Estimation of an optimal chemotherapy utilisation rate for lung cancer: An evidence-based benchmark for cancer care

Jacob, Susannah; Hovey, Elizabeth; Ng, Weng; Vinod, Shalini; Delaney, Geoff P.; Barton, Michael B.

doi:10.1016/j.lungcan.2009.11.017

« Previous Next »Lung Cancer
Volume 69, Issue 3 , Pages 307-314, September 2010

Estimation of an optimal chemotherapy utilisation rate for lung cancer: An evidence-based benchmark for cancer care

Susannah Jacob
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Liverpool Hospital and Faculty of Medicine, University of New South Wales, Sydney, Australia
- Corresponding author at: Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Liverpool Hospital, Locked Bag 7103, Liverpool, Sydney, NSW 1871, Australia. Tel.: +61 2 9828 6542; fax: +61 2 9828 6670.
Elizabeth Hovey
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia
Weng Ng
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Liverpool Hospital and Faculty of Medicine, University of New South Wales, Sydney, Australia
Shalini Vinod
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Liverpool Hospital and Faculty of Medicine, University of New South Wales, Sydney, Australia
Geoff P. Delaney
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Liverpool Hospital and Faculty of Medicine, University of New South Wales, Sydney, Australia
Michael B. Barton
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Liverpool Hospital and Faculty of Medicine, University of New South Wales, Sydney, Australia

Received 15 September 2009; received in revised form 24 November 2009; accepted 29 November 2009. published online 18 January 2010.

Abstract

Background

Optimal chemotherapy utilisation rates can serve as benchmarks to assess the quality of cancer service delivery. This study aims to determine the optimal proportion of patients with lung cancer that should receive chemotherapy at least once during the course of their illness, based on the best available evidence.

Methods

An optimal chemotherapy utilisation tree was constructed using indications for chemotherapy 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 an optimal chemotherapy utilisation rate. This optimal rate was compared with reported actual rates of chemotherapy utilisation.

Results

Chemotherapy is recommended at least once in 73% of all patients with lung cancer (93% of small cell lung cancer (SCLC) patients and 69% of non-small cell lung cancer (NSCLC) patients). Comparison of these benchmark rates with international reported actual chemotherapy utilisation rates reveals under-utilisation of chemotherapy in all newly diagnosed lung cancer patients, regardless of histological type and stage, with the exception of stage I NSCLC.

Conclusion

The optimal chemotherapy utilisation rate can serve as a feasible, evidence-based measure of the quality of cancer care. Chemotherapy may be under-utilised in the initial management of lung cancer.

Keywords: Lung cancer, Chemotherapy utilisation rate, Optimal chemotherapy utilisation, Evidence-based clinical guidelines, Small cell lung cancer, Non-small cell lung cancer