Chemotherapy use in ovarian cancer patients diagnosed 2012-2017 in Australia, Canada, Norway and the UK: An International Cancer Benchmarking Partnership (ICBP) population-based study.
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Barclay Matthew E, McPhail Sean, Johnson Shane A, Swann Ruth, Butler John, Finley Christian J, Barisic Andriana, Bennett Damien, Bucher Oliver, Creighton Nicola, Denny Cheryl A, Dewar Ron A, Donnelly David W, Downie Laura, Finn Norah, Habbous Steven, Huws Dyfed W, May Leon, Møller Bjørn, Morrison David S, Musto Grace, Nilssen Yngvar, Saint-Jacques Nathalie, Shack Lorraine, Te Marvelde Luc, Tian Xiaoyi, Thomas Robert J S, Thomson Catherine S, Walton Richard, Wong Tommy Hon Ting, Woods Ryan R, You Hui, Lyratzopoulos Georgios, ICBP Module 9 Ovarian Study Group
Аннотация
METHODS: Linked population-based data sources were used to describe use and time to chemotherapy initiation in ovarian cancer patients diagnosed in study periods during 2012-2017. Random-effects meta-analysis characterised the size of interjurisdictional variation.
RESULTS: Among 39,879 patients, chemotherapy use ranged from 49 % (Wales) to 75 % (Manitoba). Across jurisdictions, chemotherapy use was higher in advanced disease (79 %, 95 %CI: 74 %-83 %), and lower for stages 1-2 or localised/regional disease (54 %, 95 %CI: 48 %-60 %). Within jurisdictions, chemotherapy use was similar in patients aged 15-64 and 65-74 and then decreased sharply with increasing age. There was large interjurisdictional variation in chemotherapy use in patients aged 85-99 years with advanced disease, being, for example, 23 % (95 %CI: 20 %-25 %) in England and 61 % (95 %CI: 51 %-70 %) in Ontario. However, jurisdictions with the highest chemotherapy use in recorded advanced stage, including Ontario, tended to have higher percentage of missing stage information. Overall, time from diagnosis to chemotherapy initiation was shorter in New South Wales and Victoria and longer in Scotland and Wales. In patients with advanced disease, interjurisdictional variation in time-to-treatment was limited.
CONCLUSIONS: Even within the same age groups and stage strata, use of chemotherapy varied substantially between jurisdictions during the mid-2010s. Future work should examine use of surgery in combination with chemotherapy. The reasons for the international variation in chemotherapy use and its contribution to international variation in survival should be established.