Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute of Applied Medical Research, South West Clinical School, University of New South Wales, Sydney, NSW, Australia.
Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute of Applied Medical Research, South West Clinical School, University of New South Wales, Sydney, NSW, Australia.
Lancet Oncol. 2021 Feb;22(2):173-181. doi: 10.1016/S1470-2045(20)30589-1. Epub 2021 Jan 21.
Estimating a population-level benchmark rate for use of surgery in the management of cancer helps to identify treatment gaps, estimate the survival impact of such gaps, and benchmark the workforce and other resources, including budgets, required to meet service needs. A population-based benchmark for use of surgery in high-income settings to inform policy makers and service provision has not been developed but was recommended by the Lancet Oncology Commission on Global Cancer Surgery. We aimed to develop and validate a cancer surgery benchmarking model.
We examined the latest clinical guidelines from high-income countries (Australia, the UK, the EU, the USA, and Canada) and mapped surgical treatment pathways for 30 malignant cancer sites (19 individual sites and 11 grouped as other cancers) that were notifiable in Australia in 2014, broadly reflecting contemporary high-income models of care. The optimal use of surgery was considered as an indication for surgery where surgery is the treatment of choice for a given clinical scenario. Population-based epidemiological data, such as cancer stage, tumour characteristics, and fitness for surgery, were derived from Australia and other similar high-income settings for 2017. The probabilities across the clinical pathways of each cancer were multiplied and added together to estimate the population-level benchmark rates of cancer surgery, and further validated with the comparisons of observed rates of cancer surgery in the South Western Sydney Local Health District in 2006-12. Univariable and multivariable sensitivity analyses were done to explore uncertainty around model inputs, with mean (95% CI) benchmark surgery rates estimated on the basis of 10 000 Monte Carlo simulations.
Surgical treatment was indicated in 58% (95% CI 57-59) of newly diagnosed patients with cancer in Australia in 2014 at least once during the course of their treatment, but varied by site from 23% (17-27) for prostate cancer to 99% (96-99) for testicular cancer. Observed cancer surgery rates in South Western Sydney were comparable to the benchmarks for most cancers, but were higher for some cancers, such as prostate (absolute increase of 29%) and lower for others, such as lung (-14%).
The model provides a new template for high-income and emerging economies to rationally plan and assess their cancer surgery provision. There are differences in modelled versus observed surgery rates for some cancers, requiring more in-depth analysis of the observed differences.
University of New South Wales Scientia Scholarship, UK Research and Innovation-Global Challenges Research Fund.
评估癌症管理中手术使用率的人群水平基准有助于发现治疗差距，评估这些差距对生存率的影响，并为劳动力和其他资源（包括预算）制定基准，以满足服务需求。为高收入国家制定并告知政策制定者和服务提供的手术使用率人群水平基准尚未开发，但柳叶刀肿瘤委员会全球癌症手术曾建议制定。我们旨在开发和验证癌症手术基准模型。
我们研究了来自高收入国家（澳大利亚、英国、欧盟、美国和加拿大）的最新临床指南，并为 2014 年在澳大利亚报告的 30 种恶性癌症部位（19 个单独部位和 11 个归类为其他癌症）绘制了手术治疗途径，这些部位大致反映了当代高收入国家的护理模式。将手术的最佳使用定义为在特定临床情况下手术是首选治疗方法的适应症。人群层面的流行病学数据，如癌症分期、肿瘤特征和手术适应性，源自澳大利亚和其他类似高收入地区 2017 年的数据。对每个癌症的临床途径中的概率进行相乘并相加，以估计癌症手术的人群水平基准率，并通过比较 2006-12 年在西南悉尼地方卫生区的癌症手术实际发生率进一步验证。我们进行了单变量和多变量敏感性分析，以探索模型输入的不确定性，基于 10000 次蒙特卡罗模拟计算得出的基准手术率的平均值（95%CI）。
2014 年，在澳大利亚，至少有一次治疗过程中，58%（95%CI 57-59）的新发癌症患者被指示接受手术，但因部位而异，前列腺癌为 23%（17-27），睾丸癌为 99%（96-99）。西南悉尼的癌症手术实际发生率与大多数癌症的基准值相当，但某些癌症的实际发生率较高，如前列腺癌（绝对增加 29%），而其他癌症的实际发生率较低，如肺癌（-14%）。
该模型为高收入和新兴经济体提供了一个新的模板，用于合理规划和评估其癌症手术服务。一些癌症的模型预测手术率与实际手术率之间存在差异，需要对这些差异进行更深入的分析。
新南威尔士大学科学奖学金、英国研究与创新-全球挑战研究基金。
