Systemic anti-cancer therapy treatment activity

Published

22 Nov, 2017

Systemic anti-cancer therapies are used in the treatment of cancer often in conjunction with surgical therapies and radiotherapy. They are often used in conjunction with surgery, either prior to surgery to shrink the cancer (neo-adjuvant therapy) or following the surgical treatment (adjuvant therapy).

For the purposes of these analyses, cancer related treatments include “pharmaceutical agent(s) administered, with the general intent to change the outcome of the cancer and/ or provide symptom relief/palliative care”. These therapies include a range of therapeutic agents for cancer-related treatment including antineoplastic drugs (such as chemotherapy and newer “targeted therapies” e.g. Nivolumab – a human programmed death receptor-1 (PD-1) blocking antibody), endocrine (hormonal) therapy agents and immunomodulating agents (e.g. Interferons). These therapies act via a variety of mechanisms of action including, preventing cell growth; targeting the immune or hormonal systems to influence the way the body (and cancer) responds to hormones and ultimately affect the growth of the cancer.

The data presented here provide an overview of key systemic therapy treatments for all cancers combined in Australia.

This treatment indicator provides an overview of system-wide activity for these therapies in Australia between 2012 and 2016. The data are shown for the number of people who have been dispensed, and for whom a reimbursement claim was processed under the Australian Government’s Pharmaceutical Benefits Scheme (PBS). Disaggregation has been provided by demographic characteristics.

Specific information about data sources, and guidance for interpreting the data, can be found in the ‘About the Data’ tab and definitions of key terms are provided in the ‘Glossary’ page.

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Notes

• Data sourced from the Pharmaceutical Benefits Scheme database (PBS).
• Number of people represents patients who were dispensed at least one PBS items during the calendar year (refer to ‘for further detail).
• Systemic anti-cancer therapies included are those indicated as use for cancer treatment by the ATC classification
• Refer to 'About the Data' for a full list of therapeutic agent codes, inclusion and exclusion parameters.

Number of people accessing systemic anti-cancer therapies as indicated by PBS reimbursement claims, by sex, 2012 to 2016
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Notes

• Data sourced from the Pharmaceutical Benefits Scheme database (PBS).
• Number of people represents patients who were dispensed at least one PBS items during the calendar year (refer to ‘for further detail).
• Systemic anti-cancer therapies included are those indicated as use for cancer treatment by the ATC classification
• Refer to 'About the Data' for a full list of therapeutic agent codes, inclusion and exclusion parameters.

Number of people accessing systemic anti-cancer therapies as indicated by PBS reimbursement claims, by sex and age group, 2012 to 2016
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Notes

• Data sourced from the Pharmaceutical Benefits Scheme database (PBS).
• Number of people represents patients who were dispensed at least one PBS items during the calendar year (refer to 'About the Data 'for further detail).
• Systemic anti-cancer therapies included are those indicated as use for cancer treatment by the ATC classification
• Refer to 'About the Data' for a full list of therapeutic agent codes, inclusion and exclusion parameters.

Number of people accessing systemic anti-cancer therapies as indicated by PBS reimbursement claims, by sex and remoteness area of residence, 2012-2016
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Notes

• Data sourced from the Pharmaceutical Benefits Scheme database (PBS).
• Number of people represents patients who were dispensed at least one PBS items during the calendar year (refer to ‘for further detail).
• Systemic anti-cancer therapies included are those indicated as use for cancer treatment by the ATC classification
• Refer to 'About the Data' for a full list of therapeutic agent codes, inclusion and exclusion parameters.

Number of people accessing systemic anti-cancer therapies as indicated by PBS reimbursement claims, by sex and socioeconomic status (SES) areas, 2012-2016

About this measure

This measure shows the number of people receiving at least one of the cancer-related systemic therapies and a small number of supportive treatments in Australia in any one year over the period 2012 to 2016.

Cancer treatment-related systemic therapy agents were selected as defined by the Anatomical Therapeutic Classification (ATC codes) and derived from items as listed on the schedule of the Pharmaceutical Benefits Scheme (PBS) for the time period 2012 to 2016. Data for this measure therefore includes treatments for all cancers for which these therapies apply.

The data are reported for the number of people who were dispensed at least one of the agents of interest each year. This provides demographic information for patients who received treatment for cancer-related therapeutic items as outlined from 2012 to 2016. All patients represent unique entries within an individual year and, therefore, direct comparisons of demographic groups can be made within an individual year and relative comparisons can be made between years for these data (although users are encouraged to review the caveats in interpreting time series data in the ‘About the data’ tab). Note that an individual receiving ongoing treatment may be prescribed these therapies across more than one year.

Trends

During the period 2012 to 2016

All people:

The number of people who used systemic anti-cancer therapy treatment (as indicated through PBS reimbursement claims) increased annually between 2012 and 2016.
The number of people using systemic anti-cancer therapy treatment increased by about 25% over this period from 198,756 people to 247,939 people between 2012 and 2016 respectively.
Adjusting for the change in the Australian population over the time-period (crude rates), the number of people accessing these therapies per 100,000 population increased annually; with an annual increase of around 4% from 2012 to 2016.

Age and sex:

During the period 2012 to 2016, the proportion of people who used systemic anti-cancer therapies varied by sex:

The majority of people who used these systemic anti-cancer therapy treatment were women (57-60% of people annually). This was consistently higher than the proportion of users of these therapies who were male (43-40%).
The difference between the sexes increased over time:
- 57% of all people who used these therapies in 2012 were females, increasing to 60% in 2016.
- 43% of all people who used these therapies in 2012 were males, decreasing to 40% in 2016.
The number of people who used systemic anti-cancer therapy treatment annually increased for both sexes over this period:
- The number of females who used these therapies increased by 30% (from 113,986 in 2012 to 148,400 in 2016).
- The number of males who used these therapies increased by 17% (from 84,745 to 99,539).
Adjusting for the change in the Australian population over the time-period, the annual percentage point increase in the number of people in Australia who used systemic anti-cancer therapy treatment differed by sex:
For females who used these therapies, the annual percentage increases (per 100,000 females) ranged between 4% and 6% from 2012 to 2016.
For males who used these therapies, the annual percentage point increases (per 100,000 males) ranged between 2% and 3% from 2012 to 2016.

The age group representing the largest proportion of users varied by sex.

For females:

25-27% of all females who used systemic anti-cancer therapies annually were in the 10 year age group 60-69 years of age across the time period from 2012 to 2016. This compared to 29% of all cancers combined in 2017 for the female population that were in this age group.
The number of females using the therapies in this age group increased from 30,736 in 2012 to 37,737 in 2016.

For males:

29% of all males who used systemic anti-cancer therapy treatment annually were aged 70-79 years of age across the time period from 2012 to 2016. This compared to 22% of all cancers combined in 2017 for the male population that were in this age group.
The number of males using these therapies in this age group increased from 24,594 in 2012 to 29,028 in 2016.

Remoteness:

Comparison of patterns of systemic anti-cancer therapy use with the incidence of all cancers combined³ across remoteness areas of residence showed that during the period 2012 to 2016, the distribution pattern of people using these therapies was proportionally consistent with the distribution of cancer incidence across areas of residence.

The majority of people who used these therapies were living in the Major Cities (approximately 67% annually). The number of people in Major Cities who used these therapies each year increased from 133,852 in 2012 to 167,809 in 2016.
Around one third of people who used these therapies were living in Inner/Outer Regional areas (approximately 31% annually). For this remoteness area, the number of people who used these therapies each year increased from 62,070 to 76,647 people in 2012 and 2016 respectively.
Around 1% of people who used these therapies annually were living in Remote/Very Remote areas. For this remoteness area, the number of people who used these therapies each year increased from 2,637 in 2012 to 3,196 people in 2016.

Although the annual number of people who used these therapies increased by around 25% between 2012 and 2016 across all remoteness categories, the proportional distribution of the people who used these therapies across these remoteness areas was similar over this time period.

The proportion of people who used these therapies in each remoteness group over this time period however varied slightly by sex.

For females:

The majority of females who used these therapies were living in Major Cities (approximately 70% annually). For this remoteness area, the number of females who used these therapies each year increased from 78,996 in 2012 to 103,244 in 2016.
Around one third of females who used these therapies were living in Inner/Outer Regional areas (approximately 29% annually). For this remoteness area, the number of females who used these therapies each year increased from 33,446 in 2012 to 43,233 in 2016.
Around 1% of females who used these therapies annually were living in Remote/Very Remote areas. For this remoteness area, the number of females who used these therapies each year increased from 1,439 in 2012 to 1,746 people in 2016.

For males:

The majority of males who used these therapies were living in the Major Cities, (approximately 65% annually). For this remoteness area, the number of males who used these therapies each year increased from 54,854 in 2012 to 64,565 in 2016.
Around one third of males who used these therapies were living in Inner/Outer Regional areas (approximately 34% annually). For this remoteness area, the number of males who used these therapies increased from 28,623 in 2012 to 33,414 in 2016.
Around 1% of males who used these therapies annually were living in Remote/Very Remote areas. For this remoteness area, the number of males who used these therapies each year increased from 1,198 in 2012 to 1,450 in 2016.

Socioeconomic status:

Comparison of patterns of systemic anti-cancer therapy use with the incidence of all cancers combined³ across SES areas showed that during the period 2012 to 2016, the distribution pattern of people using these therapies differed from the distribution patter by cancer incidence. A comparison of the SES distribution of cancer incidence cases, showed a fairly even distribution of cancer incidence (ranging between 18% and 22% of cancer cases in each SES area, with 19% in the highest SES areas (SES 5), and 22% in the lowest SES areas (SES1).

The majority of people who used these therapies were living in the highest SES areas (SES 5) (approximately 25% annually). The number of people living in these areas that used these therapies each year increased from 50,583 in 2012 to 62,931 in 2016.
Approximately 14% of people who used these therapies annually were living in the lowest SES areas (SES 1). For these areas, number of people who used these therapies each year increased from 28,118 in 2012 to 34,421 in 2016.
Across the other SES areas (SES 2-4), the proportion of people living in these areas who used these therapies annually was similar (between 18-21%).

The annual number of people who used these therapies increased between 16-19% between 2012 and 2016 across all SES areas, the proportional distribution of the people who used these therapies within each SES area was similar over this time period.

The proportion of people who used systemic anti-cancer therapies in each SES area over this time period however differed slightly by sex.

For females:

The majority of females who used these therapies were living in the highest SES areas (approximately 27% annually). The number of females living in these areas that used these therapies each year increased from 30,709 in 2012 to 39,779 in 2016.
Approximately 13% of females who used these therapies annually were living in the lowest SES areas (SES 1). The number of females living in these areas that used these therapies each year increased from15,298 in 2012 to 19,607 in 2016.
Across SES areas (SES 2-4), the proportion of females living in these areas that used these therapies annually was similar (between 18-21%).

For males:

The majority of males who used these therapies were living in the highest SES areas (approximately 24% annually). The number of males living in these areas that used these therapies each year increased from 19,874 in 2012 to 23,152 in 2016.
Approximately 15% of males who used these therapies annually were living in the lowest SES areas. The number of males living in these areas that used these therapies each year increased from 12,818 in 2012 to 14,814 in 2016.
Across the other SES areas (SES 2-4), the proportion of males living in these areas that used these therapies annually was similar (between 20-21%).

About the data

The present data provides an overview of the number of people dispensed at least one specified systemic anti-cancer therapy agent in Australia in any year from 2012 to 2016. The dataset consists of PBS and RPBS prescriptions prescribed from 1 January 2012 to 31 December 2016 (and processed on or before 31 July 2017). The data was extracted for selected drugs (Health Cancer Definition by ATC¹) at the national level.

Unique patients are counted at the national level by calendar year. Patient postcode, patient gender and age are based on the first script supplied within each calendar year for each patient.

The postcode of the patient’s residential address at the time of the first dispensing of the relevant year was used to determine the relevant indices of remoteness and socioeconomic disadvantage. More information about the Index of Relative Socioeconomic Disadvantage used for this analysis can be found here: ABS - Socio-Economic Indexes for Areas (SEIFA), Australia, 2011.

Unit of analysis:

The number of people who were dispensed systemic anti-cancer related therapeutic items (as defined in Table 1 below) in a given individual year and for whom a reimbursement claim was processed under the Australian Government’s Pharmaceutical Benefits Scheme (PBS).

For brevity and ease of reading throughout the text, this unit of measure has been abbreviated to the term “people who used these therapies”.

To provide context of the use of these therapies within the Australian population, the number of people who accessed these therapies, were adjusted for the increase in population over the time period. Data are expressed as the number of people who accessed these therapies per 100,000 population for the relevant year (Estimated Resident Population data are sourced from the Australian Bureau of statistics). Crude rates were calculated by dividing the number of people accessing these therapies by the resident Australian population and multiplying by 100,000.

Scope:

Items related to systemic anti-cancer therapy treatment agents were selected as defined using the Anatomical Therapeutic Chemical (ATC) code information including anatomical main group, therapeutic and pharmacological subgroups and the actual chemical substance.

Relevant systemic anti-cancer therapy treatment subgroup items include selected: anti-neoplastic agents (including traditional chemotherapy drugs, and newer “targeted therapies” agents, category L01); endocrine (hormonal) therapy agents (L02); and immunomodulating agents that directly target the functioning of the immune system (including a small number of immunosuppressants and immunostimulants) from categories L03 and L04. Items are also included for a small number of supportive treatments (which treat the side-effects of the therapeutic agent). A list of the selected items is provided in Table 1.

A confirmatory check of the list of therapeutic drugs identified using the ATC code classification approach, was undertaken by comparing the selected list of drugs with those used in the current chemotherapy protocols indicated in the eviQ Cancer Treatments Online database².

Data sources:

The data were obtained from the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Schedule (RPBS) prescriptions database, managed by the Australian Government Department of Health.

To estimate activity for this measure, data have been included only for the therapeutic agents prescribed and reimbursed from the PBS. To avoid duplication of counting of the number of people receiving systemic therapy, data does not include information regarding the procedures for delivery of these therapies (e.g. as included through the MBS or NHMD databases). For context, previously published data for admitted patients in 2014–15, showed 440,561 pharmacotherapy (systemic therapy) hospitalisations for delivery of these treatments (this does not include systemic therapy provided to non-admitted patients in public hospitals)³.

More information on the data sources can be found at: https://www.pbs.gov.au/info/browse/statistics.

Data caveats:

The PBS listing of therapeutic agents is updated monthly, with new items listed and other items delisted on an ongoing basis.

The time-period for the data presented aligns with the introduction of The Revised Arrangements for the Efficient Funding of Chemotherapy Drugs³ (EFC) for injectable and infusible chemotherapy medicines used in the treatment of cancer was introduced in December 2011.
As an individual may also be receiving systemic therapy in a year subsequent to their diagnosis, the data may count the same individual in subsequent years if still being prescribed relevant treatments. As such, the data outlining the number of people accessing these therapies may be ‘semi-cumulative’. In addition, the inclusions list (see below) includes drugs introduced onto the PBS after 2012 as well as drugs that have been delisted during the overall time period.

Data have been generated outlining the number of people to whom the therapeutic agent has been dispensed and reimbursement processed under the PBS and RPBS. Data for under co-payment prescriptions was unavailable prior to 1 April 2012.

The data are not able to measure:

Current systemic therapy agents that have been approved by the Therapeutic Goods Administration (TGA) but are not yet listed on the PBS Schedules;
PBS listed medicines that fall below the general beneficiary co-payment prior to April 2012;
Data for under co-payment prescriptions was unavailable prior to 1 April 2012.

Treatment received under clinical trials where the cost of the therapeutic agent is not reimbursed under the PBS Scheme.

Modes of delivery include infusion/ injection as well as oral delivery. Data captured is not able to measure whether or not therapies have been administered.

Inclusions:

Inclusions for the listing of therapeutic agents are provided in Table 1.

Exclusions:

The scope of the therapeutic agents is defined by the ATC Classification to be generally limited to cancer-related treatment items, but with the following exclusions applying:

For a cancer-related treatment specified drug (as defined by ATC code), if there is also application for use of the drug for treatment of disease(s) other than cancer under the PBS Schedule (as indicated by a specific PBS item number descriptor), data for the individual non-cancer related PBS items are excluded from the total person count.
Due to the limited application in cancer treatment of (i) low dose oral methotrexate and (ii) injectable methotrexate items not listed on the EFC schedule, data for these PBS item numbers have been excluded from the total person count.

Table 1: Therapeutic agent inclusions

Therapeutic agent & ATC code – Antineoplastic (L01)
Arsenic (trioxide)	L01XX27	Epirubicin	L01DB03	Ofatumumab	L01XC10
Axitinib	L01XE17	Eribulin	L01XX41	Oxaliplatin	L01XA03
Azacitidine	L01BC07	Erlotinib	L01XE03	Paclitaxel	L01CD01
Bendamustine	L01AA09	Etoposide	L01CB01	Paclitaxel Nanoparticle Albumin Bound	L01CD01
Bevacizumab	L01XC07	Everolimus	L01XE10	Panitumumab	L01XC08
Bleomycin Sulfate	L01DC01	Fludarabine	L01BB05	Pazopanib	L01XE11
Bortezomib	L01XX32	Fluorouracil	L01BC02	Pembrolizumab	L01XC18
Brentuximab Vedotin	L01XC12	Fotemustine	L01AD05	Pemetrexed	L01BA03
Busulfan	L01AB01	Gefitinib	L01XE02	Pertuzumab	L01XC13
Cabazitaxel	L01CD04	Gemcitabine	L01BC05	Ponatinib	L01XE24
Capecitabine	L01BC06	Hydroxyurea	L01XX05	Raltitrexed	L01XC02
Carboplatin	L01XA02	Idarubicin	L01DB06	Rituximab	L01XE05
Carmustine	L01AD01	Ifosfamide	L01AA06	Ruxolitinib	L01XE18
Cetuximab	L01XC06	Imatinib	L01XE01	Sorafenib	L01XE05
Chlorambucil	L01AA02	Ipilimumab	L01XC11	Sunitinib	L01XE04
Cisplatin	L01XA01	Irinotecan	L01XX19	Temozolomide	L01AX03
Cladribine	L01BB04	Lapatinib	L01XE07	Thioguanine	LO1XXX
Crizotinib	L01XE16	Lenvatinib	L01XE29	Thiotepa	L01XX17
Cyclophosphamide	L01AA01	Melphalan	L01AA03	Topotecan	L01XX17
Cytarabine	L01BC01	Mercaptopurine	L01BB02	Trametinib	L01XE25
Dabrafenib	L01XE23	Methotrexate	L01BA01	Trastuzumab	L01XC03
Dasatinib	L01XE06	Mitozantrone	L01DB07	Trastuzumab Emtansine	L01XC14
Docetaxel	L01CD02	Nilotinib	L01XE08	Vinblastine	L01CA01
Doxorubicin	L01DB01	Nivolumab	L01XC17	Vincristine	L01CA02
Doxorubicin Hydrochloride-Pegylated Liposomal	L01DB01	Obinutuzumab	L01XC15	Vinorelbine	L01CA04

Table 1 continued: Therapeutic Agent Inclusions

Therapeutic agent & ATC code
Endocrine therapies (ATC Category - L02)
Abiraterone	L02BX03	Letrozole	L02BG04
Anastrozole	L02BG03	Leuprorelin	L02AE02
Bicalutamide	L02BB03	Medroxyprogesterone	L02AB02
Degarelix	L02BX02	Megestrol	L02AB01
Enzalutamide	L02BB04	Nilutamide	L02BB02
Exemestane	L02BG06	Tamoxifen	L02BA01
Flutamide	L02BB01	Toremifene	L02BA02
Goserelin	L02AE03	Triptorelin	L02AE04
Goserelin (&) Bicalutamide	L02AE03/ L02BB03
Immunostimulants (ATC Category - L03)/ Immunosuppressants (ATC Category - L04) / Sex hormones & modulators of the genital system (ATC Category – G03)
Bacillus Calmette and Guerin-Connaught strain	L03AX03	Lenalidomide	L04AX04
Bacillus Calmette and Guerin-Tice strain	L03AX03	Thalidomide	L04AX02
Interferon Alfa-2A	L03AB04	Pomalidomide	L04AX06
Interferon Alfa-2B	L03AB05	Cyproterone	G03HA01
Treatment of bone related malignancies and/ or myeloma - including anti-osteoporotics
*Hypercalcaemia of malignancy* – Clodronate and Pamidronate Disodium; *Giant cell tumour of bone and bone metastases* - Denosumab *Multiple Myeloma and bone metastases* - Zoledronic acid
Supportive therapeutic agents
Chemotherapy-induced neutropenia and/ or mobilisation of (haematopoietic) stem cells: Lenograstim; Lipegfilgrastim; Pegfilgrastim; Filgrastim and Plerixafor.

References

Activity in this area

PBS Statistics. Available from: https://www.pbs.gov.au/info/browse/statistics (accessed June 2017).

Cancer Australia – Chemotherapy. Available from: https://canceraustralia.gov.au/affected-cancer/cancer-types/breast-cancer/treatment/what-does-treatment-breast-cancer-involve/chemotherapy (accessed June 2017).

References

Anatomical Therapeutic Chemical (ATC) classification system. WHO Collaborating Centre for Drug Statistics Methodology. https://www.whocc.no/ (accessed September 2017).
eviQ Cancer Treatments Online. https://www.eviq.org.au/ (accessed June 2017).
Australian Institute of Health and Welfare 2017. Cancer in Australia 2017. Cancer series no.101.Cat. no. CAN 100. Canberra: AIHW.
Australian Government Department of Health 2017. Efficient Funding of Chemotherapy (EFC) – Section 100 Arrangements. Available from: https://www.pbs.gov.au/info/browse/section-100/chemotherapy (accessed June 2017).

Summary

Systemic anti-cancer therapy is a major treatment activity within Australia’s health systemIn 2016, 247,939 people used systemic anti-cancer therapies accessed through the PBS.

The greatest use of systemic anti-cancer therapies occurred in older Australians25%-27% of all females who used these therapies were aged 60-69 years of age; 29% of all males who used these therapies were aged 70-79 years of age. 

The distribution of all systemic anti-cancer therapy agents by remoteness of residence was in line with the distribution of the Australian populationThe majority of people who used these systemic anti-cancer therapies (approximately two thirds) were people living in Major Cities. 

The proportion of users of systemic anti-cancer therapies was greater in areas of high socioeconomic status than of lower socioeconomic status25% of people who used these therapies were living in the highest socioeconomic status areas; 14% of people who used these therapies were living in the lowest socioeconomic status areas.

Revision Type

Major

Version Number

1.4

National Cancer Control Indicators

Systemic anti-cancer therapy treatment activity

Data

During the period 2012 to 2016

Summary

Systemic anti-cancer therapy is a major treatment activity within Australia’s health system

The greatest use of systemic anti-cancer therapies occurred in older Australians

The distribution of all systemic anti-cancer therapy agents by remoteness of residence was in line with the distribution of the Australian population

The proportion of users of systemic anti-cancer therapies was greater in areas of high socioeconomic status than of lower socioeconomic status

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Data

During the period 2012 to 2016

Summary

Systemic anti-cancer therapy is a major treatment activity within Australia’s health system

The greatest use of systemic anti-cancer therapies occurred in older Australians

The distribution of all systemic anti-cancer therapy agents by remoteness of residence was in line with the distribution of the Australian population

The proportion of users of systemic anti-cancer therapies was greater in areas of high socioeconomic status than of lower socioeconomic status

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NCCI – About the Data