Table 2.

Illustrative examples of RWD used for treatment delivery optimization

Subject	Objective	Data	Key findings	Ref
Treatment adherence by patients	Assess adherence and duration of treatment with trifluridine/tipiracil versus regorafenib	469 trifluridine/tipiracil and 311 regorafenib users from the QVIA Real-World Data Adjudicated Claims U.S. database (Oct 2014-Jul 2017)	Trifluridine/tipiracil use was associated with higher medication adherence and longer time to discontinuation compared to regorafenib	[111]
Guideline adherence	Determine rates of and factors associated with adherence to the NCCN treatment guideline for colon cancer	Data of the National Cancer Database including 173.243 patients treated for colon cancer (2003–2007)	Among patients with high-risk stage II or stage III disease, older patients with pre-existing comorbidities and patients with lower socioeconomic status were less likely to be offered adjuvant chemotherapy	[93]
Practice variation	Evaluate treatment patterns and associated variables in the systemic treatment of mCRC in the Netherlands	Random sample of 2222 mCRC patients diagnosed in 20 hospitals from 2008 to 2015 from the NCR	Significant inter-hospital variation was identified in targeted therapy administration, which may effect outcome. The data suggests that practice variation is based on individual strategy of hospitals rather than guideline recommendations or patient-driven decisions	[97]
Treatment underutilization	Evaluate the adoption rate of FOLFOXIRI-B in patients with mCRC and investigate the perspectives of medical oncologists towards this treatment option	Within 1 study week, data were retrieved from eHRs of 47 hospitals on all patients with mCRC referred between Nov 2020 and Jan 2021, n = 402. Interviews were conducted with 101 medical oncologists from 52 hospitals	Prescription rates marginally increased in 5 years. Most medical oncologists discuss FOLFOXIRI-B but communicate a preference for doublet chemotherapy to patients. These oncologists reported a significantly lower awareness of guidelines and trial results	[57]
Treatment overutilization	Evaluate the use of radiotherapy (RT) in the Netherlands and discuss Dutch practice in the context of current literature	Data from the Dutch Surgical Colorectal Audit (DSCA) on 6784 patients surgically treated for primary rectal cancer in 2009–2011	From a European perspective, a high percentage of rectal cancer patients are treated with RT in the Netherlands. Considerable hospital variation was observed for RT in stage I and the proportion of chemoradiotherapy among all RT schemes	[112]
Treatment patterns	Describe the treatment of metachronous colorectal cancer metastases in a population-based cohort	5412 patients with stage I–III CRC diagnosed between Jan and Jun 2015 who were surgically treated with curative intent selected from the NCR	Patients with metastases confined to the liver and lung have the highest rates of local treatment (LT). The number of patients who underwent LT is higher than previously reported	[113]
Non-participation in screening program	Investigate differences between participants and non-participants in the Dutch CRC screening program	Data from the Dutch screening system linked with demographic characteristics from Statistics Netherlands including all invitees to the Dutch CRC screening program in 2018 and 2019	Individuals who were single, with a migration background or low income, were the least likely to participate	[114]
Subgroup identification for molecular testing	Estimate the prevalence of NTRK fusions in microsatellite instable (MSI) mCRC and determine patient characteristics and clinical behavior of this NTRK fusion subtype	FFPE tissue was requested from all (n = 203) MSI mCRC patients diagnosed between 2015 and 2020 in the Netherlands	NTRK fusions are most prevalent (23%) in RAS and BRAF wild-type MSI mCRC patients. Benefit from chemotherapy or anti-EGFR therapy in NTRK fusion positive patients was limited, but all immunotherapy-treated patients had ongoing response	[115]
Management and outcomes in elderly patients	Describe management and outcomes of surgical resection of CRC liver metastases (LM) in elderly patients in routine practice	Data of the Ontario Cancer Registry on 1310 patients who underwent resection of LM between Jan 2002 and Dec 2009, classified into age groups	Resection of CRC LM is associated with greater risk of postoperative mortality among elderly patients despite less aggressive treatment. Although the long-term outcomes are inferior to younger patients, a substantial proportion of elderly patients will have long-term survival	[116]
Racial differences	Evaluate disparity in receipt of adjuvant chemotherapy	Patients diagnosed with stage III colon cancer were randomly sampled from the SEER program from the years 1990, 1991, 1995, 2000, 2005, and 2010	There were marked racial disparities in the time period of 1990 to 1991 and again in 2010, with black patients less likely to receive adjuvant chemotherapy as compared with white patients	[117]

NCCN, National Comprehensive Cancer Network; NCR, Netherlands Cancer Registry; FFPE, Formalin-fixed paraffin-embedded