A prospective study of the use of chemotherapy in Sweden and assessment ofthe use in relation to scientific evidence

A prospective study on total utilisation of cytotoxic drugs for selected ca ncers was carried out in two Swedish health service regions, during four we eks in the autumn of 1997. The study included 1 590 patients; 1 169 with so lid tumours and 421 with haematological malignancies. The majority of patie nts (75% to 80%) were treated at university/regional hospitals, often at on cology or haematology departments, and most reserved treatment as outpatien ts. Furthermore, most were treated according to recommendations in regional or national clinical guidelines, so-called care programmes, although the p ercentage varied by diagnosis. Only 10% were participants in a clinical tri al. In approximately 40% of the patients, treatment was aimed at cure. Howe ver. this percentage varied between 0% and 94% depending on tumour type. At the population level, a comparison of the scientific evidence according to a literature review (Acta Oncol, this issue) with the survey showed that t reatment with cytotoxic drugs in Sweden was largely evidence-based. A high percentage of patients received cytotoxic drugs for diseases where recommen dations to treat were strong, i.e. outcomes were well-documented in the lit erature. A low percentage of patients received chemotherapy in disease sett ings with little or no scientific documentation. The percentage of patients treated was also limited in cases where the effects of chemotherapy are re latively small, although scientifically well-documented. For methodological reasons, one cannot exclude the possibility that cytotoxic drugs may be ov erutilised at the individual level for palliative purposes. e.g. by not dis continuing treatment despite the absence of clinical benefits. Likewise, on e cannot exclude the possibility of underutilisation, e.g, by patients decl ining treatment because they were not informed about the potential benefits .