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.
Aim: To estimate optimal uptake rates for surgery, radiotherapy, chemotherapy and chemo-radiotherapy for cervical cancer in Australia and Canada, and to quantify the differences in the optimal and the observed treatment utilisation rates in the two settings.
Methods: A decision tree was constructed to reflect treatments according to guidelines and current practice (in 1999-2008) in Australia and Canada. 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 overall stage distribution at diagnosis in the two countries. The estimated optimal rates for surgery, radiotherapy, chemotherapy and chemo-radiotherapy in Australia were 63% (95% credible range: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 in the two countries; the absolute differences for chemotherapy and chemo-radiotherapy were higher (9-15%) than those for surgery and radiotherapy (<5%) in both countries.
Conclusions:This is the first study to use detailed patterns of care data in multiple countries to compare optimal and observed rates of all treatment modalities for cervical cancer. We found that optimal treatment rates were largely dependent on the overall stage distribution in a given setting. In Australia and Canada, observed surgery rates were similar to the estimated optimal rates, whereas radiotherapy, chemotherapy and chemo-radiotherapy appeared to be under-utilised.