title: Optimal uptake rates for initial treatments for cervical cancer in concordance with guidelines in Australia and Canada: Results from two large cancer facilities.
abstract: BACKGROUND
  Prior work estimating optimal treatment utilisation rates for cervical cancer has focused on radiotherapy or chemotherapy, using proportions of patients with clinical indications for specific treatment strategies which were obtained from the published literature.
  
  
  OBJECTIVE
  To estimate optimal uptake rates for surgery, radiotherapy, chemotherapy and chemo-radiotherapy for cervical cancer treatment in Australia and Canada, and to quantify the differences in the optimal and the observed treatment utilisation rates in a large cancer facility from each country.
  
  
  METHODS
  A decision tree was constructed to reflect treatments according to guidelines and current practice (in 1999-2008) in each setting. Detailed patterns of care data from a large cancer facility in each country were obtained, and the observed stage distribution and proportions of patients with each clinical indication were used as inputs.
  
  
  RESULTS
  The estimated overall optimal treatment rates for cervical cancer in Australia and Canada differed, largely due to the difference in the stage distribution at diagnosis in the two settings; 72% vs 54% with FIGO IA-IIA disease, respectively. The estimated optimal rates for surgery, radiotherapy, chemotherapy and chemo-radiotherapy in Australia were 63% (95% credible interval: 61-64%), 52% (53-56%), 36% (35-38%) and 36% (35-38%), respectively. The corresponding rates in Canada were 38% (36-39%), 68% (68-71%), 51% (49-52%) and 50% (49-51%), respectively. The absolute differences between the optimal and the observed rates were similar between the two settings; the absolute differences for chemotherapy and chemo-radiotherapy uptake were more pronounced (9-15% less than optimal) than those for surgery and radiotherapy uptake (within 5% of optimal).
  
  
  CONCLUSIONS
  This is the first study to use detailed patterns of care data in multiple settings to compare optimal and observed rates for all cervical cancer treatment modalities. We found optimal treatment rates were largely dependent on the overall stage distribution. In Australia and Canada, observed surgery rates, as measured in the two large cancer facilities, were similar to the estimated optimal rates, whereas radiotherapy, chemotherapy and chemo-radiotherapy appeared to be under-utilised.
authors.affiliation: Prince of Wales Clinical School, UNSW, New South Wales, Australia(1); Cancer Research Division, Cancer Council NSW, New South Wales, Australia(2); School of Public Health, University of Sydney, New South Wales, Australia(3). Electronic address: yoonjung.kang@nswcc.org.au.
authors.forename: Yoon-Jung
authors.initials: YJ
authors.lastname: Kang
authors.affiliation: Cancer Research Division, Cancer Council NSW, New South Wales, Australia(2); School of Public Health, University of Sydney, New South Wales, Australia(3); School of Public Health and Community Medicine, UNSW, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, New South Wales, Australia. Electronic address: dianneo@nswcc.org.au.
authors.forename: Dianne L
authors.initials: DL
authors.lastname: O'Connell
authors.affiliation: Royal Women's Hospital, Victoria, Australia. Electronic address: Jeff.Tan@thewomens.org.au.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Tan
authors.affiliation: Prince of Wales Clinical School, UNSW, New South Wales, Australia(1); Cancer Research Division, Cancer Council NSW, New South Wales, Australia(2). Electronic address: jiebin.lew@nswcc.org.au.
authors.forename: Jie-Bin
authors.initials: JB
authors.lastname: Lew
authors.affiliation: Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada. Electronic address: alain.demers@phac-aspc.gc.ca.
authors.forename: Alain
authors.initials: A
authors.lastname: Demers
authors.affiliation: Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Division of Gynecologic Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada. Electronic address: rlotocki@mymts.net.
authors.forename: Robert
authors.initials: R
authors.lastname: Lotocki
authors.affiliation: Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Cancer Control Research, British Columbia Cancer Agency, Vancouver, British Columbia, Canada. Electronic address: Erich.Kliewer@cancercare.mb.ca.
authors.forename: Erich V
authors.initials: EV
authors.lastname: Kliewer
authors.affiliation: Royal Hospital for Women, New South Wales, Australia. Electronic address: neville.hacker@sesiahs.health.nsw.gov.au.
authors.forename: Neville F
authors.initials: NF
authors.lastname: Hacker
authors.affiliation: Prince of Wales Hospital, New South Wales, Australia. Electronic address: Michael.Jackson@sesiahs.health.nsw.gov.au.
authors.forename: Michael
authors.initials: M
authors.lastname: Jackson
authors.affiliation: Collaboration for Cancer Outcomes Research & Evaluation, Ingham Institute for Applied Medical Research, UNSW Australia, Sydney, New South Wales, Australia. Electronic address: Geoff.Delaney@sswahs.nsw.gov.au.
authors.forename: Geoff P
authors.initials: GP
authors.lastname: Delaney
authors.affiliation: Collaboration for Cancer Outcomes Research & Evaluation, Ingham Institute for Applied Medical Research, UNSW Australia, Sydney, New South Wales, Australia. Electronic address: Michael.Barton@sswahs.nsw.gov.au.
authors.forename: Michael
authors.initials: M
authors.lastname: Barton
authors.affiliation: Prince of Wales Clinical School, UNSW, New South Wales, Australia(1); Cancer Research Division, Cancer Council NSW, New South Wales, Australia(2). Electronic address: karen.canfell@nswcc.org.au.
authors.forename: Karen
authors.initials: K
authors.lastname: Canfell
mesh_terms: D001315:Australia; D002170:Canada; D005260:Female; D006801:Humans; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000628:therapy*
keywords: Cervical cancer; decision tree; guidelines; optimal rate; treatment