Nora Tabea Sibert1, Simone Wesselmann2, Clara Breidenbach2, Jens Blohmer3, Barbara Brückner4, Gerhard Gebauer5, Marina Dos Santos Guilherme6, Andreas Hartkopf7, Christoph Lindner8, Susanne Peschel9, Lorenz Rieger10, Friedemann Schad11, Paul Strecker12, Julia Ferencz13, Sebastian Dieng13, Elisabeth C Inwald14, Christoph Kowalski2, Olaf Ortmann14. 1. German Cancer Society, Kuno-Fischer-Straße 8, 14057, Berlin, Germany. sibert@krebsgesellschaft.de. 2. German Cancer Society, Kuno-Fischer-Straße 8, 14057, Berlin, Germany. 3. Department of Gynaecology Incl. Breast Center (CCM), Charité Berlin, Charitéplatz 1, 10117, Berlin, Germany. 4. Krankenhaus Waldfriede, Argentinische Allee 40, 14163, Berlin, Germany. 5. Askplepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Germany. 6. St. Vincenz Krankenhaus Limburg, Auf dem Schafsberg, 65549, Limburg, Germany. 7. Department of Obstetrics and Gynecology, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany. 8. Agaplesion Diakonieklinikum Hamburg, Hohe Weide 17, 20259, Hamburg, Germany. 9. St. Bernward Krankenhaus, Treiberstraße 9, 31134, Hildesheim, Germany. 10. Krankenhaus Landshut-Achdorf, Achdorfer Weg 3, 84036, Landshut, Germany. 11. Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany. 12. Helios Klinikum Erfurt, Nordhäuser Straße 74, 99089, Erfurt, Germany. 13. OnkoZert GmbH, Gartenstraße 24, 89231, Neu-Ulm, Germany. 14. Department of Gynaecology, Caritas-Krankenhaus St. Josef, Landshuter Straße 65, 93053, Regensburg, Germany.
Abstract
PURPOSE: Since 2008, guidelines recommend that patients with HER2-positive early breast cancer (BC) should receive adjuvant chemotherapy in combination with trastuzumab in Germany. However, recent studies highlight that a substantial share of patients do not receive trastuzumab. We investigate which patient characteristics are associated with a tumor board recommendation for trastuzumab in Breast Cancer Centers (BCC) certified by the German Cancer Society (DKG) and the German Society for Senology, and if the recommendation differs between BCCs. MATERIALS AND METHODS: Multi-level modeling was performed using quality assurance data based on 3052 HER2-positive, operated patients with a first diagnosis of early BC treated between 2006 and 2019 in 17 BCCs in Germany to investigate whether trastuzumab recommendation varies with patient sex, age, and disease characteristics, as well as over time and across BCCs. RESULTS: Tumor board recommendations for trastuzumab differ substantially between BCCs (intraclass correlation coefficient [ICC] null model: 0.11). Our final model (ICC 0.17, Akaike Information Criterion [AIC], 1328.0, R2 0.69) shows that physicians in BCCs more often recommend trastuzumab to patients who are younger than 60 years and those with a recommendation for any additional therapy (chemotherapy, radiation or endocrine therapy) (all p < 0.05). Furthermore, there is a significant time-dependent increase of trastuzumab recommendations (odds ratio [OR] = 1.38, 95% confidence interval [CI] = 1.31-1.46, p < 0.05). CONCLUSION: In certified BCCs in Germany, guideline concordant trastuzumab recommendation is increasing since 2006 (positive cohort effect). Recommendation of trastuzumab for HER2-positive BC patients in BCCs is significantly associated with patients' age and the recommendations for other additional therapy strategies, apart from surgery. The quality assurance data analyzed do not include potentially relevant confounders, such as socioeconomic status or comorbidities.
PURPOSE: Since 2008, guidelines recommend that patients with HER2-positive early breast cancer (BC) should receive adjuvant chemotherapy in combination with trastuzumab in Germany. However, recent studies highlight that a substantial share of patients do not receive trastuzumab. We investigate which patient characteristics are associated with a tumor board recommendation for trastuzumab in Breast Cancer Centers (BCC) certified by the German Cancer Society (DKG) and the German Society for Senology, and if the recommendation differs between BCCs. MATERIALS AND METHODS: Multi-level modeling was performed using quality assurance data based on 3052 HER2-positive, operated patients with a first diagnosis of early BC treated between 2006 and 2019 in 17 BCCs in Germany to investigate whether trastuzumab recommendation varies with patient sex, age, and disease characteristics, as well as over time and across BCCs. RESULTS: Tumor board recommendations for trastuzumab differ substantially between BCCs (intraclass correlation coefficient [ICC] null model: 0.11). Our final model (ICC 0.17, Akaike Information Criterion [AIC], 1328.0, R2 0.69) shows that physicians in BCCs more often recommend trastuzumab to patients who are younger than 60 years and those with a recommendation for any additional therapy (chemotherapy, radiation or endocrine therapy) (all p < 0.05). Furthermore, there is a significant time-dependent increase of trastuzumab recommendations (odds ratio [OR] = 1.38, 95% confidence interval [CI] = 1.31-1.46, p < 0.05). CONCLUSION: In certified BCCs in Germany, guideline concordant trastuzumab recommendation is increasing since 2006 (positive cohort effect). Recommendation of trastuzumab for HER2-positive BC patients in BCCs is significantly associated with patients' age and the recommendations for other additional therapy strategies, apart from surgery. The quality assurance data analyzed do not include potentially relevant confounders, such as socioeconomic status or comorbidities.
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