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Andrew Fong,
Jesmin Shafiq,
Christobel Saunders,
Alastair Thompson,
Scott Tyldesley,
Ivo A Olivotto,
Michael B Barton,
John A Dewar,
Susannah Jacob, Weng Ng,
Caroline Speers,
Geoff P Delaney
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ABSTRACT: 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.
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.
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.
Actual treatment rates varied. There was lower than estimated optimal chemotherapy use but higher than expected use of endocrine therapy.
Breast (Edinburgh, Scotland) 01/2012; 21(4):562-9. · 2.09 Impact Factor
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ABSTRACT: Ethnic minority is associated with higher cancer incidence and poorer survival than is being in the majority group. We did a systematic review and meta-analysis to assess whether psychological morbidity and health-related quality of life (HRQoL) were affected by minority status.
We searched Medline, AMED, PsycINFO, Embase, CENTRAL, CINAHL, PubMed, Sociological Abstracts, and Web of Science for English-language articles published between Jan 1, 1995, and October, 2009. Articles were eligible if they reported original data on anxiety, depression, distress (for psychological morbidity), or HRQoL in minority and majority cancer patients or survivors. Minority status was defined as being an immigrant or having an ethnic, linguistic, or religious background different to the majority of the population in the country where the research was done. We excluded African Americans and indigenous groups. Eligible articles were rated for quality of reporting, external validity, internal validity, sample size, and power. Each quality criterion was rated independently by two reviewers until inter-rater reliability was achieved. In a meta-analysis we compared mean scores adjusted for socioeconomic status and other sociodemographic and clinical variables, where available. Effect sizes greater than 0·5 and 95% CI that included 0·5 or -0·5 were deemed clinically important, with negative values indicating worse outcomes in minority patients. We assessed publication bias by estimating the number of potential unpublished studies and the number of non-signficant studies with p=0·05 required to produce a non-significant overall result.
We identified 21 eligible articles that included 18 datasets collected in the USA and one in each of Canada, Romania, and the UK. Ethnic minority groups were Hispanic, Asian or Pacific Islander, or Hungarian (one dataset). Overall, we found minority versus majority groups to have significantly worse distress (mean difference -0·37, 95% CI -0·46 to -0·28; p<0·0001), depression (-0·23, -0·36 to -0·11; p=0·0003), and overall HRQoL (-0·33, -0·58 to -0·07; p=0·013). Further analyses found disparities to be specific to Hispanic patients in the USA, in whom poorer outcomes were consistent with potentially clinically important differences for distress (effect size -0·37, 95% CI -0·54 to -0·20; p<0·0001), social HRQoL (-0·45, -0·87 to -0·03; p=0·035), and overall HRQoL (-0·49, -0·78 to -0.20; p=0·0008). Results were significantly heterogeneous for overall HRQoL and all domains. Tests for interaction, for adjusted versus unadjusted and comparisons of high-quality, medium-quality, and low-quality articles, were generally non-significant, which suggests no bias. We found no evidence of any substantive publication bias.
Hispanic cancer patients in the USA, but not other ethnic minority groups, report significantly worse distress, depression, social HRQoL, and overall HRQoL than do majority patients, of which all but depression might be clinically important. Heterogeneous results might, however, have limited the interpretation. Data for other minority groups and for anxiety are scarce. More studies are needed from outside the USA. Future reports should more clearly describe their minority group samples and analyses should control for clinical and sociodemographic variables known to predict outcomes. Understanding of why outcomes are poor in US Hispanic patients is needed to inform the targeting of interventions.
Prince of Wales Hospital, Sydney, Australia.
The lancet oncology 12/2011; 12(13):1240-8. · 14.47 Impact Factor
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ABSTRACT: 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.
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.
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.
Chemotherapy may be under-utilized in the initial management of patients presenting with metastatic rectal cancer.
Clinical Colorectal Cancer 06/2011; 10(2):102-7. · 1.68 Impact Factor
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ABSTRACT: 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.
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.
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.
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.
Lung cancer (Amsterdam, Netherlands) 09/2010; 69(3):307-14. · 3.14 Impact Factor
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ABSTRACT: 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.
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.
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%).
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.
Breast (Edinburgh, Scotland) 03/2010; 19(5):345-9. · 2.09 Impact Factor
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ABSTRACT: The proportion of breast cancer patients that received chemotherapy varies widely in high-income countries. An evidence-based estimate of the optimal chemotherapy utilisation rate for a breast cancer population may serve as a useful benchmark for measuring and improving the quality of care.
An optimal chemotherapy utilisation model was constructed using indications for chemotherapy identified from evidence-based guidelines. Data on the proportion of patient (age, performance status and preference) and tumour (stage, size, grade, nodal status, hormone receptor and HER2 status) attributes were obtained and merged with the treatment indications to calculate an optimal utilisation rate. This model was peer-reviewed by a panel of independent experts.
Chemotherapy was indicated in 17 of the 24 possible clinical scenarios depicted in the optimal utilisation model. The estimated optimal proportion of breast cancer patients who should received chemotherapy at least once was 68%. Sensitivity analyses showed that the range of optimal rate was 60-69%. The optimal rate appears to be substantially higher than the reported actual rates (29-49%).
It is possible to generate an optimal chemotherapy utilisation rate in breast cancer to serve as an evidence-based benchmark. The optimal chemotherapy utilisation rate in breast cancer has remained largely unchanged over the past 15years. The reported actual utilisation rates of chemotherapy in breast cancer populations appear to have remained below the estimated optimal rate, suggesting that potential opportunities for improvement in the compliance to guideline recommended care exist.
European journal of cancer (Oxford, England: 1990) 03/2010; 46(4):703-12. · 4.12 Impact Factor
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ABSTRACT: Optimal chemotherapy (CT) utilisation rates can serve as benchmarks to assess the quality of cancer care. This study aims to determine the optimal proportion of patients with colon cancer that should receive chemotherapy at least once.
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 (CTU rate). This optimal rate was compared with reported actual rates of chemotherapy utilisation.
Chemotherapy is indicated at least once in 55% of patients with colon cancer. While 89% of colon cancer patients presenting with Stage IV disease should optimally receive chemotherapy, 38-52% actually received chemotherapy as part of their initial treatment.
The optimal chemotherapy utilisation rate can serve as an evidence-based benchmark in the planning and evaluation of chemotherapy services. Chemotherapy may be under-utilised in the initial management of patients presenting with metastatic colon cancer.
European journal of cancer (Oxford, England: 1990) 07/2009; 45(14):2503-9. · 4.12 Impact Factor
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ABSTRACT: We estimated the optimal chemotherapy utilisation rate for head and neck cancer as a benchmark for measuring and improving the quality of cancer care.
An optimal chemotherapy utilisation tree was constructed using indications for chemotherapy that were 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 the optimal utilisation rate. The robustness of the model was tested with sensitivity analysis and Monte Carlo simulation. The optimal chemotherapy utilisation rate was compared with actual utilisation rates reported.
Chemotherapy is indicated at least once in 36% (95% CI, 33-38%) of all patients with head and neck carcinoma. The optimal utilisation rates by subsites were as follows: lip, 8%; oral cavity, 40%; nasopharynx, 69%; oropharynx, 66%; hypopharynx, 74%; larynx, 43%; salivary gland, 48% and paranasal sinus with nasal cavity, 38%.
The optimal proportion of patients who should receive chemotherapy in the head and neck carcinoma population has risen significantly over the past 20 years. This temporal rise does not appear to be reflected in the limited actual utilisation rates that are available for comparison. Large population-based studies are recommended to further assess the current practice and compliance to guideline recommended care.
European journal of cancer (Oxford, England: 1990) 04/2009; 45(12):2150-9. · 4.12 Impact Factor
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ABSTRACT: To describe the presentation and treatment of a Taser penetrating ocular injury.
Case report.
A 50-year-old man with a Taser injury 1.5 cm below the right lower eyelid margin was admitted to the emergency department of a tertiary hospital. The case report describes the ophthalmic assessment, investigation, treatment, and outcome of the Taser barb penetrating ocular injury.
The Taser has a fish hook barb that caused a full-thickness wound adequately large for vitreous to escape when the Taser was removed. Consequently, the scleral wound was repaired and cryopexy was performed. The affected eye made a satisfactory recovery, and the visual acuity was 6/9 with a pinhole 1 week after operation.
Any Taser injury around the orbits should raise the suspicion of a penetrating ocular injury. In likely cases, removal of the Taser should be performed in an operating theater under general anesthesia.
American Journal of Ophthalmology 05/2005; 139(4):713-5. · 4.22 Impact Factor
