The landscape of use of NCCN-guideline chemotherapy regimens in stage I-IIIA breast cancer in an integrated healthcare delivery system Journal Article

   


Authors: Bhimani, J.; O’Connell, K.; Persaud, S.; Blinder, V.; Burganowski, R. P.; Ergas, I. J.; Gallagher, G. B.; Griggs, J. J.; Heon, N.; Kolevska, T.; Kotsurovskyy, Y.; Kroenke, C. H.; Laurent, C. A.; Liu, R.; Nakata, K. G.; Rivera, D. R.; Roh, J. M.; Tabatabai, S.; Valice, E.; Bandera, E. V.; Aiello Bowles, E. J.; Kushi, L. H.; Kantor, E. D.
Article Title: The landscape of use of NCCN-guideline chemotherapy regimens in stage I-IIIA breast cancer in an integrated healthcare delivery system
Abstract: Purpose: The National Comprehensive Cancer Network (NCCN) guidelines recommend a variety of drug combinations with specific administration schedules for the treatment of early-stage breast cancer, allowing physicians to deliver treatments recognizing individual patient complexities, including comorbidities, and patient-physician preference. While use of guideline regimens has shifted over time, there is little data to describe changes in how treatment for early-stage breast cancer has evolved over time. Methods: In a cohort of 34,109 women treated for stage I-IIIA breast cancer between 2006–2019 at Kaiser Permanente Northern California and Kaiser Permanente Washington, we present the changes in chemotherapy regimens over time, and explore use of NCCN-guideline regimens (GR), guideline regimens used when said regimens were not included in guidelines, referred to as time-discordant regimens (TDR), and non-guideline regimens (NGR). Results are presented by drug combination and over time. Results: Among 12,506 women receiving chemotherapy, 77.4% (n = 9681) received GRs, 9.1% (n = 1140) received TDRs, and 13.5% (n = 1685) received NGRs. In 2006, AC-T (cyclophosphamide-doxorubicin, paclitaxel) was the most common regimen, with TC (cyclophosphamide-docetaxel) becoming the most prevalent by 2019. NGRs were more common in cyclophosphamide-methotrexate-5-fluorouracil (CMF); cyclophosphamide-doxorubicin-paclitaxel-trastuzumab (ACTH); and paclitaxel-trastuzumab (TH). The use of GR has increased over time (p-trend < 0.001), while use of NGR (both in terms of administration schedule and drug combination) and TDR have decreased, although patterns vary by drug combination. Conclusion: Chemotherapy delivery has changed markedly over time, with a move toward more use of GR. These data are important for understanding the landscape of chemotherapy delivery in community healthcare settings. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024.
Keywords: adult; aged; middle aged; young adult; major clinical study; doxorubicin; fluorouracil; paclitaxel; chemotherapy; methotrexate; cancer staging; antineoplastic agent; neoplasm staging; clinical practice; melanoma; multiple cycle treatment; breast cancer; antineoplastic combined chemotherapy protocols; epidermal growth factor receptor 2; skin cancer; cyclophosphamide; practice guideline; pathology; breast neoplasms; docetaxel; breast tumor; practice guidelines as topic; cancer registry; estrogen receptor; progesterone receptor; epidemiology; drug therapy; trastuzumab; guideline adherence; caucasian; hispanic; clinical practice patterns; asian; california; protocol compliance; delivery of health care, integrated; integrated health care system; estrogen receptor positive breast cancer; very elderly; humans; human; female; article; black person; estrogen receptor negative breast cancer; progesterone receptor positive breast cancer; progesterone receptor negative breast cancer; cyclophosphamide plus doxorubicin plus taxane; adherence guideline
Journal Title: Breast Cancer Research and Treatment
Volume: 208
Issue: 2
ISSN: 0167-6806
Publisher: Springer  
Date Published: 2024-11-01
Start Page: 405
End Page: 414
Language: English
DOI: 10.1007/s10549-024-07433-4
PUBMED: 39150586
PROVIDER: scopus
PMCID: PMC12045552
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85201404753&doi=10.1007%2fs10549-024-07433-4&partnerID=40&md5=75d689a89850c90923fcb3a958b8469d
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: Elizabeth D. Kantor -- Source: Scopus
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MSK Authors
  1. Narre Heon
    16 Heon
  2. Elizabeth David Kantor
    43 Kantor
  3. Kelli O'Connell
    47 O'Connell
  4. Sara Tabatabai
    15 Tabatabai
  5. Jenna Bhimani
    16 Bhimani
  6. Grace Boyan Gallagher
    16 Gallagher
  7. Yuriy Kotsurovskyy
    6 Kotsurovskyy
  8. Sonia Persaud
    22 Persaud
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