title: Chemotherapy in rectal cancer: variation in utilization and development of an evidence-based benchmark rate of optimal chemotherapy utilization.
abstract: BACKGROUND
  Published chemotherapy utilization rates for rectal cancer show considerable variation. Optimal chemotherapy utilization rates can serve as benchmarks to assess the quality of cancer care. The purpose of this study was to determine the optimal proportion of patients with rectal cancer who should receive chemotherapy at least once.
  
  
  METHODS
  An optimal chemotherapy utilization tree was constructed using indications for chemotherapy identified from evidence-based treatment guidelines. Epidemiologic data were merged with treatment indications to calculate an optimal chemotherapy utilization rate; this rate was compared with reported actual rates of chemotherapy utilization.
  
  
  RESULTS
  Chemotherapy is indicated at least once in 64% of patients with rectal cancer. Although the actual (Australian and United States data) and optimal utilization rates are comparable for patients presenting in stages II or III rectal cancer, actual utilization rates are higher than the optimal for stage I and lower than optimal for patients presenting in stage IV rectal cancer.
  
  
  CONCLUSIONS
  Chemotherapy may be under-utilized in the initial management of patients presenting with metastatic rectal cancer.
authors.affiliation: Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Liverpool Hospital, Sydney, Australia and University of New South Wales, Sydney, Australia. Susannah.Jacob@sswahs.nsw.gov.au
authors.forename: Susannah
authors.initials: S
authors.lastname: Jacob
authors.forename: Weng
authors.initials: W
authors.lastname: Ng
authors.forename: Ray
authors.initials: R
authors.lastname: Asghari
authors.forename: Geoff P
authors.initials: GP
authors.lastname: Delaney
authors.forename: Michael B
authors.initials: MB
authors.lastname: Barton
mesh_terms: D000970:Antineoplastic Agents / Q000592:standards* / Q000627:therapeutic use*; D019985:Benchmarking / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D012004:Rectal Neoplasms / Q000188:drug therapy*
chemical_list: D000970:Antineoplastic Agents