A comparative analysis: international variation in PET-CT service provision in oncology—an International Cancer Benchmarking Partnership study

Abstract

Objective To explore differences in position emission tomography-computed tomography (PET-CT) service provision internationally to further understand the impact variation may have upon cancer services. To identify areas of further exploration for researchers and policymakers to optimize PET-CT services and improve the quality of cancer services. Design Comparative analysis using data based on pre-defined PET-CT service metrics from PET-CT stakeholders across seven countries. This was further informed via document analysis of clinical indication guidance and expert consensus through round-table discussions of relevant PET-CT stakeholders. Descriptive comparative analyses were produced on use, capacity and indication guidance for PET-CT services between jurisdictions. Setting PET-CT services across 21 jurisdictions in seven countries (Australia, Denmark, Canada, Ireland, New Zealand, Norway and the UK). Participants None. Intervention(s) None. Main Outcome Measure(s) None. Results PET-CT service provision has grown over the period 2006–2017, but scale of increase in capacity and demand is variable. Clinical indication guidance varied across countries, particularly for small-cell lung cancer staging and the specific acknowledgement of gastric cancer within oesophagogastric cancers. There is limited and inconsistent data capture, coding, accessibility and availability of PET-CT activity across countries studied. Conclusions Variation in PET-CT scanner quantity, acquisition over time and guidance upon use exists internationally. There is a lack of routinely captured and accessible PET-CT data across the International Cancer Benchmarking Partnership countries due to inconsistent data definitions, data linkage issues, uncertain coverage of data and lack of specific coding. This is a barrier in improving the quality of PET-CT services globally. There needs to be greater, richer data capture of diagnostic and staging tools to facilitate learning of best practice and optimize cancer services.

International variation in oesophageal and gastric cancer survival 2012–2014: differences by histological subtype and stage at diagnosis (an ICBP SURVMARK-2 population-based study)

“…The access to more specialised staging modalities such as positron emission tomography (PET) scans, are variable between and even within jurisdictions and may influence the patient's final stage staging. [45] While, for the purpose of comparison, we used the SEER system to compare stage-specific survival estimates across countries, it should be noted that TNM remains the preferred staging classification, as it reflects patients' groupings in clinical settings.…”

Use of chemotherapy in patients with oesophageal, stomach, colon, rectal, liver, pancreatic, lung, and ovarian cancer: an International Cancer Benchmarking Partnership (ICBP) population-based study

“…These include differences in the content of national clinical guidelines, or their implementation, or both; variable constraints in health-care professional capacity and the availability of treatment facilities; variation in professional culture and norms towards more or less conservative management; the variable extent of differences in clinical practice between providers or hospital teams within the same country; the differences in patient preferences and expectations of cancer care; the geographical location of treatment centres in relation to population residence; variable research infrastructure that could enable access to clinical trial protocols; and differences in the availability and content of national cancer control strategies, which might all be contributing to interjurisdictional differences in chemotherapy use. 6,7,22,23,30 In our study, interjurisdictional variation in time-tochemotherapy was generally smaller compared with variation in use. Artefactual causes of such variation are unlikely among patients identified as having received chemotherapy.…”

“…The study forms part of the International Cancer Benchmarking Partnership, a collaboration of clinicians, policy makers, researchers, and data experts in seven countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway, and the UK), seeking to explain cancer survival differences between high-income countries with comprehensive cancer registries, similar health system expenditure, and universal health care, to help improve cancer care and outcomes globally. [5][6][7]…”

A Systematic Review of Diagnostic Modalities and Strategies for the Assessment of Complications in Adult Patients with Neurofibromatosis Type 1

“…Although the UK guidelines promote FDG PET/CT for the visualisation of MPNSTs, other systemic factors may hamper its use. The UK has fewer PET/CT machines, 0.08 per 100,000 people [ 74 ], in comparison to 0.12 in Germany [ 75 ]. The relative scarcity of PET/CT scanners in the UK may underlie the comparative lower proportion of studies involving PET/CT scans from the UK, as shown in our study.…”