scholarly journals Survival in Women with De Novo Metastatic Breast Cancer: A Comparison of Real-World Evidence from a Publicly-Funded Canadian Province and the United States by Insurance Status

2022 ◽  
Vol 29 (1) ◽  
pp. 383-391
Author(s):  
Marie-France Savard ◽  
Elizabeth N. Kornaga ◽  
Adriana Matutino Kahn ◽  
Sasha Lupichuk
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Metastatic Breast Cancer ◽  
De Novo ◽  
Private Insurance ◽  
Metastatic Breast ◽  
The United States ◽  
Insurance Status ◽  
The Us ◽  
Privately Insured

Metastatic breast cancer (MBC) patient outcomes may vary according to distinct health care payers and different countries. We compared 291 Alberta (AB), Canada and 9429 US patients < 65 with de novo MBC diagnosed from 2010 through 2014. Data were extracted from the provincial Breast Data Mart and from the National Cancer Institute’s SEER program. US patients were divided by insurance status (US privately insured, US Medicaid or US uninsured). Kaplan-Meier and log-rank analyses were used to assess differences in OS and hazard ratios (HR) were estimated using Cox models. Multivariate models were adjusted for age, surgical status, and biomarker profile. No difference in OS was noted between AB and US patients (HR = 0.92 (0.77–1.10), p = 0.365). Median OS was not reached for the US privately insured and AB groups, and was 11 months and 8 months for the US Medicaid and US uninsured groups, respectively. The 3-year OS rates were comparable between US privately insured and AB groups (53.28% (51.95–54.59) and 55.54% (49.49–61.16), respectively). Both groups had improved survival (p < 0.001) relative to the US Medicaid and US uninsured groups [39.32% (37.25–41.37) and 40.53% (36.20–44.81)]. Our study suggests that a universal health care system is not inferior to a private insurance-based model for de novo MBC.

Primary metastatic breast cancer in elderly: An international comparison.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20545-e20545
Author(s):  
Willemien Van De Water ◽  
Esther Bastiaannet ◽  
Kathleen Egan ◽  
Anton J.M. de Craen ◽  
Cornelis J. H. Van De Velde ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Adverse Events ◽  
Metastatic Breast ◽  
The United States ◽  
Population Based ◽  
The Us ◽  
Multivariable Analyses ◽  
Line Of Therapy ◽  
Survival Differences

e20545 Background: In primary metastatic breast cancer in elderly, both advanced age and advanced disease limit life expectancy. It remains a challenge to balancing the benefit from therapy and risk of adverse events impeding quality of life or survival. Our aim was to compare management and outcome of primary metastatic breast cancer in elderly treated in two health care settings. Methods: The first cohort comprised a hospital based series in the United States (US, n=73 women diagnosed between 2003 and 2012); the second comprised a population based series in The Netherlands (NL, n=125 women diagnosed between 2008 and 2012). All were ≥65 years at the time of diagnosis. Country was used as an instrumental variable, as a proxy for randomization to either care setting. Multivariable survival analyses were adjusted for age, comorbidity, T stage, nodal stage and hormone receptor status. Results: Characteristics of US and NL patients were similar, except for age (median 72; 79 years, p>0.001). US patients more often received breast surgery and chemotherapy in particular, less often endocrine therapy as monotherapy (Table), and received more lines of treatment (median 4; 2, p<0.001). Adverse events rarely were a reason for a next line of therapy (6% in each cohort). Three-year survival tended to be higher in US patients (HR for US patients was 0.71 (95% CI 0.48-1.05), p=0.089). Multivariable analyses revealed no survival differences (HR for US patients was 0.86 (95% CI 0.53-1.38), p=0.523). Results were similar after stratifying by age at diagnosis (<70; ≥70 years). Conclusions: Treatment of elderly with primary metastatic breast cancer varied considerably between the NL and the US cohort. However, no differences in overall survival were observed. These results warrant further studies to evaluate the extent of treatment in this population. [Table: see text]

Cell-free DNA comparative analysis of hormone receptor-positive, first-line metastatic breast cancer genomic landscape in the United States and China.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 1059-1059
Author(s):  
Huiping Li ◽  
Andrew A. Davis ◽  
Xiao-ran Liu ◽  
Feng Xie ◽  
Xin-Yu Gui ◽  
...  
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Metastatic Breast Cancer ◽  
Metastatic Breast ◽  
The United States ◽  
Chinese Patients ◽  
Hormone Receptor Positive ◽  
Genomic Landscape ◽  
The Us ◽  
Chinese Cohort

1059 Background: Metastatic breast cancer (MBC) is a heterogeneous disease associated with known somatic mutations of variable biological value in different subtypes. Furthermore, the clinical evolution of the disease demonstrates clonal evolution resulting in disease resistance more accurately detected using blood-based sequencing. Few studies have explored differences in genomic features of tumors across populations. Here, we performed circulating tumor DNA (ctDNA) sequencing to compare the genomic landscape of patients with hormone-receptor positive MBC at time of first recurrence or de-novo metastatic diagnosis in the United States (US) and China. Methods: Twenty-three US patients from Northwestern University and 65 Chinese patients from Peking University had ctDNA sequencing from plasma performed using the harmonized CLIA-certified, 152-gene PredicineCARE assay in laboratories in the US and China, respectively. The data analysis was conducted in China. Institutional Review Boards at each site approved the study. Fisher’s exact test was performed to compare mutational frequencies across populations. Results: Median age of patients at MBC diagnosis was 51 in the US cohort and 55 in the Chinese cohort. 87% of US patients and 82% of Chinese patients had received prior therapy for primary breast cancer, including endocrine therapy. Mutations were detected in 17 of 23 (74%) US patients and 59 of 65 (91%) Chinese patients. CNAs were observed in 57% of US patients and 58% of Chinese patients. The most common mutations detected in US patients were TP53 (26%), PIK3CA (22%), AKT1 (22%), CDH1 (17%), PTEN (13%), and ESR1 (9%) vs. PIK3CA (46%), TP53 (35%), ESR1 (12%), and BRCA2 (11%) in Chinese patients. Frequency of AKT1 and CDH1 mutations were significantly higher in the US population (P < 0.05), while PIK3CA mutations were higher in the Chinese population (P < 0.05). CNA gains in CCND3 and CDK4 were significantly higher in the US cohort, and FGFR1 was significantly more common in the Chinese cohort (all P < 0.05). Conclusions: To our knowledge, this is a first cross-regional comparison study in HR+ MBC patients in the US and China using a harmonized cfDNA NGS platform. At a population level, there were notable differences observed in somatic variants in two cohorts. Future sequencing efforts and clinical trials should include patients of diverse ethnic backgrounds to explore the impact of differences in genomic landscape on probability of benefit from treatments. A larger validation cohort is required to confirm these findings.

Real-world clinical effectiveness of eribulin in metastatic breast cancer patients with visceral metastases in the United States.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13058-e13058
Author(s):  
Sarah Schellhorn Mougalian ◽  
Jingchuan Zhang ◽  
Jonathan Kish ◽  
Marjorie E. Zettler ◽  
Bruce A. Feinberg
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Metastatic Breast Cancer ◽  
Partial Response ◽  
Brain Metastases ◽  
Metastatic Breast ◽  
Clinical Effectiveness ◽  
The United States ◽  
The Us ◽  
Visceral Metastases

e13058 Background: Eribulin mesylate was approved in the United States (US) in 2010 for the treatment of metastatic breast cancer (mBC) after at least two prior chemotherapeutic regimens, which should have included an anthracycline and a taxane in either the adjuvant or metastatic setting. Visceral metastases, including those to the lung and brain, have been identified as poor prognostic features for patients with mBC. The objective of this analysis was to assess the real-world clinical effectiveness of eribulin in mBC patients with visceral metastases when treated in accordance with the US label. Methods: Patients with mBC initiating eribulin consistent with the US label between 2011-2017 were identified through a retrospective, multi-site chart review study conducted in US oncology practices. De-identified, patient-level demographics, clinical characteristics, treatment patterns, and outcomes were entered into an electronic case report form by the patients’ treating physicians. Sites of metastases at initiation of eribulin were indicated by providers. Clinical outcomes assessed included best overall response to eribulin as recorded in the patient’s chart, progression-free survival (PFS), and overall survival (OS). The proportion of patients with either a complete or partial response as their best overall response was calculated. PFS and OS were calculated by the Kaplan-Meier method from the initiation of eribulin for all patients with visceral metastases and subsets reporting lung or brain metastases site, respectively. Results: The analysis included 470 patients with visceral metastases, including 342 with lung metastases and 22 with brain metastases at the time of eribulin initiation. Eribulin was third-line therapy for approximately three quarters of patients in these subgroups, and the remainder received eribulin in fourth line or later. Mean age was 59 years in general (59 and 54 years in those with lung and brain metastases, respectively). Over half of patients (53.6%) had either a complete or partial response to eribulin. Median PFS was estimated at 6.0 months, and median OS was estimated at 10.5 months. Results for the subgroups of patients with lung and brain metastases are shown in the table. Conclusions: The results of this retrospective analysis affirm clinical effectiveness of eribulin in mBC patients with visceral metastases, when used consistent with the US label.[Table: see text]

scholarly journals Breast cancer mortality hot spots among Black women with de novo metastatic breast cancer

2020 ◽  
Author(s):  
Yunan Han ◽  
Marvin Langston ◽  
Lindsay Fuzzell ◽  
Saira Khan ◽  
Marquita W Lewis-Thames ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Black Women ◽  
Cancer Mortality ◽  
Hot Spots ◽  
De Novo ◽  
Hot Spot ◽  
Breast Cancer Mortality ◽  
Metastatic Breast ◽  
The Us

Abstract Background Black women living in southern states have the highest breast cancer mortality rate in the US. The prognosis of de novo metastatic breast cancer is poor. Given these mortality rates, we are the first to link nationally representative data on breast cancer mortality hot spots (counties with high breast cancer mortality rates) with cancer mortality data in the US and investigate the association of geographic breast cancer mortality hot spots with de novo metastatic breast cancer mortality among Black women. Methods We identified 7,292 Black women diagnosed with de novo metastatic breast cancer in SEER. The county-level characteristics were obtained from 2014 County Health Rankings and linked to SEER. We used Cox proportional hazards models to calculate adjusted hazard ratios (aHRs) and 95% confidence interval (CIs) for mortality between hot spot and non-hot spot counties. Results Among 7,292 patients, 393 (5.4%) resided in breast cancer mortality hot spots. Women residing in hot spots had similar risks of breast cancer-specific mortality (aHR = 0.99; 95% CI = 0.85-1.15) and all-cause mortality (aHR = 0.97; 95% CI = 0.84-1.11) as women in non-hot spots after adjusting for individual and tumor-level factors, and treatments. Additional adjustment for county-level characteristics did not impact mortality. Conclusion Living in a breast cancer mortality hot spot was not associated with de novo metastatic breast cancer mortality among Black women. Future research should begin to examine variation in both individual and population-level determinants, as well in molecular and genetic determinants that underlie the aggressive nature of de novo metastatic breast cancer.

scholarly journals Low Overall Survival in Women With De Novo Metastatic Breast Cancer: Does This Reflect Tumor Biology or a Lack of Access to Health Care?

2020 ◽  
pp. 679-687
Author(s):  
Leonardo R. Soares ◽  
Ruffo Freitas-Junior ◽  
Maria P. Curado ◽  
Regis R. Paulinelli ◽  
Edesio Martins ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Overall Survival ◽  
Metastatic Breast Cancer ◽  
Access To Health Care ◽  
De Novo ◽  
Breast Surgery ◽  
Multivariable Analysis ◽  
Metastatic Breast ◽  
Access To Health

PURPOSE As a result of its epidemiologic and therapeutic aspects, metastatic breast cancer (MBC) is a highly relevant clinical condition. This study aimed to estimate overall survival (OS) in women with de novo MBC in a Brazilian population. PATIENTS AND METHODS Patients were identified in the Goiânia population-based cancer registry between 1995 and 2011. All women with metastatic disease at diagnosis were included in the study. OS was analyzed at 5 and 10 years of follow-up. We used the Kaplan-Meier estimator and Cox regression for statistical analysis. RESULTS Over the 16-year period covered by the study, 5,289 women were diagnosed with breast cancer in Goiânia. Of these, 277 women (5.2%) had MBC. OS rates at 5 and 10 years were 19.9% and 7.3%, respectively. The mean OS time of women treated in the public health system was 7.5 months shorter than in women who had private health care (19.7 v 27.2 months, respectively). In the univariable analysis, the following factors were statistically significant for OS: T3/4 staging, histologic grade 3, progesterone receptor status, tumor phenotype, breast surgery, CNS metastasis at initial presentation, and surgery for resection of metastasis. In multivariable analysis, initial CNS metastasis (hazard ratio, 3.09; 95% CI, 1.16 to 8.19) and breast surgery (hazard ratio, 0.45; 95% CI, 0.25 to 0.78) remained independent prognostic factors. CONCLUSION OS was lower than rates found in specialist centers in Brazil and in developed countries. Several intrinsic and extrinsic factors were significant in predicting OS. Despite the difference in the 5-year survival rate, the type of access to health care was not significant in the multivariable analysis of the entire period.

Health insurance literacy, status, and financial toxicity in women receiving treatment for metastatic breast cancer.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 96-96
Author(s):  
Courtney Williams ◽  
Stacey A. Ingram ◽  
Valerie Lawhon ◽  
Clara Wan ◽  
Kelly Kenzik ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Insurance ◽  
Private Insurance ◽  
Metastatic Breast ◽  
Insurance Status ◽  
Financial Toxicity ◽  
Health Insurance Status ◽  
Health Insurance Literacy ◽  
Insured Patients ◽  
Privately Insured

96 Background: Though uninsurance rates declined after the Affordable Care Act, the number of underinsured, or individuals who spend > 10% of their income on out-of-pocket (OOP) medical costs, continues to rise. In patients with metastatic breast cancer (MBC), underinsurance may lead to financial toxicity (FT), or patient-level financial burden and distress, since diagnosis and treatment is extremely costly. This study explores health insurance literacy and the association between FT and health insurance status in women receiving treatment for MBC. Methods: This cross-sectional study utilized survey data collected from 2017-2019 in women age ≥18 receiving treatment for MBC at two academic medical centers in Alabama. FT was measured by the Comprehensive Score for Financial Toxicity (COST) tool (11-item scale from 0-44, with lower scores indicating worse FT). Health insurance status and OOP costs were self-reported. Effect sizes were calculated using Cohen’s d or Cramer’s V. Mixed and generalized linear models clustered by site and treating medical oncologist estimated the association between FT and health insurance status. Results: In 81 women with MBC, median COST score was 24 (interquartile range [IQR] 17-30), 44% had private insurance, 40% Medicare, and 16% Medicaid. Though 25% and 33% of surveyed patients did not know their health insurance premium or deductible cost, respectively, privately insured patients more often knew the cost of their premiums (97%; V = 0.58) and deductibles (81%; V = 0.33) compared to publicly insured patients. In adjusted models, FT levels did not differ significantly based on health insurance type (private insurance COST 21, 95% confidence interval [CI] 18-25; Medicaid COST 23, 95% CI 17-29; Medicare COST 24, 95% CI 20-27). However, risk of severe FT (COST ≤13) was 147% higher for privately insured patients versus Medicare beneficiaries (risk ratio 2.47, 95% CI 1.44-4.21). Conclusions: Despite higher levels of health insurance literacy, privately insured patients receiving treatment for MBC may be at increased risk of severe FT. Further research is needed to understand causes of underinsurance in patients with MBC, which could lead to cancer-related FT.

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