Estimation of an Optimal Chemotherapy Utilisation Rate for Upper Gastrointestinal Cancers: Setting an Evidence-Based Benchmark for the Best-Quality Cancer Care

Table 1

Upper gastrointestinal cancers: indications for chemotherapy, levels, and sources of evidence.

Outcome number	Clinical scenario	Treatment indicated	Level of evidence^a	Reference(s)	Proportion of all patients with that cancer
Oesophageal cancer
3	Oesophageal cancer, recurrence, good PS	Palliative chemotherapy	II	NCCN [18]; NCI PDQ [23]; BCCA [27]; SIGN [32]	0.23
5	Oesophageal cancer, localised, unresectable, good PS	Radical chemoradiation	I	NCCN [18]; NCI PDQ [23]; BCCA [27]	0.29
6	Oesophageal cancer, metastatic, good PS	Palliative chemotherapy	II	NCCN [18]; NCI PDQ [23]; BCCA [27]; SIGN [32]	0.27
Total proportion of patients with oesophageal cancer in whom chemotherapy is recommended					0.79
Gastric cancer
7	Gastric cancer, resected stage 1A, recurrence, good PS	Palliative chemotherapy	I	NCCN [21]; NCI PDQ [22]; BCCA [27]; CCO [35]	<0.01
9	Gastric cancer, locoregional,; resectable, higher than stage 1A, good PS	Postoperative chemoradiation; or perioperative chemotherapy	II	NCCN [21]; NCI PDQ [22]; BCCA [27]; SIGN [32]	0.42
10	Gastric cancer, locoregional disease, unresectable	Palliative chemotherapy	I	NCCN [21]; NCI PDQ [22]; BCCA [27]; SIGN [32]	0.15
11	Gastric cancer, metastatic, good PS	Palliative chemotherapy	I	NCCN [21]; NCI PDQ [22]; BCCA [27]; SIGN [32]	0.26
Total proportion of patients with gastric cancer in whom chemotherapy is recommended					0.83
Pancreatic cancer
1	Pancreatic cancer, localised, operable	Palliative chemotherapy	I	NCCN [19]; NCI PDQ [24]; BCCA [35]; CCO [28]	0.08
2	Pancreatic cancer, localised, inoperable, good PS	Palliative chemotherapy	II	NCCN [19]; NCI PDQ [24]; BCCA [35]; CCO [28]	0.12
4	Pancreatic cancer, metastatic, good PS	Palliative chemotherapy	II	NCCN [19]; NCI PDQ [24]; BCCA [35]; CCO [28]	0.15
Total proportion of patients with pancreatic cancer in whom chemotherapy is recommended					0.35
Hepatocellular cancer
6	Liver cancer, localised, unresectable, good PS	Chemoembolization	I	NCCN [20]; NCI PDQ [25]; BCCA [27]	0.20
8	Liver cancer, localised, resected,; intrahepatic recurrence, good PS	Chemoembolization	IV	NCI PDQ [25]	0.07
Total proportion of patients with hepatocellular cancer in whom chemotherapy is recommended					0.27
Gallbladder cancer
17	Gallbladder cancer, locoregional,; recurrence, good PS	Palliative chemotherapy	III	NCCN [20]; NCI PDQ [26]; BCCA [27]; CCO [31]	0.47
18	Gallbladder cancer, metastatic, good PS	Palliative chemotherapy	III	NCCN [20]; NCI PDQ [26]; BCCA [27]; CCO [31]	0.33
Total proportion of patients with gallbladder cancer in whom chemotherapy is recommended					0.80

PS: performance status, NCCN: National Comprehensive Cancer Network, NCI PDQ: National Cancer Institute Physicians Data Query, BCCA: British Columbia Cancer Agency, CCO: Cancer Care Ontario, and SIGN: Scottish Intercollegiate Guidelines Network.
^aLevels of evidence: level I: evidence obtained from a systematic review of all relevant randomised controlled trials; level II: evidence obtained from at least one properly designed randomised controlled trial; level III: evidence obtained from well-designed controlled trials without randomisation (these include trials with “pseudorandomisation” where a flawed randomisation method was used (e.g., alternate allocation of treatments) or comparative studies with either comparative or historical controls); level IV: evidence obtained from case series. Taken from the National Health and Medical Research Council (NHMRC) hierarchy of levels of evidence [33].