Underutilization of GnRH analogues (G) and exemestane (E) in young patients with early-stage breast cancer (BC) in Ontario.
Bibliographic record
Abstract
73 Background: In 2014-15, the randomized control trials SOFT and TEXT showed that premenopausal women with hormone receptor-positive, early stage BC treated with ovarian suppression (G or oophorectomy) in combination with E had improved outcomes compared to those treated with tamoxifen (T) alone. The largest benefit was observed in women younger than 35 ( < 35y). In Ontario, these regimens are not fully publicly funded for premenopausal women. We examined the utilization of adjuvant G + E for premenopausal BC patients in Ontario, as underutilization might reflect difficulty accessing these drugs. Methods: We determined the current utilization of adjuvant endocrine therapy for patients with BC through Ontario’s systemic therapy database. In particular, we examined the utilization of T, E and E + G in BC patients < 35y as these patients are expected to have the highest rates of uptake based on the outcomes of SOFT and TEXT. Results: In the first year following the publication of SOFT and TEXT, 20% of BC patients receiving adjuvant endocrine therapy received E + ovarian suppression (G or oophorectomy). This value was 14% in the following year, reflecting low uptake of the optimal treatment strategy. Conclusions: In Ontario, uptake of G + E is low in BC patients < 35y. One possible barrier to access is the lack of public funding for these drugs in this population. The low uptake may also reflect the toxicity associated with this treatment and the need for further knowledge translation. A 2017 provincial prioritization process ranked this unmet funding need as a high priority. Thus, a funding submission will be prepared to promote access to this evidence informed therapy. The submission will include a full evidence review and pharmacoeconomic analysis.[Table: see text]
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".