Sociodemographic Disparities in HER2+ Breast Cancer Trastuzumab Receipt: An English Population-Based Study.

IF 3.7 3区 医学 Q2 ONCOLOGY Cancer Epidemiology Biomarkers & Prevention Pub Date : 2024-10-02 DOI:10.1158/1055-9965.EPI-24-0144
Ruth P Norris, Rosie Dew, Alastair Greystoke, Nicola Cresti, Henry Cain, Adam Todd, Linda Sharp
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Abstract

Background: Sociodemographic disparities in traditional breast cancer treatment receipt in nonpublicly funded healthcare systems are well documented. This study investigated trastuzumab receipt by sociodemographic factors within a female, HER2+ breast cancer population in England's publicly funded National Health Service.

Methods: The English national population-based cancer registry and linked Systemic Anti-Cancer Therapy database identified 36,985 women with HER2+ invasive breast cancer diagnosed between January 1, 2012 and December 31, 2017. Multivariable logistic regression determined the likelihood of trastuzumab receipt in early and metastatic disease by the deprivation category of area of residence and other sociodemographic characteristics.

Results: Early-stage trastuzumab receipt followed a socioeconomic gradient. Women residing in the most deprived areas were 10% less likely to receive trastuzumab [multivariable OR 0.90; 95% confidence interval (CI), 0.83-0.98] compared with women residing in the least deprived areas. In both early and metastatic disease, trastuzumab receipt was less likely in older women with more comorbidities, estrogen receptor-positive disease, and who were not discussed at a multidisciplinary team meeting.

Conclusions: Despite the provision of free care at the point of delivery in England, sociodemographic disparities in early-stage HER2+ trastuzumab receipt occur. Further research determining how inequities contribute to disparities in outcomes is warranted to ensure optimized trastuzumab use for all.

Impact: Fair access to novel cancer treatments regardless of place of residence, sociodemographic characteristics, and/or cancer stage requires prioritization in future cancer improvement policies. See related In the Spotlight, p. 1259.

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接受曲妥珠单抗治疗的 HER2+ 乳腺癌患者的社会人口差异:一项基于英国人口的研究。
背景:在非公费医疗系统中,接受传统乳腺癌治疗的社会人口统计学差异已被充分记录。本研究调查了英国公费国民医疗服务体系中女性 HER2+ 乳腺癌患者接受曲妥珠单抗治疗的社会人口因素:英国国家人口癌症登记处和链接的系统抗癌疗法(SACT)数据库确定了 36,985 名于 2012 年 1 月 1 日至 2017 年 12 月 31 日确诊的 HER2+ 侵袭性乳腺癌女性患者。多变量逻辑回归确定了在(i)早期和(ii)转移性疾病中接受曲妥珠单抗治疗的可能性,并按居住地的贫困类别和其他社会人口特征进行了分类:结果:早期患者接受曲妥珠单抗治疗的几率呈社会经济梯度分布。与居住在最贫困地区的妇女相比,居住在最贫困地区的妇女接受曲妥珠单抗治疗的可能性要低10%(多变量OR为0.90,(95% CI)为0.83,0.98)。在早期和转移性疾病中,合并症较多、ER阳性以及未在多学科小组会议上讨论过的老年妇女接受曲妥珠单抗治疗的可能性较低:尽管英格兰提供免费的分娩护理,但在早期HER2+曲妥珠单抗的接受方面仍存在社会人口差异。为确保所有人都能优化使用曲妥珠单抗,有必要开展进一步研究,确定不平等是如何导致结果差异的:无论居住地、社会人口特征和/或癌症分期如何,都应公平获得新型癌症治疗方法,这需要在未来的癌症改善政策中予以优先考虑。
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来源期刊
Cancer Epidemiology Biomarkers & Prevention
Cancer Epidemiology Biomarkers & Prevention 医学-公共卫生、环境卫生与职业卫生
CiteScore
6.50
自引率
2.60%
发文量
538
审稿时长
1.6 months
期刊介绍: Cancer Epidemiology, Biomarkers & Prevention publishes original peer-reviewed, population-based research on cancer etiology, prevention, surveillance, and survivorship. The following topics are of special interest: descriptive, analytical, and molecular epidemiology; biomarkers including assay development, validation, and application; chemoprevention and other types of prevention research in the context of descriptive and observational studies; the role of behavioral factors in cancer etiology and prevention; survivorship studies; risk factors; implementation science and cancer care delivery; and the science of cancer health disparities. Besides welcoming manuscripts that address individual subjects in any of the relevant disciplines, CEBP editors encourage the submission of manuscripts with a transdisciplinary approach.
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