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BACKGROUND: In the absence of randomized controlled trials, real-world evidence may aid practitioners in optimizing the selection of therapy for patients with cancer. The study's aim was to determine real-word use, as well as compare effectiveness, of single-agent and combination chemotherapy as palliative treatment for female patients with metastatic breast cancer (mBC).
MATERIALS AND METHODS: Using administrative claims data from the Symphony Health's Integrated Oncology Dataverse, female patients with mBC treated with at least one chemotherapy-only treatment (COT) between January 1, 2013, and December 31, 2017 were selected. The frequency of use of single-agent versus combination chemotherapy overall and by line of therapy (LOT) was calculated whereas effectiveness was measured using time to next treatment (TNT).
RESULTS: A total of 12,381 patients with mBC were identified, and 3,777 (31%) received at least one line of COT. Of the 5,586 observed LOTs among the 3,777 patients, 66.5% were single-agent and 33.5% combination chemotherapy. Combination chemotherapy was most frequently used in first-line (45%) and least frequently in fifth-line (16%). Across all LOTs, median TNT was significantly longer for single-agent versus combination chemotherapy (5.3 months vs. 4.1 months, p < .0001). Comparison of median TNT by LOT showed significance in third-line and greater but not in first-line or second-line. Among single agents, the median TNT for patients receiving capecitabine was longest in comparison to all other single agents.
CONCLUSIONS: The frequency of combination COT use, particularly in first-line, warrants further research given published guideline recommendations. The observed TNT difference favoring single-agent treatment in later lines supports guideline recommendations. Variance between single-agent preference and observed TNT was noteworthy.
IMPLICATIONS FOR PRACTICE: Although published data from evidence- and consensus-based guidelines recommend single-agent over combination chemotherapy, the extensive list of agents available for use and a gap in the comparative effectiveness research of these agents have resulted in significant variances in patterns of care. The aim of this study was to assess real-world treatment patterns and their effectiveness during palliative therapy of metastatic breast cancer. The objective was to understand when and how chemotherapy-only treatment is used in metastatic breast cancer and whether comparative effectiveness analysis supports the observed patterns of care.

Origine : PubMed

Addressing child custody concerns of parents with life-limiting illness

NELSON, Courtney A. ; STANTON, Kate E. ; BOWERS, Savannah M. ; PARK, Eliza M.
JOURNAL OF PALLIATIVE MEDICINE, 08/2020, vol.23, n°8, p. 1134-1138

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BUDHWANI, Suman ; MOINEDDIN, Rahim ; WODCHIS, Walter P. ; ZIMMERMANN, Camilla ; HOWELL, Doris
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BRIZZI, Kate ; ZUPANC, Sophia N. ; UDELSMAN, Brooks V. ; TULSKY, James A. ; WRIGHT, Alexi A. ; POORT, Hanneke ; LINDVALL, Charlotta
The American journal of hospice and palliative care, 05/2020, vol.37, n°5, p. 371-376

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Four conversations - a randomized controlled trial of an online, personalized coping, and decision aid for metastatic breast cancer patients

SMITH, Sophia K. ; WESTBROOK, Kelly ; MACDERMOTT, Kristin ; AMARASEKARA, Sarthya ; LEBLANC, Matthew ; PAN, Wei
JOURNAL OF PALLIATIVE MEDICINE, 03/2020, vol.23, n°3, p. 353-358

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From palliative to curative intent - PET/CT findings in the light of breast cancer intrinsic subgroup

BRUNET, Maxime ; CAZEAU, Anne-Laure ; BEN REJEB, Houda ; CATENA, Vittorio ; GRELLETY, Thomas
Tumori, 23/10/2019, Pagination inconnue

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