Treatment Patterns, Survival, and Outcomes in Older Patients with Metastatic Breast Cancer

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A recent population-based observational study highlights important real-world evidence on treatment patterns, health care burden, occurrence of adverse events, and survival outcomes after a metastatic breast cancer (MBC) diagnosis, in particular among older women with the HR+/HER2–subtype in the United States.

The treatment landscape for HR+/HER2– MBC is evolving, but limited real-world data exist— especially among older women such as those in the US Medicare population. This study, coauthored by RTI Health Solutions researchers, was conducted to bridge that gap and to supplement existing literature with new data from the Medicare community setting. 

Study Findings

The study findings, based on the SEER-Medicare data (2006-2013), highlight that as patients progressed from first- to fourth-line therapies, the proportion treated with endocrine therapy decreased. There were also simultaneous increases in the use of chemotherapy in later lines of therapy. In addition, the study found that considerably high numbers of unique treatment regimens were used across lines of therapy (181 in first-line, 171 in second-line, and 128 in third-line), which underscores the magnitude of heterogeneity and a lack of consensus for the management of HR+/HER2– MBC in routine clinical practice. 

The study reports that the mean, per-patient monthly expenditures by Medicare were $16,075 for all-cause and $11,537 for MBC-related care. Results from multivariable analysis highlight that advanced age, higher comorbidity burden, metastatic disease at initial diagnosis, and the presence of brain, visceral, and bone metastases were significant predictors of higher total MBC-related costs.  The median overall survival time from the metastatic diagnosis reported in this study (25 months) was found to be consistent with the existing literature.

The study findings underscore the unmet needs that exist among older women with HR+/HER2– MBC. The results of this study provide comprehensive background information on treatment patterns, health care burden, and survival—against which the utilization of newer therapies can be assessed in future research.

Research publication:
Goyal RK, Cuyun Carter G, Nagar SP, Smyth EN, Price GL, Huang YL, Li L, Davis KL, Kaye JA. Treatment patterns, survival, and economic outcomes in Medicare-enrolled, older patients with HR+/HER2– metastatic breast cancer. Current Medical Research and Opinion. 2019 June 12.


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