Optimal uptake rates for initial treatments for cervical cancer in concordance with guidelines in Australia and Canada: Results from two large cancer facilities Yoon-Jung Kang a,b,c, *, Dianne L. O’Connell b,c,d,e , Jeffrey Tan f , Jie-Bin Lew a,b , Alain Demers g,h , Robert Lotocki g,i , Erich V. Kliewer g,h,j , Neville F. Hacker k , Michael Jackson l , Geoff P. Delaney m , Michael Barton m , Karen Canfell a,b a Prince of Wales Clinical School, UNSW, New South Wales, Australia 1 b Cancer Research Division, Cancer Council NSW, New South Wales, Australia 2 c School of Public Health, University of Sydney, New South Wales, Australia 3 d School of Public Health and Community Medicine, UNSW, New South Wales, Australia e School of Medicine and Public Health, University of Newcastle, New South Wales, Australia f Royal Women’s Hospital, Victoria, Australia g Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada h Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada i Division of Gynecologic Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada j Cancer Control Research, British Columbia Cancer Agency, Vancouver, British Columbia, Canada k Royal Hospital for Women, New South Wales, Australia l Prince of Wales Hospital, New South Wales, Australia m Collaboration for Cancer Outcomes Research & Evaluation, Ingham Institute for Applied Medical Research, UNSW Australia, Sydney, New South Wales, Australia Cancer Epidemiology xxx (2015) xxx–xxx A R T I C L E I N F O Article history: Received 10 November 2014 Received in revised form 16 April 2015 Accepted 17 April 2015 Available online xxx Keywords: Cervical cancer treatment optimal rate guidelines decision tree A B S T R A C T 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. Objectives: To estimate optimal uptake rates for surgery, radiotherapy, chemotherapy and chemo- radiotherapy for cervical cancer treatment in Australia and Canada, and to quantify the differences in the optimal and the observed treatment utilisation rates in a large cancer facility from each country. Methods: A decision tree was constructed to reflect treatments according to guidelines and current practice (in 1999–2008) in each setting. Detailed patterns of care data from a large cancer facility in each country were obtained, and the 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 stage distribution at diagnosis in the two settings; 72% vs 54% with FIGO IA-IIA disease, respectively. The estimated optimal rates for surgery, radiotherapy, chemotherapy and chemo-radiotherapy in Australia were 63% (95% credible interval: 61–64%), 52% (53–56%), 36% (35–38%) and 36% (35–38%), respectively. The corresponding rates in Canada were 38% Abbreviations: FIGO, International Federation of Gynecology and Obstetrics; MCR, Manitoba Cancer Registry; HR, hazard ratio; CI, confidence interval; CrI, credible interval; ECOG, Eastern Cooperative Oncology Group; NCI, National Cancer Institute; BCCA, British Columbia Cancer Agency; GMCT, Greater Metropolitan Clinical Taskforce; EBRT, External beam radiotherapy; CCMB, CancerCare Manitoba; RWH, Royal Women’s Hospital; POWH, Prince of Wales Hospital; NSW, New South Wales. * Corresponding author at: Cancer Screening Group, Cancer Research Division, Cancer Council NSW, 153 Dowling Street, Woolloomooloo NSW 2011, Australia. Tel.: +61 2 9334 1632; fax: +61 2 8302 3550. E-mail addresses: yoonjung.kang@nswcc.org.au (Y.J. Kang), dianneo@nswcc.org.au (D.L. O’Connell), Jeff.Tan@thewomens.org.au (J. Tan), jiebin.lew@nswcc.org.au (J.B. Lew), alain.demers@phac-aspc.gc.ca (A. Demers), rlotocki@mymts.net (R. Lotocki), Erich.Kliewer@cancercare.mb.ca (E.V. Kliewer), neville.hacker@sesiahs.health.nsw.gov.au (N.F. Hacker), Michael.Jackson@sesiahs.health.nsw.gov.au (M. Jackson), Geoff.Delaney@sswahs.nsw.gov.au (G.P. Delaney), Michael.Barton@sswahs.nsw.gov.au (M. Barton), karen.canfell@nswcc.org.au (K. Canfell). 1 Past affiliation of Kang, Lew and Canfell. 2 Current affiliation of Kang, Lew and Canfell. 3 Past affiliation of Kang. G Model CANEP-854; No. of Pages 12 Please cite this article in press as: Kang Y-J, et al. Optimal uptake rates for initial treatments for cervical cancer in concordance with guidelines in Australia and Canada: Results from two large cancer facilities. Cancer Epidemiology (2015), http://dx.doi.org/10.1016/ j.canep.2015.04.009 Contents lists available at ScienceDirect Cancer Epidemiology The International Journal of Cancer Epidemiology, Detection, and Prevention jou r nal h o mep age: w ww.c an cer ep idem io log y.n et http://dx.doi.org/10.1016/j.canep.2015.04.009 1877-7821/ß 2015 Elsevier Ltd. All rights reserved.