Abstract 5793
Background
Treatment pathways in metastatic breast cancer are complex. The accelerated adoption of new medicines has resulted in an uncertain evidence base supporting their use. Uncertainties are related to the mismatch between trial-recruited and real-world populations and variation in the order of sequential drugs. Published examples describing real-world practice in SBC are scarce, mainly due to the complexity of the clinical pathways that rely on a mixture of chemotherapy, endocrine therapy and biologicals, often over a long period. We demonstrate how new opportunities in routine healthcare data allow a highly granular description of real-world treatment pathways and how this varies in light of patient (pt) case-mix.
Methods
Scottish nationally available data source datasets for linkage included the National Cancer Registry, Scottish Morbidity Record, the National Cancer Quality Audit and the national Prescribing Information System. Scottish CHI number was the universal identifier for linkage. Key baseline characteristics included age, de-novo presentation, prior adjuvant treatments, co-morbidities, concomitant medications and socioeconomic status. Targeted and random sampling manual review was used to quantify missing data. R version 3.6 was used for analysis.
Results
345 pts were identified of which 276 had ER+HER2- SBC between 2012-2017. First line therapy included 68% (235 patients) endocrine therapy, 17% (59 pts) chemotherapy, 14% (50 pts) received no treatment. Subsequent treatment decisions, including best supportive care and death, have been tracked to identify 70 unique pathways with up to 8 lines of treatment. Graphical representation of treatment pathways is made using Sankey plots. Detailed data quality reports describe missing data rates over time and a comprehensive guide for analysts has been produced as a wiki [https://blogs.ed.ac.uk/canceroutcomes/edinburgh-cancer-informatics-wiki/].
Conclusions
It is now possible to describe treatment sequences using routine, nationally available administrative healthcare data. Pathways are complex and do not always conform to standard guidelines. Interpretation requires modern graphical visualisation methods.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
NHS Lothian and the University of Edinburgh.
Funding
NHS Lothian and.
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
3330 - Tumour-infiltrating lymphocytes and BRCA-like status in stage III breast cancer patients treated with intensified carboplatin-based chemotherapy
Presenter: Leonora De Boo
Session: Poster Display session 2
Resources:
Abstract
3971 - Unravelling the biological characteristics of MammaPrint extreme risk subgroups
Presenter: Rajith Bhaskaran
Session: Poster Display session 2
Resources:
Abstract
5871 - Residual Cancer burden as a prognostic factor in a large series of Neoadjuvant chemotherapy. Subgroup analysis per molecular surrogated subtypes
Presenter: Catalina Falo
Session: Poster Display session 2
Resources:
Abstract
5014 - Clinical validation of CanAssist Breast in a Spanish cohort
Presenter: Manjiri Bakre
Session: Poster Display session 2
Resources:
Abstract
2787 - Meta-analysis on association of pathological complete response with long-term survival outcomes in triple-negative breast cancer
Presenter: Peter A. Fasching
Session: Poster Display session 2
Resources:
Abstract
4301 - Immune infiltrate composition across intrinsic subtypes in hormone receptor (HR)+/HER2- early breast cancer (BC) enrolled in the prospective LETLOB trial
Presenter: Gaia Griguolo
Session: Poster Display session 2
Resources:
Abstract
3205 - Frequency of germline mutations in women's cancer susceptibility genes in a large cohort of Chinese breast cancer patients
Presenter: Ning Liao
Session: Poster Display session 2
Resources:
Abstract
4091 - Triple blinded Prospective Study assessing the Impact of Genomics & Artificial Intelligence Watson For Oncology (WFO) on MDT’s Decision of Adjuvant Systemic Therapy for Hormone Receptor Positive Early Breast Carcinoma-
Presenter: Somashekhar Sampige Prasannakumar
Session: Poster Display session 2
Resources:
Abstract
4359 - Prognostic significance of Progesterone Receptor levels in luminal-like Her2- early Breast Cancer patients. A retrospective single Cancer Center analysis.
Presenter: Anna Diana
Session: Poster Display session 2
Resources:
Abstract
1369 - PAM50 HER2-enriched subtype and pathological complete response in HER2-positive early breast cancer: a meta-analysis
Presenter: Francesco Schettini
Session: Poster Display session 2
Resources:
Abstract