19P - Referral patterns among breast cancer patients in county-level hospitals in China

Background

County-level hospitals, as the "gatekeepers" for rural cancer patients (pts) in the hierarchical diagnosis and treatment system (HDTS) in China, shoulder significant responsibilities in facilitating cancer treatment and patient referrals. Here, we report the referral data from the CHASE001 trial (NCT05544123).

Methods

CHASE001, a prospective, non-interventional multicenter study exploring real-world treatment and referral practices among pts in Chinese county-level hospitals with HER2+ or HR+/HER2- breast cancer (BC) is ongoing since Sep. 2022. The primary endpoint is to describe the treatment patterns. A key secondary endpoint is referral behavior. Descriptive statistics were utilized to analyze the referral data.

Results

At data cutoff (May 17, 2023), 1436 BC pts were included from 26 county-level hospitals in China. 1172 (81.62%) pts were initially diagnosed at county-level hospitals, among them, 81 (6.91%) pts were subsequently referred to higher-level hospitals. 58 out of 81 pts were referred out primarily to receive breast surgery (71.60%), and most of them were eventually referred back to county-level hospitals to receive adjuvant systemic treatment (94.83%, 55/58). Among 264 pts who were initially diagnosed at higher-level hospitals, a significant portion (84.09%) were referred to county-level hospitals to receive adjuvant systemic treatment. The majority (75.99%, 1092/1436) underwent the entire process of diagnosis and treatment within the county-level hospitals without requiring referral-out, however. Among 341 pts who received treatment at higher-level hospitals, 153 (44.87%) brought back their treatment plan to county-level hospitals, and the majority (90.20%, 138/153) adhered to that treatment plan. Interestingly, pts with higher education levels, and employee medical insurance were more inclined to seek treatment at higher-level hospitals, primarily to recieve breast surgery and neoadjuvant treatment.

Conclusions

Most of the patients admitted to county-level hospitals in China underwent the entire process of diagnosis and treatment within these hospitals, indicated that further efforts to provide high quality, guideline centric care should be concentrated at county-level hospitals.

Clinical trial identification

NCT05544123.

Editorial acknowledgement

Legal entity responsible for the study

P. Lu.

Funding

AstraZeneca.

Disclosure

All authors have declared no conflicts of interest.