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Table 2 Prevalence of overuse as reported in European studies on patterns of care for breast, colorectal and prostate cancer, published between 2006 and 2016

From: Overuse in cancer care: do European studies provide information useful to support policies?

Breast cancer

Country

Years of care delivery

Interventions/procedures

Prevalence of overuse (95% CI)

Wockel, 2010 [17]

Germany

2001–2005

BCS in tumour size > 4 cm, in multicentric cancer, in inflammatory carcinoma

4.4% (n.a.)

Axillary dissection in non-invasive carcinoma

12.5% (n.a.)

Radiotherapy after BCS in invasive carcinoma

4.1% (n.a.)

Chemotherapy in patients eligible to endocrine therapy

8.7% (n.a.)

Claravezza, 2012 [18]

Italy

2008

Adjuvant chemotherapy in luminal A patients

38% (35–41%)

Poncet, 2009 [19]

France

1999–2003

Trastuzumab in metastatic breast cancer without previous treatment with anthracyclines or in < her-2 negative patients

68% (61–77%)

Lebeau, 2011 [20]

France

2003–2004

Chemotherapy

15% (13–17%)

Hormonal therapy

both in non-metastatic breast cancer, according to appropriateness criteria

9% (7–11%)

Mano, 2010 [21]

Italy

2007

Axillary dissection in DCIS

5% (3–8%)

Axillary dissection or sentinel lymph node procedure in DCIS or benign lesions

33% (30–37%)

Kiderlen et al., 2015 [22]

Germany, Italy, United Kingdom, The Netherlands, Switzerland, Belgium, Austria

2008–2012

Radical mastectomy in cancer ≤ 3 cm

13% (n.a.)

ALND in DCIS

4% (n.a.)

Ponti et al., 2007, 2011, 2015 [23,24,25]

Italy

2011–2012

Axillary staging in cancers other than in pN0

10% (9–11%)

Axillary dissection in DCIS

3% (2–4%)

Radical surgery in DCIS < 20 mm

10% (7–12%)

Van de Water, 2012 [26]

The Netherlands

2005–2008

RT in patients aged < 65 years

6% (n.a.)

RT in patients aged ≥ 75 years

4,5% (n.a.)

Chemotherapy in patients aged < 65 years

2% (n.a.)

Endocrine therapy in patients aged < 65 years

2.5% (n.a.)

Endocrine therapy in patients aged ≥ 75 yearts

7.5% (n.a.)

Lu, 2011 [27]

The Netherlands

1989–2003

Hospital visits in follow-up

31% (28–35%)

Mammography in follow-up

after surgical treatment

18% (16–22%)

Grandjean, 2012 [28]

The Netherlands

2003

Consultations during follow-up

55% (48–62%)

Mammography during follow-up after surgical treatment

4% (1–7%)

Schwentner, 2013, 2012, 2012 [29,30,31]

Germany

1992–2008

Surgical management, radiotherapy and chemotherapy in primary breast cancer

Only overall rates of guideline violation are reported, without distinguishing between over and under treatment Guideline violations were 8% for radiotherapy, 13% for surgical management and 16% for chemotherapy

Fong, 2012 [32]

United Kingdom (region of Dundee, Scotland)

2004–2004

Endocrine therapy (comparing observed vs. optimal utilisation rate, predicted from guidelines recommendations)

4% (n.a.)

Ponti, 2014 [33]

Italy, Denmark, Czech Republic, Finland, Ireland, The Netherlands, Norway, Spain, Switzerland (it includes also patients from United States and Japan)

2004–2007

Axillary dissection in DCIS

8% (7–9%)

Axillary dissection in low/intermediate grade DCIS

5.6% (4.6–7.0%)

Axillary dissection after breast conserving surgery

4.8% (4–5.5%)

Colorectal cancer

Country

Years of care delivery

Interventions/procedures

Prevalence of overuse

(95% CI)

Bonifazi, 2012 [34]

Italy

2006–2007

Bevacizumab use as second-line or advanced line in metastatic colorectal cancer

37% (34–42%)

Adler, 2007 [35]

Germany

Not reported

Diagnostic colonoscopy outside screening programme

14% (11–17%)

Lepage, 2006 [36]

France

2000

Excess of tests executed in pre-operative workup

30% (26–34%)

Adjuvant chemotherapy in stage III

5% (3–7%)

Eliot, 2014 [37]

Sweden

2000–2010

Pre-operative RT (with or without chemotherapy) in early rectal cancer

55% (50–60%)

Prostate cancer

Country

Years of care delivery

Interventions/procedures

Prevalence of overuse (95% CI)

Hernes, 2009 [38]

Norway

2004

Radical prostatectomy or Radiotherapy in low risk patients

57% (52–61%)

Grundmark, 2012 [39]

Sweden

1997–2006

Anti-androgen (bicalutamide) in low/intermediate risk patients

2.1% (n.a.)

Evans, 2010 [40]

United Kingdom

Not available

CT scan in diagnostic workup

10% (7–11%)

Radical prostatectomy

< 1%

RT

< 1%

Hormone therapy after diagnosis of prostate cancer

< 1%

Miscellaneous a

Country

Years of care delivery

Interventions/procedures

Prevalence of overuse

Ray-Coquard, 2012 [41]

France

2010

Erythropoiesis stimulating agents in chemotherapy-induced anaemia

Overall prevalence of overuse 5% in breast (n = 185) and lung (n = 227) cancer patients (20/412)

Joerger, 2014 [42]

Switzerland

2012

Anticancer drugs in several cancers, including breast, lung and colorectal

Results by cancer site reported only in graphic

Overall, 32% of all patients received at least one off-label drug, but off-label use was unsupported by European Society for Medical Oncology guidelines only in 6.6% of cases

Inappropriate use was higher for bevacizumab (29%) also because of its use in advanced breast cancer

  1. aStudies including patients with different cancers are in this category
  2. ALND axillary lymph nodes dissection, BCS breast conserving surgery, DCIS ductal carcinoma in situ, n.a. not available, RT radiotherapy