Optimal chemotherapy utilization rate in cancer care: Setting an evidence-based benchmark for quality improvement.
2010; Lippincott Williams & Wilkins; Volume: 28; Issue: 15_suppl Linguagem: Inglês
10.1200/jco.2010.28.15_suppl.6099
ISSN1527-7755
AutoresW. L. Ng, Susannah Jacob, Geoff P. Delaney, Maria Barton,
Tópico(s)Economic and Financial Impacts of Cancer
Resumo6099 Background: A wide variation in the utilization rates of chemotherapy exists in cancer care in Australia and internationally. We developed an evidence-based utilization model to estimate the optimal proportion of new cases of cancer where chemotherapy is indicated at least once as a benchmark for measuring and improving the quality of care. Methods: We constructed an optimal chemotherapy utilization model using indications for chemotherapy identified from evidence-based treatment guidelines. Population-based data on the proportion of patient and tumor-related attributes for which chemotherapy was indicated were obtained from Australian cancer registries where possible. Treatment indications and epidemiological data were merged using TreeAge Pro 2007 to calculate the optimal rate. Monte Carlo simulations and sensitivity analyses were used to assess the impact of controversial chemotherapy indications and variations in epidemiological data on our model. Results: Chemotherapy was indicated at least once in 50.8% (95% CI 50.6-51%) of all new cancer patients. The optimal chemotherapy utilization rates by tumor sites ranged from a low of 13% in thyroid cancers to a high of 94% in myeloma. Conclusions: Our model generates an optimal chemotherapy utilization rate that can function as a valuable evidence-based benchmark against which patterns of care data on chemotherapy utilization may be compared. The actual chemotherapy utilization rate appears to be substantially lower than the optimal rate in most tumor sites (except for liver cancer) suggesting that chemotherapy may be underutilized in cancer treatment. Optimal and actual chemotherapy utilization rates by tumor site Tumor site Optimal rate (%) Actual rate (%) Breast 68 29-42 Colon 55 28-32 Lung 73 21-41 Rectum 64 42-54 Prostate 15 NA Melanoma 19 NA Head and neck 36 12-17 Unknownprimary 65 5-49 Lymphoma 85 NA Leukemia 85 NA Pancreas 35 19-31 Stomach 83 10-34 Urinary bladder 66 10-28 Kidney 33 3-7 Thyroid 13 1-2 Brain 72 NA Endometrium 20 2-12 Esophagus 79 38-52 Gallbladder 80 22-24 Liver 27 22-37 Testis 70 NA Myeloma 94 76 Ovary 84 52-79 Cervix 51 NA Abbreviation: NA, not available. No significant financial relationships to disclose.
Referência(s)