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Purpose: Estimates of the appropriate rate of use of radiation therapy (RT) are required for planning and monitoring access to RT. Our objective was to compare estimates of the appropriate rate of use of RT derived from mathematical models, with the rate observed in a population of patients with optimal access to RT., Methods and Materials: The rate of use of RT within 1 year of diagnosis (RT1Y) was measured in the 134,541 cases diagnosed in Ontario between November 2009 and October 2011. The lifetime rate of use of RT (RTLIFETIME) was estimated by the multicohort utilization table method. Poisson regression was used to evaluate potential barriers to access to RT and to identify a benchmark subpopulation with unimpeded access to RT. Rates of use of RT were measured in the benchmark subpopulation and compared with published evidence-based estimates of the appropriate rates., Results: The benchmark rate for RT1Y, observed under conditions of optimal access, was 33.6% (95% confidence interval [CI], 33.0%-34.1%), and the benchmark for RTLIFETIME was 41.5% (95% CI, 41.2%-42.0%). Benchmarks for RTLIFETIME for 4 of 5 selected sites and for all cancers combined were significantly lower than the corresponding evidence-based estimates. Australian and Canadian evidence-based estimates of RTLIFETIME for 5 selected sites differed widely. RTLIFETIME in the overall population of Ontario was just 7.9% short of the benchmark but 20.9% short of the Australian evidence-based estimate of the appropriate rate., Conclusions: Evidence-based estimates of the appropriate lifetime rate of use of RT may overestimate the need for RT in Ontario., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Aims: Determining the appropriate rate of radiotherapy is important for ensuring optimal radiotherapy utilisation and accessibility. A criterion-based benchmark (CBB) was developed for estimating the need for radiotherapy in incident breast cancer cases. Our primary objective was to compare an evidence-based estimate (Ebest) of need against the CBB. These estimates were then compared with radiotherapy rates in Ontario, Canada and the USA. Surgical rates were also examined., Materials and Methods: Benchmarks were defined in Ontario as communities in proximity to cancer centres and without long waiting lists. Patient data from 1997 to 2001 were prospectively collected from radiotherapy cancer centres. Surgical data were obtained from the Canadian Institute for Health Information database. The public use file of Surveillance, Epidemiology and End Results (SEER) described treatment in the USA., Results: In total, 4241 cases of breast cancer were diagnosed in benchmark communities. The overall radiotherapy rate by Ebest was 64.0% (95% confidence interval: 58.1-69.8%) compared with the CBB of 60.7% (59.3-62.1%). In comparison, Ontario's overall radiotherapy rate was 55.6% (55.0-56.1%) and in SEER it was 49.3% (48.9-49.6%). Adjuvant radiotherapy rates after lumpectomy were 100% in Ebest and 83.6% (82.0-85.1%) by the CBB. The Ebest and CBB post-mastectomy rates were 21.9% (20.6-23.3%) and 34.6% (32.5-36.7%), respectively. Observed post-lumpectomy radiotherapy rates were 75.1% in Ontario and 65.3% in SEER. Post-mastectomy radiotherapy rates were 29.5% in Ontario and 17.0% in SEER., Conclusions: CBB provides a reasonable estimate of the overall need for radiotherapy in breast cancer. Observed radiotherapy rates in Ontario and the USA suggest an age-related decrease in the use of radiotherapy. The benchmark estimate suggests a shortfall of adjuvant breast radiotherapy utilisation in Ontario.

Background: We have previously used an evidence-based, epidemiologic approach to estimate the proportion of incident cases that should be treated with radiotherapy (RT) for lung cancer. The first objective of the present study was to compare this evidence-based estimate of the appropriate rate of use of RT with the rates observed in selected "benchmark" communities where there are no barriers to the appropriate use of RT and no incentives to the unnecessary use of RT. The second objective of the study was to compare the rates of use of RT in the general populations in the United States and Canada with the estimated appropriate rate., Methods: We established benchmark rates for the use of RT for lung cancer in Ontario, Canada, where: 1) residents make no direct payments for RT; 2) all RT is provided by site-specialized radiation oncologists in multidisciplinary cancer centers, and 3) radiation oncologists receive a salary in lieu of technical fees. Communities located close to cancer centers without long waiting lists for RT were selected to serve as benchmarks. Prospectively gathered electronic treatment records from all RT cancer centers were linked to the provincial cancer registry to describe the rate of use of RT in Ontario. The public use file of Surveillance, Epidemiology and End Results Registries (SEER) was used to describe the use of RT in the United States., Results: Overall, 41.3% (95% confidence interval [CI], 39.9%, 42.7%) of incident cases of lung cancer received RT as part of their initial management in the benchmark communities compared with the evidence-based estimate of 41.6% (95% CI, 39.2%, 44.1%). The rate of use of RT in the initial management of nonsmall cell lung cancer (NSCLC) in the benchmark communities was 49.3% (95% CI, 47.5%, 51.1%) compared with the evidence-based estimate of 45.9% (95% CI, 41.6%, 50.2%). The use of RT in the initial management of small-cell lung cancer (SCLC) in the benchmark communities was 47.0% (95% CI, 43.3%, 50.7%) compared with the evidence-based estimate of 45.4% (95% CI, 42.4%, 48.4%). In many counties of Ontario, the observed rates of RT use in the initial management of lung cancer were significantly lower than either the benchmark rate or the evidence-based estimate of the appropriate rate. In contrast, rates of use of RT in most counties in the SEER regions of the United States were close to, or higher than, the estimated appropriate rate., Conclusions: The observed benchmark rate converged on the evidence-based estimate of the appropriate rate of use of RT for lung cancer, suggesting that either measure might reasonably be used as a "standard" against which to compare rates observed in similar populations elsewhere.