Abstract P2-07-02: Concordance with National comprehensive cancer network (NCCN) metastatic breast cancer guidelines and impact on overall survival
| Autor: | B Smita, F Andres, Bradford E. Jackson, Maria Pisu, Gabrielle B. Rocque, Karina I. Halilova, Courtney P. Williams |
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| Rok vydání: | 2017 |
| Předmět: | |
| Zdroj: | Cancer Research. 77:P2-07 |
| ISSN: | 1538-7445 0008-5472 |
| Popis: | Introduction:Payers are implementing reimbursement restrictions for non-guideline based care. Limited information exists regarding real-world concordance with guidelines for metastatic breast cancer (MBC) treatment. Further, the impact of non-concordance on mortality is unknown. We address these gaps by using the Surveillance, Epidemiology, and End Results (SEER) Program-linked Medicare database to evaluate national concordance with NCCN guidelines and the association between concordance and mortality. Methods: From 2007 to 2013, women with de novo (n=988) or recurrent metastatic breast cancer (n=5651) were evaluated for concordance of first-line systemic therapy (hormonal therapy, chemotherapy, and Her2-targeted therapy) with NCCN guidelines. Concordance was defined as receipt of single agent or combination treatments listed on NCCN guidelines. Non-concordant treatments were grouped into 5 categories: single-agent HER2-targeted therapy (33%), adjuvant regimens used in the metastatic setting (12%), therapy mismatched with ER/HER2 status (12%), non-approved bevacizumab regimens (10%), and other miscellaneous reasons (33%). Multivariable logistic regression was used to identify predictors of non-concordance. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox regression to compare all-cause mortality associated with non-concordant vs. concordant treatment adjusted for receptor status, comorbidities, age, race, poverty level, entitlement reason, and treatment year. Results: Mean age at MBC diagnosis was 69y; 77% were white. Median follow-up was 1.2 years. The prevalence of non-concordant first-line systemic therapy was 19% for de novo MBC and 18% for recurrent MBC. Younger age, hormone-receptor negative status, and Her2-positive status were associated with non-concordant treatments for Stage IV and recurrent MBC patients (p Conclusions: In the first-line setting, treatment inconsistent with NCCN guidelines remains common (18%). Overall mortality was not substantially higher among non-concordant patients. However, mortality risk varied (in both directions) by category of non-concordance. These findings may provide an opportunity for considering refinement of NCCN guidelines. Citation Format: Rocque GB, Williams CP, Jackson BE, Halilova KI, Pisu M, Andres F, Smita B. Concordance with National comprehensive cancer network (NCCN) metastatic breast cancer guidelines and impact on overall survival [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-07-02. |
| Databáze: | OpenAIRE |
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