palliative radiotherapy: systematic review and meta-analysis

“…The majority of studies focusing on utilisation of PRT (online supplemental table 1) identified an association between living further away from a radiotherapy centre and being less likely to receive PRT,6 18 19 22–27 35 with the exception of only one study, which did not find an association 32. When comparing the utilisation of SF versus MF (table 2), all but one study17 identified an association with patients living further away from the radiotherapy centre and being more likely to receive SF 20 21 28–30 34 36…”

“…The studies were all from Global North countries despite the study team not imposing any restrictions on healthcare system or country in the searches. These included 11 studies from Canada,6 18–27 four studies from the USA,28–32 one from Australia,33 two from Norway34 35 and one from France 17. This represented a mixture of healthcare systems from the free at the point of use systems in Canada, Norway and Australia to a mixture of insurance and non-insurance-based healthcare systems in the USA and France.…”

“…The end point of the journey was described as the nearest radiotherapy centre, the centre attended,31 the reporting facility28 29 and the cancer centre most frequently visited by patients in the same census subdivision 27 35. The calculation of distance and travel time using these origins and destination also varied across the studies with some using straight line distance ‘as the crow flies’,22–24 27 29 road distance17–21 24 26 28 30–36 and travel time 6 25. All studies with the exception of Laugsand et al 34 (who included travel distance as a continuous variable) split the calculated travel distances and times into categories.…”

“…Evidence of different travel thresholds, beyond which it becomes less likely to receive treatment or the type of treatment changes emerged from the review. Barnes et al 21 identified evidence that as patients lived further from the radiotherapy centre they were more likely to receive SF PRT, but for those travelling the furthest distance (>200 km), this association started to break down and patients were increasingly likely to receive MF PRT as they may travel and stay to receive the MF rather than making individual trips. Asli et al 35 also found that patients living in the furthest distances from the treatment centre (>800 km) had higher odds of receiving PRT (compared with patients living 0-9.9 km away) than those closer to the radiotherapy centre.…”

Short-Course 2-Dimensional Radiation Therapy in the Palliative Treatment of Esophageal Cancer in a Developing Country: A Phase II Study (Sharon Project)

“…Compared with radical RT schedules delivered over several weeks, palliative RT is usually completed in only a few treatment days. 16 In the literature, several RT schedules (30 Gy in 10 daily fractions or 20 Gy in 5 daily fractions) for ECa palliation have been reported. 6,17,18 From a radiobiologic perspective, an accelerated hypofractionated schedule delivering a high RT dose per fraction, twice-a-day (bid), could achieve a faster relief of symptoms compared with the usual schedules.…”