title: Estimation of an optimal chemotherapy utilisation rate for head and neck carcinoma: setting an evidence-based benchmark for the best-quality cancer care.
abstract: BACKGROUND
  We estimated the optimal chemotherapy utilisation rate for head and neck cancer as a benchmark for measuring and improving the quality of cancer care.
  
  
  METHODS
  An optimal chemotherapy utilisation tree was constructed using indications for chemotherapy that were identified from evidence-based treatment guidelines. Data on the proportion of patient and tumour-related attributes for which chemotherapy was indicated were obtained and merged with the treatment indications to calculate the optimal utilisation rate. The robustness of the model was tested with sensitivity analysis and Monte Carlo simulation. The optimal chemotherapy utilisation rate was compared with actual utilisation rates reported.
  
  
  RESULTS
  Chemotherapy is indicated at least once in 36% (95% CI, 33-38%) of all patients with head and neck carcinoma. The optimal utilisation rates by subsites were as follows: lip, 8%; oral cavity, 40%; nasopharynx, 69%; oropharynx, 66%; hypopharynx, 74%; larynx, 43%; salivary gland, 48% and paranasal sinus with nasal cavity, 38%.
  
  
  CONCLUSIONS
  The optimal proportion of patients who should receive chemotherapy in the head and neck carcinoma population has risen significantly over the past 20 years. This temporal rise does not appear to be reflected in the limited actual utilisation rates that are available for comparison. Large population-based studies are recommended to further assess the current practice and compliance to guideline recommended care.
authors.affiliation: Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Hospital and Faculty of Medicine, University of New South Wales, Liverpool, NSW, Sydney, Australia. Weng.Ng@swsahs.nsw.gov.au
authors.forename: Weng
authors.initials: W
authors.lastname: Ng
authors.forename: Susannah
authors.initials: S
authors.lastname: Jacob
authors.forename: Geoff
authors.initials: G
authors.lastname: Delaney
authors.forename: Michael
authors.initials: M
authors.lastname: Barton
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D019985:Benchmarking; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy*; D019317:Evidence-Based Medicine; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic