A 2019/2020 Summer Studentship research project
This study will offer better understanding about the current practice treating metastatic breast cancer in our Christchurch region, including whether all funded options are eventually used, and whether treatment is limited by any remediable factor
Student: Ella Robertson
Supervisors: Professor Bridget Robinson, Dr Jenny Mclachlan, Dr Hilde Wolzac, Dr Matthew Strother
Sponsor: Breast Cancer Foundation NZ
New Zealand is reported to trail Australia in outcome for women with metastatic breast cancer. A recent review published by the New Zealand Breast Cancer Foundation, based on data from the National Breast Cancer Registers, found low rates of chemotherapy use, and low rates of use of second or later line chemotherapy, for women treated between 2000 and 2015 (NZBCF, September 2018). The median survival was 18.8 months for the years 2010 to 2015. Median number of systemic therapies used was 2 up to age 69 years and 1 if 70 years or older; with a median of one line of chemotherapy. This appeared to be similar in each of the 4 regions (including Christchurch) included in the Register, which covered 70% of breast cancers diagnosed in New Zealand. This has surprised Oncologists who have treated these women, and has led to this review of management of women presenting with metastatic breast cancer.
Establish all the treatment modalities used for metastatic breast cancer, and their sequence, in an unselected series of consecutive women and men presenting with advanced breast cancer in Christchurch. Associate treatment with factors such as patient age, domicile, tumour characteristics including estrogen and HER2 receptor status, site of metastases, and comorbidity. Secondary outcomes are outcome as progression-free survival, treatment free interval after each treatment, survival.
All women and men who are diagnosed with metastatic breast cancer will be included, over 2 periods, between the years of 2010 and 2011 and 2016 to 2017. They will be identified from the Oncology mosaiq database. The dataset will be compared with the Christchurch patients on the National Breast Cancer Register, to find those not referred to the Oncology Service. The Oncology mosaiq and CDHB electronic records will be searched for patient demographics, age at diagnosis of breast cancer, and of metastases; detailed pathology of primary and secondary cancer (where biopsied), estrogen, progesterone and HER2 receptors, grade, sites of metastases, treatments used (chemotherapy, endocrine therapy, biological therapies, radiation). Date of start and end of each therapy will be recorded, to enable time to next therapy to be calculated. Metastases at diagnosis will be compared with metastases at recurrence. Comorbidity will be recorded, using the Charlson Score. Differences in treatment received will be compared between the 2010 and 2015 2-year cohorts. Correlations will be explored between these variables. The results will be compared with the NZBCF publication.
Student researcher’s component of the study
The student will set up the database, find the information from the records, do simple analyses and work with the supervisors and statistician to uncover correlations. We will aim to include at least 100 patients from each 2-year period, but more if time allows.
"I’m still here" : Insights into living – and dying – with Advanced Breast Cancer in New Zealand, NZBCF, September 2018.
Weide et al. “Metastatic breast cancer: prolongation of survival in routine care is restricted to hormone-receptor and Her2-positive tumors”, SpringerPlus 2014, 3:535
S Dawood et al, “Survival differences among women with de novo stage IV and relapsed breast cancer”, Annals of Oncology (2010) 21: 2169–2174
C Bartmann et al, “Pattern of metastatic spread and subcategories of breast cancer”, Arch Gynecol Obstet (2017) 295:211–223 DOI 10.1007/s00404-016-4225-4
M Sundquist et al, “Improved survival in metastatic breast cancer 1985-2016”, The Breast 31 (2017) 46e50
E Gobbini et al, “Time trends of overall survival among metastatic breast cancer patients in the real-life ESME cohort”, European Journal of Cancer (2018) Volume 96, 17-24
Medical student preferred, database skills favoured.