In an International Cancer Benchmarking Partnership study reported in The Lancet Oncology, McPhail et al found wide interjurisdictional variation in the use of radiotherapy among patients with newly diagnosed common cancers in Norway, the United Kingdom, Canada, and Australia.
Study Details
The study involved data on 786,955 patients aged 15 to 99 years with a new diagnosis of esophageal, stomach, colon, rectal, liver, pancreatic, lung, or ovarian cancer between January 2012 and December 2017 from Norway, four United Kingdom nations, eight Canadian provinces, and two Australian states. Interjurisdictional variations in radiotherapy use and time to radiotherapy use were quantified in multivariate analyses using 95% prediction intervals (PI).
Key Findings
There were large interjurisdictional variations in radiotherapy use, indicated by wide 95% PIs, for multiple cancers, including 95% PIs of:
- 17.8% to 82.4% (pooled estimate = 50.2%) for esophageal cancer
- 35.5% to 55.2% (pooled estimate = 45.2%) for rectal cancer
- 28.6% to 54.0% (pooled estimate = 40.6%) for lung cancer
- 4.6% to 53.6% (pooled estimate = 19.0%) for stomach cancer.
Radiotherapy use was uncommon but still variable for other cancers, with 95% PIs consisting of:
- 1.7% to 16.5% (pooled estimate = 5.5%) for pancreatic cancer
- 1.8% to 11.2% (pooled estimate = 4.5%) for liver cancer
- 1.6% to 5.0% (pooled estimate = 2.9%) for colon cancer
- 0.8% to 7.6% (pooled estimate = 2.5%) for ovarian cancer.
Patients aged 85 to 99 years were significantly less likely to receive radiotherapy vs those aged 65 to 74 years (odds ratio [OR] = 0.38, 95% PI = 0.2–0.73). Overall, women were numerically less likely to receive radiotherapy vs men (OR = 0.88, 95% PI = 0.77–1.01).
Large variation in median time to first radiotherapy was also observed, with 95% PIs including:
- 3 to 112.8 days (pooled estimate = 62.0 days) for esophageal cancer
- 7 to 77.3 days (pooled estimate = 56.0 days) for rectal cancer
- 2 to 128.1 days (pooled estimate = 65.7 days) for liver cancer
- 6 to 248.2 days (pooled estimate = 169.9 days) for ovarian cancer.
Median time to radiotherapy was 9.5 days shorter among patients aged 85 to 99 vs 65 to 74 years (95% PI = −26.4 to 7.4 days).
The investigators concluded, “Large interjurisdictional variation in both use and time to radiotherapy initiation were observed, alongside large and variable age differences. To guide efforts to improve patient outcomes, underlying reasons for these differences need to be established.”
Georgios Lyratzopoulos, MD, of the Institute of Epidemiology and Health Care, University College London, is the corresponding author for The Lancet Oncology article.
Disclosure: The study was funded by the International Cancer Benchmarking Partnership. For full disclosures of the study authors, visit thelancet.com.
