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Background: Different jurisdictions report different breast cancer treatment rates. Evidence-based optimal utilization models may be specific to the derived population. We compared predicted optimal with actual endocrine and chemotherapy utilization in British Columbia, Canada; Dundee, Scotland; and Perth, Western Australia., Design: Data were analyzed for differences in demography, tumour, and treatment. Epidemiological data were fitted to published Australian optimal radiotherapy utilization trees and region-specific optimal treatment rates were calculated. Optimal and actual systemic therapy rates from 2 population-based and 1 institution-based cancer registries were compared for patients diagnosed with breast cancer between 2000-2004, and 2002 for British Columbia., Results: Chemotherapy rates differed between British Columbia (32%), Perth (29%), and Dundee (24%, p = 0.014). Endocrine therapy rates were similar between British Columbia (56%), Perth (59%), and Dundee (64%, p > 0.05). Actual utilization rates were lower than optimal estimates for chemotherapy, but higher for endocrine therapy. Region-specific optimal utilization rates at diagnosis varied between 50-56% for chemotherapy, and 49-54% for endocrine therapy. Variation was attributed to local differences in demographics, and tumour stage., Conclusion: Actual treatment rates varied. There was lower than estimated optimal chemotherapy use but higher than expected use of endocrine therapy., (Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.)

Background: Published chemotherapy utilization rates for rectal cancer show considerable variation. Optimal chemotherapy utilization rates can serve as benchmarks to assess the quality of cancer care. The purpose of this study was to determine the optimal proportion of patients with rectal cancer who should receive chemotherapy at least once., Patients and Methods: An optimal chemotherapy utilization tree was constructed using indications for chemotherapy identified from evidence-based treatment guidelines. Epidemiologic data were merged with treatment indications to calculate an optimal chemotherapy utilization rate; this rate was compared with reported actual rates of chemotherapy utilization., Results: Chemotherapy is indicated at least once in 64% of patients with rectal cancer. Although the actual (Australian and United States data) and optimal utilization rates are comparable for patients presenting in stages II or III rectal cancer, actual utilization rates are higher than the optimal for stage I and lower than optimal for patients presenting in stage IV rectal cancer., Conclusion: Chemotherapy may be under-utilized in the initial management of patients presenting with metastatic rectal cancer., (Copyright © 2011 Elsevier Inc. All rights reserved.)