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.) | |||
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%) | |||
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 |