Estimation of an evidence-based benchmark for the optimal endocrine therapy utilization rate in breast cancer.
BACKGROUND
There are no evidence-based benchmarks to establish optimal rates of use of endocrine therapy in the whole breast cancer population. Reported utilization rates vary widely. The aim of the study was to estimate the optimal proportion of breast cancer patients who should receive endocrine therapy based on treatment guideline recommendations and to compare this with actual treatment rates.


METHODS
An optimal endocrine therapy utilization tree was constructed based on indications from evidence-based treatment guidelines. Frequency data on patient and tumour attributes were obtained from Australian cancer registries where possible and merged with the guideline recommendations to calculate the optimal utilization rate. These were compared with actual proportions obtained from published reports.


RESULTS
According to the best available evidence, the proportion of invasive breast cancer patients in whom endocrine therapy is indicated at diagnosis is 67%. Endocrine therapy is under-utilized in Australia (actual utilization rate 41%), and USA (35%), but approximate the benchmark rate in the UK (75%) and Italy (63%).


CONCLUSIONS
This evidence-based model provides a benchmark for optimal endocrine therapy utilization rates in the breast cancer population, and comparison of best practice evidence and actual treatment. The results show an underutilization of endocrine therapy in Australia and the USA, with more appropriate utilization in the UK and Italy.
Fong
Andrew
A
Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Hospital and the Faculty of Medicine, Liverpool NSW 1871, University of New South Wales, Sydney, Australia. andrewfong@eml.cc
Ng
Weng
W
Barton
Michael B
MB
Delaney
Geoff P
GP
D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001315:Australia; D019985:Benchmarking / Q000379:methods*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data*; D003661:Decision Support Techniques; D004363:Drug Utilization; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007558:Italy; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D006113:United Kingdom; D014481:United States
D018931:Antineoplastic Agents, Hormonal; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone