Aims: We aimed to examine oral-anti-cancer-medication (OAM)-dispensing rates across all areas of Australia, and determine whether area- and population-level factors affect OAM-dispensing rates.
Methods: An ecological study was undertaken. OAMs were defined as orally administered antineoplastics or immunosuppressants primarily used in cancer. OAM-dispensing and population counts for 336 Statistical Area Level 3 (SA3) areas in 2023 were sourced from Services Australia and Australian Bureau of Statistics, respectively. OAM-dispensing rates per 10,000 population were collapsed into quintiles for choropleth mapping and multivariable partial proportional odds ordinal logistic regression. OAM-dispensing rates per 10,000 population were categorised into lowest (0-73.5), lower (73.6-98.7), middle (98.8-127.7), higher (127.8-164.1) and highest (164.2-1,473.4) levels.
Results: Median OAM-dispensing rates per 10,000 population were 110.1 across SA3s Australia-wide, 106.2 across remote/rural/regional (henceforth termed ‘rural’) SA3s, and 112.3 across metropolitan SA3s. Rural SA3s tended to be independently associated with decreasing OAM-dispensing-rate levels, while percentage of 85+-year-olds tended to be independently associated with increasing OAM-dispensing-rate levels (p-value<0.05). An increase in community-pharmacy-density levels was independently associated with greater odds of increased OAM-dispensing-rate levels (p-values<0.05). Highest-level socioeconomic status, Victorian SA3s and Queensland SA3s were independently associated with greater odds of highest-level-OAM-dispensing rates (p-values<0.05). Percentages of females and 65-84-year-olds were unrelated to OAM-dispensing-rate levels. Areas of lowest-level-OAM-dispensing rates were clustered across large parts of some states/territories, particularly the Northern Territory, which had Australia’s lowest median OAM-dispensing rate per 10,000 population (14.6).
Conclusions: OAM-dispensing rates were lower in rural than metropolitan areas and higher in other (e.g., older and socioeconomically advantaged) areas. Health services in areas of lowest-level-OAM-dispensing rates—particularly rural and socioeconomically disadvantaged areas—could investigate why OAM-dispensing rates are so low (e.g., low cancer rates or OAM access issues). Clinicians in areas of highest-level-OAM-dispensing rates could consider whether they need further education and resources to optimally care for everyone taking OAMs, particularly 85+-year-olds.