Optimal chemotherapy utilisation rate in breast cancer: setting an evidence-based benchmark for the best-quality cancer care

Abstract

6613 Background: The proportion of patients with breast cancer receiving chemotherapy varies from 21% to 42% in high-income countries. The utility and accountability of the quality measures developed by The National Initiative for Cancer Care Quality and National Quality Forum are limited by the lack of benchmarks that can be applied to the entire breast cancer population. The aim of this study was to estimate the optimal proportion of patients with breast cancer who should receive chemotherapy at 1) first course of treatment and 2) at least once during the course of their illness. Methods: Indications for chemotherapy were identified from all nationally endorsed guidelines. Epidemiological data on the proportion of patient (age, performance status, patient preference) and tumour (stage, size, grade, nodal status, hormone receptor and HER2 status) attributes for each indication were sourced and ranked. Treatment indications and epidemiological data were merged using the decision analysis software (TreeAge Pro 2007) to construct an optimal chemotherapy utilisation model. Sensitivity analyses were performed to assess the impact of controversial indications and major variations in the epidemiological data on the overall utilisation rate. The model was externally reviewed by independent experts. Results: Chemotherapy is indicated in 58% of patients as part of their initial management of breast cancer. Chemotherapy is indicated at least once during the course of their disease in 68% of breast cancer patients. Sensitivity analyses indicate a range of 51%-59% for first course of treatment and 60–69% for at least once during the course of their illness. The available data on actual first course treatment rates in Australia (32%), United States (36%), United Kingdom (29%) and Canada (40%-42%) showed underutilisation of chemotherapy for breast cancer. Conclusions: The evidence-based model sets an optimal chemotherapy utilisation rate for breast cancer. Available data from high-income countries showed significant underutilisation of chemotherapy for breast cancer. No significant financial relationships to disclose.