Aims
The increasing number of urological cancers has contributed significantly to cancer related morbidity and mortality in Australia. Appropriate and timely utilization of surgical treatment improves the survival of most cancers. An optimum surgical utilization at population level has not been derived before in Australia or elsewhere. This study used the clinical guidelines to develop models to estimate the optimum rates of curative and palliative surgical utilization for all major urological cancers in Australia.
Methods
To develop the models of optimum surgical utilization, latest clinical guidelines were examined to identify the indication for surgery. Decision trees were created using the Tree Age Pro software to map treatment pathways for individual cancers. Epidemiological data from Australia and other settings were used in the trees to estimate the optimum surgical utilization rate for each cancer. Univariate and multivariate sensitivity analyses of input parameters were conducted to demonstrate the uncertainty over the optimum rate predicted. The optimum rates were then compared with the actual rates of utilization.
Results
The optimum surgical utilization rates were estimated for prostate (22%), kidney (81%), bladder (88%) and testicular (99%) cancers. The actual surgical utilization rate for prostate cancer in the South Western Sydney, NSW Australia (51%) was greater than the estimated benchmark, while for bladder cancer (77%) it was lower. For kidney (81%) and testicular cancer (96%) the actual utilization rates closely resembled the model estimated optimum rates.
If the guidelines were followed then the estimated minimum number of surgeries performed for urological cancer in Australia will increase to 19397 by year 2040, from 12215 in year 2020.
Conclusions
These model outputs could be used to establish benchmarks for surgery provision and reorientate the health services and investment to optimize urological cancer surgical utilization in Australia and internationally.