Estimation of an optimal radiotherapy utilization rate for breast carcinoma: a review of the evidence.
BACKGROUND
Radiotherapy utilization rates for breast carcinoma vary widely, both within and between countries. Current estimates of the proportion of patients with carcinoma who optimally should receive radiotherapy are based either on expert opinion or on the measurement of actual utilization rates, and not on the best scientific evidence.


METHODS
To develop an evidence-based benchmark for radiotherapy utilization in patients with breast carcinoma, the authors undertook a systematic review of treatment guidelines on the use of radiotherapy for breast carcinoma. A decision tree was constructed, and the proportions of patients with clinical features that lead to a decision for radiotherapy were obtained from epidemiological data. This ideal utilization rate was compared with the utilization rates of radiotherapy over the last decade for breast carcinoma in Australia and internationally.


RESULTS
The proportion of patients with breast carcinoma in whom radiotherapy would be recommended according to the best available evidence was calculated at 83% (95% confidence interval, 82-85%) of all patients with breast carcinoma. A review of actual radiotherapy utilization rates for breast carcinoma revealed that, in clinical practice, actual utilization rates varied between 24% and 71%.


CONCLUSIONS
A substantial difference was found between the recommended optimal utilization of radiotherapy based on evidence and the actual rates reported in clinical practice. The reasons for these differences need to be examined, and a plan for addressing the suboptimal use of radiotherapy needs to be implemented. Cancer 2003.
Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Hospital, Sydney, Australia. delaney@swsahs.nsw.gov.au
Geoff
G
Delaney
Michael
M
Barton
Susannah
S
Jacob
D001943:Breast Neoplasms / Q000453:epidemiology / Q000532:radiotherapy*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008954:Models, Biological; D020380:Needs Assessment; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011878:Radiotherapy / Q000706:statistics & numerical data*; D012680:Sensitivity and Specificity