Key selected surgical pocedures for cancer treatment - admitted patients
Trends between 2010 and 2015
Breast cancer
The following analysis presents information on key selected surgical procedures for breast cancer provided in Australian hospitals for females only. For males, the number of separations was unchanged between 2010 and 2015, from 129 to 131 separations. Data for breast cancer related separations for males are not available for procedure type, remoteness, and SES areas due to small numbers.
Breast cancer (female) surgical removal procedures
All separations:
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The number of hospital separations for the key selected surgical procedures related to breast cancer increased annually between 2010 and 2015.
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The number of separations increased overall by15% (from 16,762 to 19,246) between 2010 and 2015.
Procedure types:
During the period 2010 to 2015, the proportion of all breast cancer related hospital separations varied for each procedure group:
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“Breast excision” surgical procedures, was the most common procedure group.
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Between 2010 and 2015, the proportion of separations was relatively consistent from 51% to 53% of all separations (from 8,576 to 10,234 separations).
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Around one in ten separations were for “Breast re-excision” surgical procedures.
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Between 2010 and 2015, the proportion of breast re-excision separations was unchanged comprising 12% of all separations (from 2,012 to 2,292 separations).
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Around one third of separations were for mastectomies:
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The proportion of annual separations for “Simple mastectomy” procedures decreased from 34% to 29% of all separations (5,691 to 5,579);
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The proportion annual separations for “Subcutaneous mastectomy” procedures increased from 3% to 6% of all separations (492 to 1,141 respectively).
Age:
During the period 2010 to 2015, the proportion of hospital separations related to age group varied:
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In 2010, females aged 60-64 years accounted for the highest proportion of annual separations (15%; 2,529 separations) while in 2015 the highest proportion was in the 65-69 year age group (15%; 2,866).
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A comparison of the age distribution of breast cancer-related hospital separations and incidence of breast cancer showed that the distribution of separations was consistent with that of incidence for each age group.
In Australia, screening for breast cancer commences at 50 years of age, with the Australian Government providing free mammograms every two years to all women aged between 50 and 74 years through the BreastScreen Australia program.
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Females aged 50 years and older accounted for approximately three quarters of all separations. This proportion increased over time from 76% (12,723 separations) to 79% (15,178) in 2010 and 2015, respectively.
Remoteness area of residence:
During the period 2010 to 2015, the distribution of hospital separations by remoteness area of residence remained relatively consistent:
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The majority of separations were for females living in the Major Cities with 11,433 separations (68%) and 13,302 separations (69%) in 2010 and 2015, respectively.
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Almost a third of separations were for females living in Inner/Outer Regional areas (29-30%), with 30% in both 2010 and 2015 (5,047 and 5,668 separations, respectively).
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Approximately 1-2% of separations were for females living in Remote/Very Remote areas; with 251 separations (1.5%) and 233 separations (1.2%) in 2010 and 2015, respectively.
Comparison of remoteness distributions for breast cancer-related hospital separations and breast cancer incidence showed that the distribution of separations was consistent with the distribution of breast cancer incidence among the remoteness categories.
Socioeconomic status:
During the period 2010 to 2015, the proportion of hospital separations related to each socioeconomic status (SES) area has remained relatively consistent:
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Approximately 22% of separations were for the females living in the highest SES areas (SES 5) across this time period, from 3,725 to 4,239 separations in 2010 to 2015 respectively.
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The proportion of separations for females living in the other SES areas (SES 1-4) were similar in each group ranging from19-20% of all separations (from 3,002 to 3,883 separations) across these groups.
A comparison of SES areas distributions for breast cancer-related hospital separations and breast cancer incidence showed that the distribution of separations was consistent with the distribution of incidence among the SES areas.
Breast cancer-related (female) lymph node removal
The following analysis presents information on the number of hospital separations for lymph node procedures provided in Australian hospitals with a principal diagnosis of breast cancer (C50). For breast cancer-related lymph node procedures, 2 key procedure groups were examined:
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“Sentinel Lymph Node Biopsy” (SLNB) procedures, and
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“Excision of lymph node of axilla” procedures (including excision as well as regional and radical excision procedure types).
The number of hospital separations for these lymph node procedures, where breast cancer was indicated as the principal diagnosis:
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Increased annually between 2010 and 2014 (from 15,131 to 17,788 separations) and decreased in 2015 (17,574 separations).
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The overall change was an increase of 16% between 2010 and 2015.
During the period 2010 to 2015, the proportion of hospital separations related to these procedure groups varied:
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The proportion of separations for SLNB procedures increased from 61% to 71% of all breast-cancer related lymph node surgical procedures (from 9,229 to 12,436) in 2010 and 2015, respectively.
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There was a corresponding decrease in the proportion of separations for “Excision of lymph node of axilla” procedures from 39% to 29% of all breast-cancer related lymph node surgical procedures (from 5,902 to 5,138) in 2010 and 2015, respectively.
Colorectal cancer
All separations:
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The number of hospital separations for the key selected surgical procedures related to colorectal cancer increased between 2010 and 2011 and then decreased annually from 2012 to 2015.
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The number of separations overall decreased slightly by 1.6% (from 12,053 to 11,863 separations) between 2010 and 2015.
Procedure types:
During the period 2010 to 2015, the proportion of all colorectal cancer related hospital separations varied for each procedure group:
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“Hemicolectomies” was the most common procedure group.
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The proportion of annual separations for these procedures ranged between 43-48% of all separations over this time period;
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Between 2010 and 2015, the proportion increased from 43% to 47% of all separations (from 5,202 to 5,609 separations, respectively).
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The proportion of annual separations for these procedures was higher in females (between 50-55%) than males (37-42%).
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Around one third of separations were for “Anterior rectal resections”
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The proportion of annual separations for these procedures ranged between 35-37% of all separations over this time period;
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Between 2010 and 2015, the proportion decreased from 37% to 35% of all separations (from 4,420 to 4,162 separations).
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The proportion of annual separations for these procedures was higher in males (between 38-41%) than females (30-31%).
Age and Sex:
During the period 2010 to 2015, the proportion of all hospital separations related to age group and sex varied:
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The proportion of annual separations was consistently higher for males (between 55-56%) than females (between 44-46%).
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The number of separations:
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Was consistent between 2010 and 2011 for males from 6,701 to 6,711 separations, and increased by 3% for females from 5,352 to 5,531;
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Was consistent between 2010 and 2015 for females between 5,352 and 5,326 separations and decreased for males by 2%; from 6,701 to 6,537 separations).
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The highest proportion of separations by age was in the age group 75 years and over for both sexes. The proportion for this age group was approximately 40% of annual female separations and ranged between 32-35% of annual male separations.
In Australia, screening for bowel cancer commences at 50 years of age, with the Australian Government providing free screening to all Australians aged between 50 and 74 years through The National Bowel Cancer Screening Program.
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Females aged 50 years and older accounted for almost all female separations. This proportion decreased over time from 92% (4,923 separations) to 90% (4,813 separations) in 2010 and to 2015, respectively.
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Males aged 50 years and older accounted for a similar proportion of all male separations. The proportion remained consistent over time from 93% (6,252 separations) to 92% (6,016 separations) in 2010 and 2015, respectively.
A comparison of the age distribution of colorectal cancer-related hospital separations and incidence of colorectal cancer showed that the number of separations was relatively consistent with that of incidence for each age group up to 74 years for both males and females. While 43% of all incident colorectal cancers were those aged 75 years and over, only 36% of all separations (36%) were observed in this age group.
Remoteness area of residence:
During the period 2010 to 2015, the distribution of hospital separations by remoteness area of residence remained relatively consistent:
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The majority of separations were for people living in the Major Cities, with 7,593 separations (63%) and 7,651 separations (65%) in 2010 and 2015, respectively.
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Around one third of separations were for people living in Inner/Outer regional areas (34-35%), with 4,237 separations (35%) in 2010 and 4,026 separations (34%) in 2015.
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Approximately, 1-2% were for people living in Remote/Very Remote areas; with 200 separations (1.7%) and 153 separations (1.3%) in 2010 and 2015, respectively.
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Separations for males and females followed a similar distribution across remoteness areas.
A comparison of remoteness distributions for colorectal cancer-related hospital separations and colorectal cancer incidence showed that the distribution of separations was consistent with the distribution of colorectal cancer incidence among the remoteness categories.
Socioeconomic status:
During the period 2010 to 2015, the proportion of hospital separations related to each socioeconomic status (SES) area remained relatively consistent:
For males:
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Between 22-23% of all separations were for males living in the lowest SES areas (SES 1) across this time period, from 1,501 to 1,472 separations in 2010 and 2015, respectively.
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The proportion of separations was lowest for males living in the highest SES areas (SES 5), ranging from 17-16% of all separations (from 1,160 to 1,050 separations) in 2010 and 2015, respectively.
For females:
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Between 21-23% of all separations were for females living in the lowest SES areas (SES 1 and 2) over this time period. This remained consistent over this period from 1,143 to 1,125 separations for SES 1, and from 1,169 to 1,149 for SES 2 in 2010 and 2015, respectively.
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The proportion of separations in the other SES areas (SES 3-5) was similar for each group ranging between 19-21% of all separations.
A comparison of SES areas distributions for colorectal cancer-related hospital separations and colorectal cancer incidence showed that the distribution of separations was consistent with the distribution of incidence among the SES areas.
Lung cancer
All separations:
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The number of hospital separations for the key selected surgical procedures related to lung cancer increased annually between 2010 and 2015.
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The number of separations increased overall by 38% (from 2,057 to 2,833) between 2010 and 2015.
Procedure types:
During the period 2010 to 2015, the proportion of all lung cancer related hospital separations varied for each procedure group:
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“Lobectomies” was the most common procedure group:
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The proportion of annual separations for these procedures increased from 53% to 56% of all separations (from 1,082 to 1,581);
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“Segmental/wedge resections of lung” accounted for over one third of all separations:
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Between 2010 and 2015, the proportion of annual separations for these procedures was consistent at around 37% (from 759 to 1,052 separations, respectively).
Age and Sex:
During the period 2010 to 2015, the proportion of hospital separations related to age group and sex varied:
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The proportion of annual separations was consistently higher for males (between 52-56%) than females (between 44-48%).
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Notably, the proportion of all separations for males decreased and the proportion for females increased from 2010 to 2015.
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Between 2010 and 2015, the number of separations increased for both sexes. The increase was larger for females (an increase of 47%; from 926 to 1,357) than males (an increase of 31%; from 1,131 to 1,476).
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The highest proportion of separations was for the age group 75 years and over, for both sexes, accounting for 20-23% of annual female separations and 26-29% of annual male separations.
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A comparison of the age distribution of lung cancer-related hospital separations and incidence of lung cancer showed that the distribution of separations differed from the distribution of incidence by sex: People aged 60-74 years accounted for a higher proportion of overall separations (55%) relative to the proportion of incident lung cancer cases (44%) for these age groups. Similar patterns were apparent for both males and females.
Remoteness area of residence:
During the period 2010 to 2015, the distribution of hospital separations by remoteness area of residence remained relatively consistent:
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The majority were for people living in the Major Cities, with 1,392 separations (68%) and 1,906 separations (67%) in 2010 and 2015, respectively.
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Around one third of separations were for people living in Inner/Outer Regional areas, with 31% in both 2010 and 2015 (638 and 881 separations respectively).
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Approximately 1-2% were for people living in Remote/Very Remote areas; with 25 separations (1.2%) and 34 separations (1.2%) in 2010 and 2015, respectively.
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Separations for males and females followed a similar distribution across remoteness areas.
Comparison of remoteness distribution for lung cancer-related hospital separations and lung cancer incidence showed that the distribution of separations was consistent with the distribution of lung cancer incidence among the remoteness categories.
Socioeconomic status:
During the period 2010 to 2015, the proportion of hospital separations related to each socioeconomic status (SES) area remained relatively consistent, but differed by sex:
For males:
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Between 21%-24% of all separations for these procedures were for males lowest SES areas (SES 1), increasing from 240 to 357 separations in 2010 and 2015, respectively.
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The proportion of separations related to SES areas decreased for higher SES areas. The proportion was lowest for males living in highest SES areas (SES 5), with around 16% of all separations (from 184 to 228 separations) in 2010 and 2015, respectively.
For females:
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Between 20-21% of separations were for females living in the lowest SES areas(SES 1) over this time period. This increased from 181 to 282 separations in 2010 and 2015, respectively.
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The proportion of separations was lowest for females living in the highest SES areas (SES 5; between 18 and 21%), increasing from 192 to 251 separations in 2010 and 2015, respectively.
Comparison of SES areas distributions for lung cancer-related hospital separations and lung cancer incidence showed that there were differences in the distribution of separations and incidence among the SES areas. The proportion of incident cases of lung cancer and separations decreased for the higher SES areas. People living in the highest SES areas (SES 4 and SES 5) accounted for a higher proportion of separations relative to the proportion of incident cases of lung cancer diagnosed compared to the lower SES areas (SES 1 and SES 2).
Melanoma
As surgical excision procedures for melanoma can be performed in either an inpatient or outpatient setting, data for both admitted patients and MBS claims (for outpatients) are provided here for completeness. Refer to ‘About the Data’ for more information.
Melanoma (Admitted patients)
All separations:
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The number of hospital separations for the key surgical procedures related to melanoma increased annually between 2010 and 2015.
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The number of annual separations increased overall by15% (from 10,184 to 11,690 separations) between 2010 and 2015.
Procedure types:
During the period 2010 to 2015, the proportion of all melanoma related hospital separations was unchanged for each procedure group:
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“Excision of lesion(s) of skin and subcutaneous tissue” was the most common procedure group, applying to 99% of all separations over this period.
Age and Sex:
During the period 2010 to 2015, the proportion of all hospital separations related to age group and sex varied:
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The proportion of annual separations was consistently higher for males (between 58-59%) than females (between 41-43%).
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Between 2010 and 2015, the number of annual separations increased for both sexes. The increase was larger for females (an increase of 20%; from 4,143 to 4,973 separations) than males (an increase of 11%; from 6,041 to 6,717 separations).
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The highest proportion of separations was for the age group 75 years and over, for both sexes, accounting for 25-27% of annual female separations and 29-34% of annual male separations.
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A comparison of the age distribution of melanoma-related hospital separations and incidence of melanoma showed that the distribution of separations was consistent with that of incidence for each age group for both males and females.
Remoteness area of residence:
During the period 2010 to 2015, the distribution of hospital separations by remoteness area of residence remained relatively consistent:
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The majority of separations were for people living in the Major Cities, with 6,524 separations (64%) and 7,659 separations (66%) in 2010 and 2015, respectively.
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Around one third of separations were for people living in Inner/Outer Regional areas, with 3,481 separations (34%) and 3,822 separations (33%) in 2010 and 2015, respectively.
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Approximately 1-2% were for people living in Remote/Very Remote areas; with 144 separations (1.4%) and 191 separations (1.6%) in 2010 and 2015, respectively.
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Comparison of remoteness distributions for melanoma-related hospital separations and melanoma incidence showed that the distribution of separations was consistent with the distribution of melanoma incidence among the remoteness categories.
The distribution of separations for these procedures by remoteness area of residence differed by sex:
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For males, the proportion of separations by remoteness remained consistent with 65% in Major Cities, 34% in Inner/Outer Regional and 2% in Remote/Very Remote areas.
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For females, the remoteness distribution of separations changed between 2010 and 2015. The proportion of separations for females living in Inner/Outer Regional areas decreased from 36% to 32% (1,476 to 1,569 separations), with a corresponding increase in the proportion living in Major Cities from 63% to 67% (2,590 to 3,330 separations).
Socioeconomic status:
During the period 2010 to 2015, the proportions of separations related to each socioeconomic status (SES) area has remained relatively consistent:
For males:
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Between 16-18% of separations were for males living in the lowest SES areas (SES 1) across this time period, from 973 to 1,222 in 2010 and 2015, respectively.
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The proportion of separations was highest for males living in the highest SES areas (SES 5), with 23% of separations in both 2010 and 2015.
For females:
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Between 17-18% of separations were for females living in the lowest SES areas (SES 1) across this time period, from 1,683 to 2,047 separations in 2010 and 2015, respectively.
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The proportion of separations was highest for females living in the highest SES areas (SES 5), with 23% of separations in both 2010 and 2015.
A comparison of SES areas distributions for melanoma-related hospital separations and melanoma cancer incidence showed that the distribution of separations was consistent with the distribution of incidence among the SES areas.
Melanoma (MBS reimbursed procedures)
Primary surgical treatments for melanoma (skin) may also be provided on a non-admitted patient basis. The majority of these services are processed as reimbursement claims through the Medicare Benefits Schedule (MBS). The scope of the MBS data provided below may include:
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Eligible reimbursement claims for procedures undertaken on a non-admitted basis.
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Reimbursement claims for procedures for people admitted as “private” patients. Therefore, there would be some overlap with the admitted patient data for privately admitted patients.
The number of services provided for MBS reimbursement claims data is available by service item number. Between 2010 and 2015, there were 8 MBS item codes which cover services provided for the definitive excision of malignant melanoma (refer to About the data). The data presented in the following section relates specifically to malignant tumours covered by these 8 MBS item codes. As these data represent services that are processed though the MBS as reimbursed claims, the unit of measure for these data are “service counts”.
Due to small numbers for some procedures, age groups for these data have been restricted to 2 groups: under 65 years of age; and 65 years and over.
All service counts:
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The number of services for the key selected surgical procedures related to melanoma increased annually between 2010 and 2015.
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The number of annual services increased overall by 37% (from 30,416 to 41,762 service counts) between 2010 and 2015.
By Sex & Age:
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The number of annual services increased for both sexes between 2010 and 2015. This increase was slightly larger for males (38%; from 17,715 to 24,475 services) than for females (34%; from 12,890 to 17,287 services).
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In 2010 and 2011, the largest proportion of services (52%) was for people aged <65 years, with 15,920 and 16,733 services in 2010 and 2011 respectively. By comparison, 48% of services were for people who were aged ≥65 years, with 14,496 and 15,393 reported for this age range in 2010 and 2011, respectively).
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By 2015, this difference reversed, in that a larger proportion of services was for people aged ≥65 years (53%, 22,265 services) than those aged <65 years (47%, 19,947 services).
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The age distribution of the number of melanoma-related services varied by sex:
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For males, 59% of services were for those aged 65 years and over.
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For females 54% of services were for those aged 65 years and under.
Melanoma (lymph node key selected surgical removal procedures for admitted patients)
The following analysis presents information on the number of hospital separations for sentinel lymph node biopsy (SLNB) procedures provided for admitted patients with a principal diagnosis of melanoma (C43). For melanoma-related procedures, two SLNB procedures were examined:
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SLNB of axilla; and
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SLNB, not elsewhere classified.
The number of hospital separations for SLNB procedures of the axilla where melanoma was indicated as the principal diagnosis:
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Increased annually from 2010 to 2014 (from 820 to 994) and decreased slightly in 2015 (972).
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The overall change was an increase of 19% between 2010 and 2015. Similar trends were apparent for both males and females.
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Males accounted for around 60% of separations.
The procedure code for SLNB, not elsewhere classified was introduced in 2013, therefore data is available for 2013-2015 only. During this period, the number of hospital separations relating to these procedure types:
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Increased annually from 347 to 947 in 2013 to 2015, respectively.
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The number of separations almost tripled between 2010 and 2015. Similar trends were apparent for both males and females.
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Males accounted for around 60% of separations.
Prostate cancer
All separations:
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The number of hospital separations for the key selected surgical procedures related to prostate cancer increased between 2010 and 2011 and then decreased annually from 2012 to 2015.
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The number of separations decreased overall by 4% (from 12,460 to 12,019 separations) between 2010 and 2015.
Procedure types:
During the period 2010 to 2015, the proportion of all prostate cancer related hospital separations varied for each procedure group:
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“Radical prostatectomies” (including both open and laparoscopic procedures) was the most common procedure group.
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The proportion of annual separations for these procedures was consistent between 54-52% of all separations in 2010 and 2015;
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Around one quarter of separations were for “Transurethral resection procedures” (TURPs). These procedures are usually performed for the treatment of urinary symptoms and may ultimately be diagnostic of prostate cancer rather than applied as a specific treatment.
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Between 2010 and 2015, the proportion of annual separations for these procedures decreased from 29% to 24% of all separations (from 3,658 to 2,918 separations, respectively).
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A comparison of age distributions for these two procedure groups showed that separations for “Radical prostatectomies” increased with age until the 60-64 and 65-69 year age groups, with the separations less common among men aged 70 years and older. TURP-related separations however, were uncommon in males less than 65 years of age and then increased rapidly with age with the highest proportion in males 75 years of age and over.
Age:
During the period 2010 to 2015, the proportion of all hospital separations related to age group varied:
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In 2010, males aged 60-64 years of age accounted for the highest proportion with 22% of annual male separations (2,731 separations), while in 2015 the highest proportion was in the 65-69 year age group (26%; 3,142).
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A comparison of the age distribution of prostate cancer-related hospital separations and incidence of prostate cancer showed that the distribution of separations was consistent with that of incidence for each age group.
Remoteness area of residence:
During the period 2010 to 2015, the distribution of hospital separations by remoteness area of residence remained relatively consistent:
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The majority of separations were for males living in the Major Cities, with 7,983 separations (64%) and 7,951 (66%) separations in 2010 and 2015, respectively.
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Around a third of separations were for males living in Inner/Outer Regional areas, (between 34-32%), with 4,262 separations and 3,862 separations in 2010 and 2015, respectively.
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Approximately 1-2% were for males from Remote/Very Remote areas; with 197 separations (1.6%) and 174 separations (1.5%) in 2010 and 2015, respectively.
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Comparison of remoteness distributions for prostate cancer-related hospital separations and prostate cancer incidence showed that the distribution of separations was consistent with the distribution of prostate cancer incidence among the remoteness categories.
Socioeconomic status:
During the period 2010 to 2015, the proportions of hospital separations related to each socioeconomic status (SES) area remained relatively consistent:
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Between 22%-23% of all separations were for males highest SES areas (SES 5), from 2,800 to 2,705 separations in 2010 and 2015, respectively.
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The proportion of separations was lowest for males living in the lowest SES areas (SES 1; from 18-19%) with 2,237 and 2,235 separations in 2010 and 2015, respectively.
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A comparison of SES areas distributions for prostate cancer-related hospital separations and prostate cancer incidence showed that the distribution of separations was consistent with the incidence distribution among the SES areas.
