Shack Lorraine, Lu Shuang, Weeks Lee-Anne, Craighead Peter, Kerba Marc
Department of Oncology, Cumming School of Medicine, University of Calgary, Canada; Surveillance & Reporting, C-MORE, CancerControl, Alberta Health Services, Canada; Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada.
Surveillance & Reporting, C-MORE, CancerControl, Alberta Health Services, Canada.
Radiother Oncol. 2017 Jan;122(1):152-158. doi: 10.1016/j.radonc.2016.12.006. Epub 2016 Dec 21.
Determining the appropriate rate of radiotherapy (RT) utilization is important for health care planning and resource allocation. The difference between the observed and the appropriate RT rate is influenced by the choice of a criterion based benchmarking (CBB) or evidence-based estimates (EBEST) measure. Our primary objective was to determine the utilization of radiotherapy for cancers of the breast (B), cervix (C), lung (L), prostate (P) and rectum (R) in Alberta (AB) Canada and to compare the observed RT rates to estimates of need derived from the criterion based benchmarking (CBB) and evidence-based estimates (EBEST).
All incident cases of B,C,L,P and R cancers diagnosed in AB during 2004-8 (prior to the decentralization of provincial RT capacity) were identified from the Alberta Cancer Registry. Patients receiving RT within one year (RT-1y) of diagnosis were identified and the proportion receiving RT-1y was then calculated. Factors associated with RT utilization were analysed by region. Estimates of the need for RT were derived from CBB and EBEST methods in the literature.
A total of n=68,164 cancer cases were identified from the ACR. RT-1y rates (95% C.I.) were B: 51.5% (50.1-52.9), C: 48.9% (43.8-54.0), L: 37.1% (35.4-38.8), P: 26.9% (25.1-28.7) and R: 39.3% (36.5-42.1). Observed rates of RT in AB were lower than estimates derived using the CBB and EBEST estimates. Shortfalls varied across cancer sites according to whether a CBB or EBEST estimate was used ranging from a low of -0.3% in cancer of the cervix to a high of 30.3% in rectal cancer.
RT shortfalls exist in the utilization of RT in AB, Canada despite centralized cancer care and a publically funded health care system. Decisions to address shortfalls need to be mindful of how model selection can impact on findings.
确定合适的放射治疗（RT）利用率对于医疗保健规划和资源分配至关重要。观察到的RT率与合适的RT率之间的差异受基于标准的基准（CBB）或循证估计（EBEST）测量方法选择的影响。我们的主要目标是确定加拿大艾伯塔省（AB）乳腺癌（B）、宫颈癌（C）、肺癌（L）、前列腺癌（P）和直肠癌（R）的放射治疗利用率，并将观察到的RT率与基于标准的基准（CBB）和循证估计（EBEST）得出的需求估计值进行比较。
从艾伯塔癌症登记处识别出2004 - 2008年（省级RT能力下放之前）在AB诊断出的所有B、C、L、P和R癌症的新发病例。确定在诊断后一年内接受RT（RT - 1y）的患者，并计算接受RT - 1y的比例。按地区分析与RT利用相关的因素。RT需求估计值来自文献中的CBB和EBEST方法。
从ACR中总共识别出n = 68164例癌症病例。RT - 1y率（95%置信区间）分别为：乳腺癌51.5%（50.1 - 52.9）、宫颈癌48.9%（43.8 - 54.0）、肺癌37.1%（35.4 - 38.8）、前列腺癌26.9%（25.1 - 28.7）和直肠癌39.3%（36.5 - 42.1）。AB省观察到的RT率低于使用CBB和EBEST估计得出的估计值。根据使用的是CBB还是EBEST估计，各癌症部位的短缺情况有所不同，从宫颈癌的低至 - 0.3%到直肠癌的高至30.3%不等。
尽管有集中的癌症护理和公共资助的医疗保健系统，但加拿大艾伯塔省在RT利用方面仍存在短缺。解决短缺问题的决策需要考虑模型选择如何影响研究结果。
