A comparison of systemic breast cancer therapy utilization in Canada (British Columbia), Scotland (Dundee), and Australia (Western Australia) with models of "optimal" therapy.
BACKGROUND
Different jurisdictions report different breast cancer treatment rates. Evidence-based optimal utilization models may be specific to the derived population. We compared predicted optimal with actual endocrine and chemotherapy utilization in British Columbia, Canada; Dundee, Scotland; and Perth, Western Australia.


METHODS
Data were analyzed for differences in demography, tumour, and treatment. Epidemiological data were fitted to published Australian optimal radiotherapy utilization trees and region-specific optimal treatment rates were calculated. Optimal and actual systemic therapy rates from 2 population-based and 1 institution-based cancer registries were compared for patients diagnosed with breast cancer between 2000-2004, and 2002 for British Columbia.


RESULTS
Chemotherapy rates differed between British Columbia (32%), Perth (29%), and Dundee (24%, p = 0.014). Endocrine therapy rates were similar between British Columbia (56%), Perth (59%), and Dundee (64%, p > 0.05). Actual utilization rates were lower than optimal estimates for chemotherapy, but higher for endocrine therapy. Region-specific optimal utilization rates at diagnosis varied between 50-56% for chemotherapy, and 49-54% for endocrine therapy. Variation was attributed to local differences in demographics, and tumour stage.


CONCLUSIONS
Actual treatment rates varied. There was lower than estimated optimal chemotherapy use but higher than expected use of endocrine therapy.
Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Hospital, Australia. andrewfong@eml.cc
Andrew
A
Fong
Jesmin
J
Shafiq
Christobel
C
Saunders
Alastair
A
Thompson
Scott
S
Tyldesley
Ivo A
IA
Olivotto
Michael B
MB
Barton
John A
JA
Dewar
Susannah
S
Jacob
Weng
W
Ng
Caroline
C
Speers
Geoff P
GP
Delaney
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy*; D001955:British Columbia; D004363:Drug Utilization / Q000592:standards / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D008962:Models, Theoretical; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012042:Registries; D012606:Scotland; D014904:Western Australia
D000970:Antineoplastic Agents; D018931:Antineoplastic Agents, Hormonal