Download files
Abstract
Introduction: Chemotherapy utilisation rates can vary widely between area health services, between states and internationally. Variation in chemotherapy utilisation rates is particularly marked in lung cancer, which is the major cause of cancer death in many developed countries including Australia. This study aims to estimate, using the best available evidence, the proportions of patients with cancers of the lung, colon, rectum, prostate, brain, testes and leukaemia that should ideally receive chemotherapy at least once at some time during the course of their disease (the optimal utilisation rate). These optimal utilisation rates can serve as benchmarks to evaluate chemotherapy service provision for the above cancers.
Methods: Models of optimal chemotherapy utilisation (optimal utilisation trees) were constructed for each of the above seven cancer sites based on indications for chemotherapy identified from evidence-based treatment guidelines. Data on the proportion of patients with clinical attributes corresponding to each branch in the tree were identified, using Australian population-based data wherever possible. The treatment indications and epidemiological data were merged using TreeAge Pro 2007 to calculate an optimal chemotherapy utilisation rate for each cancer. Sensitivity analyses were conducted to assess the impact of controversial chemotherapy indications and variations in epidemiological data on the optimal utilisation rates. In those cancers where recent actual utilisation rates were identified, the reported actual rates were compared with the calculated optimal rates.
Results: The proportion of cancer patients in whom chemotherapy is indicated at least once during the course of their illness is 73% of all lung cancer patients, 55% of all patients with colon cancer, 64% of rectal cancer, 72% of brain cancer, 15% of prostate cancer, 70% of testicular cancer patients and 86% of patients with leukaemia. Chemotherapy is under-utilised in the initial management of patients with lung, colon and rectal cancers.
Conclusions: This study has identified areas of significant under-utilisation of chemotherapy in some of the commonest cancers in Australia. The models of optimal chemotherapy utilisation developed in this study can easily be modified to take into account any future changes in cancer incidence, stage at presentation, or treatment recommendations.