Healthcare cost of HER2-positive and negative breast tumors in the United States (2012–2035)

The approach to advanced breast cancer has been revolutionized by targeted agents.

•The total cost of HER2-positive patients was estimated for $2,719,542,347 in 2012.•The total estimated cost for HER2-negative patients in 2012 was $8,376,028,459.•In 2035, we estimated a cost of $3.6 and $11.2 bilions for HER2+ and HER2− tumors.•The cost of HER2-negative tumors should be carefully evaluated in the coming years.

"...our data strongly suggest that cost-analyses should be carefully evaluated in the coming years, aimed to improve the cost-effectiveness of targeted approaches for advanced BC, in particular in patients with HER2-negative tumors. This will be crucial to guarantee the access to cure for all cancer patients and the future economic sustainability of health system."

https://www-sciencedirect-com.ezproxy.liberty.edu/...

https://doi.org/10.1016/j.ctrv.2017.08.005

{This article was evidently published in 2017, but I only recently located a link. It is a bit cringeworthy because the implication seems to me to be that we are not worth the high cost. Of course, it is mostly the drugs.... which, thankfully, are often effective, but which we know to be astronomically unaffordable. The costs/prices they cite are dramatically higher than my shocking EOB's. I can't quite make sense of that. Access to full article seems to be free.}

The FDA has granted emergency use authorization to an antibody combination called Evusheld that is highly effective at preventing COVID-19 infection in immune compromised patients. Press release here.

https://www.astrazeneca.com/media-centre/press-rel...

Most Oncologists Discuss Drug Side Effects, Open to Reduce Doses

Roxanne Nelson, RN, BSN

December 15, 2021

Many patients with metastatic breast cancer (MBC) experience distressing toxicity related to treatment.

According to a new survey, all oncologists reported talking to their patients about side effects at every visit and nearly all (97%) were open to lowering medication doses.

The findings, presented during a poster session at the 2021 San Antonio Breast Cancer Symposium (SABCS), were encouraging to Charles Shapiro, MD, of the Icahn School of Medicine at Mount Sinai in New York City.

"I think this survey confirms that a lot of oncologists are willing to reduce the dose if patients have side effects, and a high percentage discuss side effects with their patients," said Shapiro, who was not involved in the study.

Anne L. Loeser, who has MBC and is co-author of the survey alongside a team of oncologists, agreed that it is vitally important for doctors to discuss toxicity and take patients' quality of life into consideration.

"Patients with MBC are incurable — albeit treatable — and the majority will remain on therapy for the rest of their lives," Loeser, founder of the Patient-Centered Dosing Initiative (PCDI), told Medscape Medical News. "Understandably, we want to make the most of the time we have left."

When patients begin treatment, oncologists often prescribe the recommended starting dose, which is based on the clinical trial results used to approve the drug. However, patient tolerance for this dose in the real-world setting often differs from that of clinical trial participants, the survey authors note.

In fact, Loeser said, "this dose generally precipitates the most, and worst, side effects."

In a previous survey, the team of researchers found that, among 1221 patients with MBC, 86% experienced at least one significant treatment-related side effect and almost all were willing to discuss individualized dosing with their physicians. The current study expands on that research, highlighting responses about treatment side effects and dosing options from medical oncologists.

In the new study, a confidential, 28-question online survey was sent to US medical oncologists identified via professional organizations, social media, and email lists. The objective of the survey was to gain a better understanding of oncologists' perspectives regarding the prevalence and severity of treatment-related toxicity, increase recognition of the impact of dosage-related mitigation strategies on clinical outcomes, and determine their willingness to discuss flexible dosing options.

A total of 119 medical oncologists participated in the survey. Of this group, 85% specialized in breast cancer, 66% worked in an academic setting, and 82% had been in practice for more than 5 years.

Overall, respondents estimated that nearly half of their patients had reported a distressing treatment-related side effect, 15% visited the emergency department or hospital for this reason, and 37% required a break from treatment. The most common mitigation strategies included prescribing supportive medication, offering suggestions for palliation, and lowering the medication dose.

All respondents reported reducing medication doses as a means of alleviating side effects; 74% reported that dose reduction helped relieve side effects; and 71% indicated that efficacy of the reduced dose was similar to that of the standard dose.

Notably, 60% of oncologists indicated that patients felt better when therapy began with a lower starting dose rather than the standard dose, and 59% indicated that treatment efficacy was similar to the standard dose. The drugs, or drug classes, most commonly prescribed at lower initial doses were capecitabine (91%), taxanes (60%), and palbociclib (50%).

The authors concluded that "these patient-centered dosing discussions should be part of routine care and may consequently improve [quality of life] for patients with MBC."

In the past, quality of life and quantity of life were perceived as an "either/or" proposition, but that mentality is changing, Loeser said. "In fact, the [US Food and Drug Administration] is moving away from the concept of maximum tolerated dose in favor of identifying the optimal dose with regard to safety and efficacy."

Loeser also noted that toxicity-related side effects not only affect quality of life, they also affect treatment options. These side effects "may force some patients to stop a working treatment prematurely," she said. In addition, "cumulative side effects that build up over successive treatments may preclude patients from [using] the full list of therapies available to them because they can no longer withstand the toxicities from further drugs."

Some survey participants also posted comments in the survey, elaborating on how they communicate with patients and manage treatment-related toxicities.

One oncologist emphasized the need for an individualized approach to dose adjustments: "Like other decisions, this requires good communication and an effort to understand patients' preferences and expectations, so that an informed decision can be made."

Another participant noted that "it is critical to be able to vary dose based on the individual, as well as the biology of their cancer. It is quite likely that lower doses are less effective in some cases, but this can be sorted out as treatment is ongoing."

For certain patients, dose reduction may not be the best option, one respondent said. "In some cases, it may be prudent to go a step further and move to best supportive care rather than reduce dose, particularly for late line therapy or indolent disease."

For Shapiro, establishing a strong partnership between physician and patient is critical to ensuring patients get the best care possible.

"You rely on patients to tell you what's working and what isn't with the drug, and we can make adjustments," he said. "It can be the greatest drug in the world, but if your patient can't tolerate it, then it isn't going to do much good."

The survey was conducted by PCDI. Loeser is the founder of the PCDI.

SABCS 2021. Abstract P4-10-09. Presented December 9, 2021

https://www.medscape.com/viewarticle/964899?uac=21...

{Free access.}

BevJen,

Thanks for the link to the reporting on the link between stress and cancer. Ugh! Just what we don't need. We mostly focus on our own cancers and those of family and friends, but that could have all kinds of crazy implications for public health.

BevJen, Yes, my life was very stressful in the years leading up to my becoming sick and eventually being diagnosed. I have often wondered to what extent this contributed to the cancer's development and progression. Thx again.

'First Reliable Estimate' of Breast Cancer Metastasis

For the first time, there are now 'reliable' data to show what proportion of women with breast cancer go on to develop metastatic disease.

The data come from a massive meta-analysis of more than 400 studies conducted around the world, involving tens of thousands of women.

It found that the overall risk of metastasis is between 6% and 22%, with younger women having a higher risk.

While women aged 50 years or older when they were diagnosed with breast cancer have a risk of developing metastasis that ranged from 3.7% to 28.6%, women diagnosed with breast cancer before age 35 had a higher risk — 12.7% to 38%. The investigators speculate that this may be because younger women have a more aggressive form of breast cancer or because they are diagnosed at a later stage.

The risk of metastasis also varies by tumor type, with luminal B cancers having a 4.2% to 35.5% risk of metastasis vs a 2.3% to 11.8% risk with luminal A tumors.

"The quantification of recurrence and disease progression is important to assess the effectiveness of treatment, evaluate prognosis, and allocate resources," commented lead investigator Eileen Morgan, PhD, of the International Agency for Research on Cancer.

Morgan and colleagues presented the new meta-analysis at the virtual Advanced Breast Cancer Sixth International Consensus Conference.

She added that this information has not been available until now "because cancer registries have not been routinely collecting this data."

In fact, the US National Cancer Institute began a project earlier this year to track this information, after 48 years of not doing so.

Reacting to the findings, Shani Paluch-Shimon, MBBS, director of the Breast Unit at Hadassah University Hospital, Jerusalem, Israel, commented that this work "provides the first reliable estimate of how many breast cancer patients go on to develop advanced disease in contemporary cohorts."

"This information is, of course, important for patients who want to understand their prognosis," she continued.

"But it's also vital at a public health level for those of us working to treat and prevent advanced breast cancer to help us understand the scale of the disease around the world," she said. "It will help us identify at-risk groups across different populations and demonstrate how disease course is changing with contemporary treatments.

"It will also help us understand what resources are needed and where, to ensure we can collect and analyze quality data in real-time as this is key for resource allocation and planning future studies."

The work was funded by a grant from the Susan G. Komen Foundation.

Advanced Breast Cancer Sixth International Consensus Conference: Abstract Abstract OR91. Presented October 15, 2021.

Source: https://www.medscape.com/viewarticle/962289?uac=21...

Risk for Breast Cancer Recurrence Persists Past 30 Years

For the first time, new data show that risk for breast cancer recurrence extends past 30 years.

The data come from a Danish study involving 20,315 women who were treated for early operable breast cancer between 1987 and 2004, and all of whom were disease-free at 10 years.

Further follow-up showed that 2595 women had a breast cancer recurrence more than 10 years after their primary diagnosis.

The cumulative incidence of recurrence was 8.5% at 15 years; 12.5% at 20 years; 15.2% at 25 years, and 16.6% at 32 years.

Recurrence risk was greatest early in the study period.

Women who had primary tumors larger than 20 mm, lymph node-positive disease, and estrogen receptor-positive tumors were at higher risk for late recurrence.

"Such patients may warrant extended surveillance, more aggressive treatment, or new therapy approaches," said the investigators, led by Rikke Pedersen, MD, a PhD candidate in epidemiology at Aarhus University Hospital in Denmark.

"Our observed high cumulative incidence of late breast cancer recurrence is a concern given the increasing prevalence of long-term survivors." Among other things, a new model to better select women for prolonged surveillance is needed, they said.

The new findings were published online November 8 in the Journal of the National Cancer Institute (NCI).

This study confirms previous investigations, but it is the first to report that breast cancer can recur more than 30 years after diagnosis, note the authors of an accompanying editorial, Serban Negoita, MD, DrPH, and Esmeralda Ramirez-Peña, PhD, MPH, both from the National Cancer Institute.

The caveat is that treatment has evolved considerably since the women in the study were diagnosed, so the prognostic value of the findings with current treatment regimens is uncertain, they note. Some studies haven't found a recurrence benefit for aggressive upfront treatment, but those studies had shorter follow-ups.

Research into the issue is "increasingly important" to guide clinical management and counsel women who are living longer after their primary diagnosis, they comment.

Further Details from the Study

Data for the study came from the Danish Breast Cancer Group clinical database and other national databases. The researchers focussed on women who were disease-free at 10 years after their primary diagnosis, which was stage I or II disease. Median age was 55 years.

Cumulative incidence for breast cancer recurrence was highest for grade 1 tumors with four or more positive lymph nodes (37.9% 10-25 years after the primary diagnosis) and was lowest for patients with grade 3 disease and no involved lymph nodes (7.5%).

The finding of higher recurrence incidence with lower grade tumors goes against some previous reports, the researchers commented. It may be that some tumors considered lower risk decades ago, and treated accordingly, would be considered higher risk in more recent times.

The cumulative incidence of late recurrence was also higher in younger patients and those treated with breast-conserving surgery instead of mastectomy, the team reported.

Adjusted hazard ratios followed the incidence trends, with higher hazards of recurrence for women diagnosed before age 40 as well as those who had breast-conserving surgery, four or more positive lymph nodes, and primary tumors 20 mm or more across.

The work was funded by the Danish Cancer Society and Aarhus University. Lead author Pedersen reports no disclosures, but co-authors report ties to Amgen, Novo Nordisk, Roche, and other companies. The editorialists have disclosed no relevant financial relationships.

J Natl Cancer Inst. Published online November 8, 2021. Abstract, Editorial

https://www.medscape.com/viewarticle/963031?uac=21...