This measure focuses initially on the five highest incidence cancers in Australia: prostate, breast, colorectal, lung and melanoma (skin). To determine the frequency of surgical procedures undertaken for the treatment of newly diagnosed cancers, a dataset of key selected surgical treatments has been developed for patients with a principal diagnosis of: prostate (C61), breast (C50), colorectal (C18-20), melanoma (C43), or lung (C33-34) cancer.
The data presented here provide an overview of the number of cancer surgical treatments provided in Australian hospitals for patients with a principal diagnosis of cancer. Initial data for these five cancers for the years 2010 to 2015 inclusive were retrieved and analysed, and frequencies of surgical treatment by cancer principal diagnosis is presented in the following sections.
The data refer to hospital separations, not individual patients, meaning that an individual may have more than one hospital separation for the primary treatment of their cancer. A hospital separation refers to an episode of admitted patient care which can be a total hospital stay (from admission to discharge or transfer) or a portion of a hospital stay beginning or ending in a type of care (for example from acute care to rehabilitation).
For the purposes of these analyses, cancer related treatments include “key selected surgical procedures performed with the general intent to change the outcome of the cancer and/ or provide symptom relief/palliative care”
Due to differences in the age structures of Indigenous and non-Indigenous populations, surgical treatment activity data for these groups have been examined separately using age standardisation methods on the 'Surgical treatment activity for Aboriginal and Torres Strait Islander Peoples' page.
More information about the scope and data sources for surgical treatment activity data can be found in the ‘About the Data’ tab and definitions of key terms are provided in the ‘Glossary’ page.
Charts
About this measure
This measure focuses initially on the five highest incidence cancers in Australia: prostate, breast, colorectal, melanoma and lung. Initial examination of procedure codes by principal diagnosis indicated a degree of overlap for treatment procedures recorded for colon and rectal cancers. To avoid potential confusion in reporting the data, these cancers have been analysed as a group (i.e. colorectal cancers). It is anticipated that for later data analyses, where a confirmed incidence for these two cancers are available, separate data will be presented for colon and rectal cancers.
The incidence of each of these cancers in 2013 is provided below:
|
Cancer |
Incidence (2013) |
|
Prostate |
Male – 19,233
|
|
Breast |
Male – 142 Female – 15,902 Persons – 16,045 |
|
Colorectal |
Male – 8,214 Female – 6,748 Persons – 14,962 |
|
Melanoma |
Male – 7,513 Female – 5,232 Persons – 12,744 |
|
Lung |
Male – 6,627 Female – 4,548 Persons – 11,174 |
Source: AIHW 20171
Surgical treatment for these cancers depends on the tumour size and spread, the severity of symptoms and the patient’s age and general health, as well as the use of radiotherapy and chemotherapy. Surgical treatment usually involves removing the tumour and part or all of the surrounding tissue. In certain cases, best practice guidelines also recommend the removal of one or more lymph nodes.2 The key surgical procedure codes for each cancer included in this analysis are listed in the ‘About the Data’ tab and definitions of key terms are provided in the ‘Glossary’ page.
Data on the surgical treatment activity for these cancers at a population-level contribute to our understanding of evidence-based best-practice care. This measure will be updated on an ongoing basis, including a future examination of surgical cancer procedures by stage at diagnosis.
Trends
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:
-
The number of hospital separations for the key selected surgical procedures related to breast cancer increased annually between 2010 and 2015.
-
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:
-
“Breast excision” surgical procedures, was the most common procedure group.
-
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).
-
-
Around one in ten separations were for “Breast re-excision” surgical procedures.
-
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).
-
-
Around one third of separations were for mastectomies:
-
The proportion of annual separations for “Simple mastectomy” procedures decreased from 34% to 29% of all separations (5,691 to 5,579);
-
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:
-
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).
-
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.
-
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:
-
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.
-
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).
-
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:
-
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.
-
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:
-
“Sentinel Lymph Node Biopsy” (SLNB) procedures, and
-
“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:
-
Increased annually between 2010 and 2014 (from 15,131 to 17,788 separations) and decreased in 2015 (17,574 separations).
-
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:
-
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.
-
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:
-
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.
-
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:
-
“Hemicolectomies” was the most common procedure group.
-
The proportion of annual separations for these procedures ranged between 43-48% of all separations over this time period;
-
Between 2010 and 2015, the proportion increased from 43% to 47% of all separations (from 5,202 to 5,609 separations, respectively).
-
The proportion of annual separations for these procedures was higher in females (between 50-55%) than males (37-42%).
-
-
Around one third of separations were for “Anterior rectal resections”
-
The proportion of annual separations for these procedures ranged between 35-37% of all separations over this time period;
-
Between 2010 and 2015, the proportion decreased from 37% to 35% of all separations (from 4,420 to 4,162 separations).
-
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:
-
The proportion of annual separations was consistently higher for males (between 55-56%) than females (between 44-46%).
-
The number of separations:
-
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;
-
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).
-
-
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.
-
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.
-
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:
-
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.
-
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.
-
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.
-
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:
-
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.
-
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:
-
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.
-
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:
-
The number of hospital separations for the key selected surgical procedures related to lung cancer increased annually between 2010 and 2015.
-
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:
-
“Lobectomies” was the most common procedure group:
-
The proportion of annual separations for these procedures increased from 53% to 56% of all separations (from 1,082 to 1,581);
-
-
“Segmental/wedge resections of lung” accounted for over one third of all separations:
-
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:
-
The proportion of annual separations was consistently higher for males (between 52-56%) than females (between 44-48%).
-
Notably, the proportion of all separations for males decreased and the proportion for females increased from 2010 to 2015.
-
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).
-
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.
-
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:
-
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.
-
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).
-
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.
-
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:
-
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.
-
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:
-
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.
-
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:
-
The number of hospital separations for the key surgical procedures related to melanoma increased annually between 2010 and 2015.
-
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:
-
“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:
-
The proportion of annual separations was consistently higher for males (between 58-59%) than females (between 41-43%).
-
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).
-
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.
-
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:
-
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.
-
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.
-
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.
-
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:
-
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.
-
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:
-
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.
-
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:
-
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.
-
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:
-
Eligible reimbursement claims for procedures undertaken on a non-admitted basis.
-
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:
-
The number of services for the key selected surgical procedures related to melanoma increased annually between 2010 and 2015.
-
The number of annual services increased overall by 37% (from 30,416 to 41,762 service counts) between 2010 and 2015.
By Sex & Age:
-
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).
-
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).
-
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).
-
The age distribution of the number of melanoma-related services varied by sex:
-
For males, 59% of services were for those aged 65 years and over.
-
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:
-
SLNB of axilla; and
-
SLNB, not elsewhere classified.
The number of hospital separations for SLNB procedures of the axilla where melanoma was indicated as the principal diagnosis:
-
Increased annually from 2010 to 2014 (from 820 to 994) and decreased slightly in 2015 (972).
-
The overall change was an increase of 19% between 2010 and 2015. Similar trends were apparent for both males and females.
-
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:
-
Increased annually from 347 to 947 in 2013 to 2015, respectively.
-
The number of separations almost tripled between 2010 and 2015. Similar trends were apparent for both males and females.
-
Males accounted for around 60% of separations.
Prostate cancer
All separations:
-
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.
-
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:
-
“Radical prostatectomies” (including both open and laparoscopic procedures) was the most common procedure group.
-
The proportion of annual separations for these procedures was consistent between 54-52% of all separations in 2010 and 2015;
-
-
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.
-
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).
-
-
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:
-
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).
-
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:
-
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.
-
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.
-
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.
-
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:
-
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.
-
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.
-
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.
About the data
This measure shows the distribution of hospital separations for key selected surgical procedures (see list below), for admitted patients with a principal diagnosis of the relevant cancer between 2010 and 2015.
Unit of analysis:
Number of hospital separations where the principal diagnosis for a relevant cancer was recorded and where at least one cancer-related procedure listed below was performed.
Note that the unit of analysis is for hospital separations, not individual patients. An individual who had multiple separations in a given year will have a record for each of these separations. Therefore an individual patient may be counted more than once in these data.
Scope:
The key cancer-related surgical procedures were selected through a process of stakeholder consultation. The scope of the analysis relates to procedures for the primary treatment of the cancer performed in an admitted patient setting. For this reason it does not include hospitalisations for non-cancer specific surgery on cancer patients.
Most of the separations relate to surgical removal, resection and excision procedures. Due to the importance of sentinel lymph node biopsy in the surgical staging and treatment, breast cancer and melanoma these data are also provided for these cancers
Data source:
The data for this measure are sourced from the AIHW National Hospital Morbidity Database (NHMD). The AIHW NHMD is a compilation of episode-level records from admitted patient morbidity data collection systems in Australian hospitals. The data supplied are based on the National Minimum Data Set (NMDS) for Admitted patient care; they include demographic, administrative and length of stay data, as well as data on the diagnoses of the patients, the procedures they underwent in hospital and external causes of injury and poisoning.
The scope of the NMDS is episodes of care for admitted patients in all public and private acute and psychiatric hospitals, free-standing day hospital facilities, and alcohol and drug treatment centres in Australia. Hospitals operated by the Australian Defence Force, corrections authorities and in Australia’s off-shore territories are not in scope, but some are included.3
More information about the NHMD and definitions used can be found in Appendices A and B of Admitted patient care 2015-16: Australian hospital statistics.3
Principal diagnosis codes for cancer:
|
Cancer type |
ICD-10-AM codes |
|
Breast |
C50 |
|
Colorectal |
C18-C20 |
|
Lung |
C33-34 |
|
Melanoma |
C43 |
|
Prostate |
C61 |
Admitted patient procedures:
Some admitted patient procedures included may have been diagnostic for a particular cancer rather than a specific treatment for the cancer. The following procedure codes defined by the Australian Classification of Health Interventions (ACHI) 6th-8th edition were included in the analysis. The ACHI is based on the Medicare Benefits Schedule (MBS) and was developed by the National Centre for Classification in Health (NCCH). For further information on the ACHI please refer to the Australian Consortium for Classification and Development website.
|
Cancer type |
Procedure group |
ACHI codes (6th-8th edition) |
|
Breast* |
Breast excision |
31500-00 |
|
Breast re-excision |
31515-00 |
|
|
Subcutaneous mastectomy |
31524-00, 31524-01 |
|
|
Simple mastectomy |
31518-00, 31518-01 |
|
|
Sentinel Lymph Node Biopsy (SLNB) |
30300-00, 30300-01 |
|
|
Lymph node excision (Internal mammary/ Axilla) |
30075-11, 30332-00, 30335-00, 30336-00 |
|
|
Colorectal |
Anterior rectal resections |
32024-00, 32025-00, 32026-00, 32028-00, 92208-00 |
|
Hemicolectomy |
32000-03, 32000-01, 32003-01, 32003-03, 32004-01, 32005-01, 32005-03, 32006-00, 32006-01, 32006-02, 32006-03 |
|
|
Colectomy |
32005-02, 32009-00, 32009-01, 32012-00, 32012-01 |
|
|
Proctectomy |
32039-00, 32047-00 |
|
|
Proctocolectomy |
32015-00, 32051-00, 32051-01 |
|
|
Rectosigmoidectomy |
32030-00, 32030-01, 32112-00 |
|
|
Other colorectal procedures |
30392-00, 30479-02, 32000-00, 32000-02, 32003-00, 32099-00, 90308-00, 90959-00, 30479-01, 32105-00, 32108-00, 90297-02, 90341-00 |
|
|
Lung |
Palliative procedures (pleurectomy and excision of lesion) |
38424-00**, 41892-01**, 41901-00** |
|
Portion of lung (segmental/wedge resections) |
38438-00, 38440-00, 38440-01, 90169-00 |
|
|
Lobe of lung (lobectomy) |
38438-01, 38441-00 |
|
|
Whole lung (pneumonectomy) |
38438-02, 38441-01 |
|
|
Melanoma |
Excision of lesion |
31205-00, 31230-00, 31230-01, 31230-02, 31230-03, 31230-04, 31230-05, 31235-00, 31235-01, 31235-02, 31235-03, 31235-04 |
|
Wedge excision |
45665-00, 45665-01, 45665-02 |
|
|
Other melanoma/ skin procedures |
45668-00, 31000-00, 30205-00, 30205-01, 31205-01, 90403-00, 90440-00 |
|
|
Sentinel Lymph Node Biopsy (SLNB) |
30300-00, 30300-01 |
|
|
Prostate |
Radical prostatectomies |
37210-00, 37210-01, 37211-00, 37211-01 |
|
Radical prostatectomies (NOS) |
37209-00***, 37209-01*** |
|
|
Other prostate procedures |
37203-02, 37203-03, 37203-05, 37203-06, 37224-00 37224-01, 37207-00, 37207-01 |
|
|
Brachytherapy implant |
37227-00 |
|
|
TURP |
37203-00*** |
* For breast cancer related hospital separations, “breast reconstruction” procedures have not been included as these may not necessarily be intended for the treatment of breast cancer
** The lung cancer admitted patient procedures “pleurectomy” (38424-00) and “excision of lesion” (41892-01, 41901-00) are not intended to treat lung cancer directly and are intended for symptom relief or palliative care.
***The prostate cancer procedures “Transurethral resection of the prostate” (37203-00), “Radical prostatectomy (NOS)” (37209-00), and “Laparoscopic radical prostatectomy (NOS)” (37209-01) are procedures that may result in the diagnosis of prostate cancer and are not a specific treatment for prostate cancer.
Admitted patient procedures data not provided:
The table below summarised admitted patient procedures in selected years have not been provided. For these procedures, data are not provided where:
- There are fewer than three reporting units, or;
- There are three or more reporting units, and one reporting unit contributed more than 85% of the total separations, or;
- There are three or more reporting units, and one reporting unit contributed more than 90% of the total separations.
Admitted patient procedures in selected years have that have not been provided for these reasons are summarised below:
|
Year |
Period |
ACHI codes (6th-8th edition) |
|
2010 |
January-June |
30075-11, 37201-00, 37203-02, 37203-05, 37203-06, 37207-00, 38427-00, 45533-00 |
|
July-December |
37201-00, 37203-02, 37203-06 |
|
|
2011 |
January-June |
37201-00, 37203-02, 37203-06, 38427-00 |
|
July-December |
37203-02, 37203-05, 37203-06, 38427-00, 45533-00, 45536-00 |
|
|
2012 |
January-June |
32108-00, 37203-02, 37203-05, 37203-06, 38427-00, 45536-00 |
|
July-December |
32108-00, 37203-02, 37204-04, 37203-05, 37203-06, 38427-00, 45533-00, 45536-00 |
|
|
2013 |
January-June |
32108-00, 37203-02, 37203-05, 37203-06, 38427-00, 45533-00, 45536-00 |
|
July-December |
30205-00, 37201-00, 38427-00, 45533-00 |
|
|
2014 |
January-June |
30205-00, 30479-02, 37201-00, 37203-03, 37203-04, 38427-00, 43987-00, 45533-00 |
|
July-December |
30205-00, 30479-02, 37201-00, 37203-03, 37203-04, 38427-00, 43987-00, 45533-00 |
|
|
2015 |
January-June |
30205-00, 30479-02, 37201-00, 37203-03, 37203-04, 38427-00, 43987-00, 45533-00 |
|
July-December |
30205-01, 37201-00, 37203-02, 37203-04, 37203-06, 37224-01, 38427-00 |
Melanoma inclusions
In addition, as surgical excision procedures for melanoma are often performed in an outpatient setting, data relating to both admitted patient and MBS claims data are provided for completeness. The MBS codes used for this analysis (and respective ACHI codes) are:
|
MBS codes – Malignant melanoma, definitive surgical excision |
ACHI codes (6th edition) - Excision of lesion(s) of skin and subcutaneous tissue |
|
|
|
The MBS codes include a group of malignancies as follows: malignant melanoma, appendageal carcinoma, malignant fibrous tumour of skin, Merkel cell carcinoma of skin. Also included in the MBS codes is Hutchinson’s melanotic freckle (also known as Lentigo maligna). Lentigo maligna is a common skin tumour, unlike those included in the MBS codes above.
Caution should be applied in interpreting these data as:
- They represent two different units of analysis, i.e. number of hospital separations (for admitted patients) and number of services that are processed (MBS claims).
- There may be an overlap between the NHMD and the MBS datasets (e.g. admitted private patients may be included in both).
- Year is determined by the date the service was processed by Medicare Australia, not the date the service was provided.
- Figures for MBS reimbursed procedures are presented as aggregated frequency counts of services delivered rather than individual patients treated. Individuals may be counted more than once if they made more than MBS claim.
- Information on cancer diagnosis cannot be reliably ascertained in the absence of data linkage.
Data caveats:
- Unless otherwise stated, the data do not include cancer-related surgical procedures performed in a non-admitted patient setting.
- The data excludes separations for which ‘Care type’ was reported as Newborn (with unqualified days only), Posthumous organ procurement or Hospital boarder.
- Due to confidentiality provisions, the data do not include separations where:
- there were fewer than three reporting units, or
- there were three or more reporting units, and one reporting unit contributed more than 85% of the total separations, or
- there were three or more reporting units, and two reporting units contributed more than 90% of the total separations.
- A record is included for each separation, not for individual patients. A patient who had multiple hospital separations will have a record for each of these separations.
References
Activity in this area
Data - General
Australian Institute of Health and Welfare 2017. Admitted patient care 2015–16: Australian hospital statistics. Health services series no. 75. Cat. no. HSE 185. Canberra: AIHW.
Medicare Benefits Schedule (MBS) - Items by Patient Demographics Report. Available from: http://www.data.gov.au/dataset/medicare-benefits-schedule-mbs-group-by-patient-demographics-report
Breast cancer
Cancer Australia – Breast Cancer. Available from: https://canceraustralia.gov.au/affected-cancer/cancer-types/breast-cancer (accessed January 2017).
Australian Institute of Health and Welfare 2015. Breast cancer in young women: key facts about breast cancer in women in their 20s and 30s. Cancer series no. 96. Cat. No. CAN 94. Canberra: AIHW.
Lung cancer
Cancer Australia – Lung Cancer. Available from https://lung-cancer.canceraustralia.gov.au/ (accessed May 2017).
Cancer Australia. Report to the Nation - Lung Cancer 2011. Cancer Australia, Sydney, NSW, 2011.
Prostate cancer
Cancer Australia – Prostate Cancer. Available from https://prostate-cancer.canceraustralia.gov.au (accessed May 2017).
Colorectal cancer
Cancer Australia – Bowel Cancer. Available from https://bowel-cancer.canceraustralia.gov.au/ (accessed May 2017).
Melanoma
Australian Institute of Health and Welfare 2016. Skin cancer in Australia. Cat. no. CAN 96. Canberra: AIHW.
Cancer Australia – Melanoma of the skin. Available from https://melanoma.canceraustralia.gov.au/ (accessed May 2017).
References
1. Australian Institute of Health and Welfare (AIHW) 2017. Australian Cancer Incidence and Mortality (ACIM) books. Canberra: AIHW.
2. Cancer Australia. https://canceraustralia.gov.au/affected-cancer/cancer-types/breast-cancer (Accessed January 2017)
3. Australian Institute of Health and Welfare 2017. Admitted patient care 2015–16: Australian hospital statistics. Health services series no. 75. Cat. no. HSE 185. Canberra: AIHW.