Variations in Use of Chemotherapy in Patients With Newly Diagnosed Common Cancers

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In an International Cancer Benchmarking Partnership study reported in The Lancet Oncology, McPhail et al found wide interjurisdictional variation in chemotherapy use among patients with newly diagnosed common cancers in Norway, the United Kingdom, Canada, and Australia.

Study Details

The study involved data on 781,892 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 UK nations, eight Canadian provinces, and two Australian states. Interjurisdictional variations in chemotherapy use and time to chemotherapy use were quantified in multivariate analyses using 95% prediction intervals.

Key Findings

Large interjurisdictional variation in chemotherapy use, indicated by wide 95% prediction intervals, was observed for all cancers.

Ninety-five percent prediction intervals (PI) were:

  • 5% to 81.2% (pooled estimate = 66.4%) for ovarian cancer
  • 9% to 59.8% (pooled estimate = 47.2%) for esophageal cancer
  • 3% to 62.3% (pooled estimate = 40.8%) for rectal cancer
  • 7% to 55.5% (pooled estimate = 39.6%) for stomach cancer
  • 2% to 56.3% (pooled estimate = 34.1%) for pancreatic cancer
  • 9% to 49.0% (pooled estimate =31.4%) for lung cancer
  • 6% to 43.8% (pooled estimate = 29.7%) for colon cancer
  • 5% to 50.7% (pooled estimate = 16.1%) for liver cancer.

Patients aged 85 to 99 years had a very low likelihood of receiving chemotherapy compared with those aged 65 to 74 years (odds ratio = 0.05, 95% PI = 0.01–0.19).

Large variation was also observed in median time to first chemotherapy from date of diagnosis.

Nintety-five percent prediction intervals included:

  • 8 to 59.2 days (pooled estimate = 38.0 days) for ovarian cancer
  • 1 to 67.0 days (pooled estimate = 44.5 days) for lung cancer
  • 1 to 113.3 days (pooled estimate = 78.7 days) for colon cancer
  • –15.5 to 193.9 days (pooled estimate = 89.2 days) for rectal cancer.

Compared with patients aged 65 to 74 years, those aged 85 to 99 years had a shorter time to chemotherapy (pooled estimate = –3.7 days, 95% PI = –7.6 to 0.1 days).  

The investigators concluded, “Large variation in use and time to chemotherapy initiation were observed between the participating jurisdictions, alongside large and variable age group differences in chemotherapy use. To guide efforts to improve patient outcomes, the underlying reasons for these patterns 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

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