Abstract P2-08-13: Survival in women with de novo metastatic breast cancer: Comparison of real-world evidence from publicly-funded Canadian province and the United States by insurance status
Bibliographic record
Abstract
Abstract Background: Access to cancer screening, diagnosis and treatment in the United States (US) is affected by insurance status; whereas, access within a publicly-funded health care system is similar across the whole population. The aim of this study was to compare overall survival (OS) of de novo stage IV (metastatic) breast cancer (BC) pts in a Canadian province and in the US according to insurance status. Methods: All female pts 18-64 yrs of age diagnosed with de novo stage IV BC from Jan 1, 2010 through Dec 31, 2014 with available biomarker information were included. Pts diagnosed by death certificate or autopsy and pts ≥ 65 yrs were excluded due to unreliable insurance status classification in the US SEER database. The Alberta cohort (AB) was obtained from the Alberta Health Services CancerControl Breast Data Mart (BDM), a repository of information on all pts diagnosed with their first BC diagnosis from Jan 1, 2004 onwards in the province of Alberta, Canada. The U.S. cohort was obtained from the US Surveillance, Epidemiology, and End Results (SEER) program cancer database. A total of 9,604 pts from the SEER database and 294 pts from the BDM were analyzed. OS was evaluated over a 2 yr period and median and 2 yr OS were estimated. Unadjusted associations were compared using the log-rank test, and hazard ratios (HR) were estimated using the Cox proportional hazards model with US insured set as reference group. Results: Comparison of AB and US cohorts showed no differences based on age group (18-49 vs 50-64), yr of diagnosis or receipt of primary surgery. The AB cohort had a higher incidence of hormone receptor positive (HR+), similar frequency of HER2+, and a lower incidence of triple negative (TN) BC relative to the US cohort: HR+ 60.5% vs 56.4%; HER2+ 30.6% vs 28.8%; and TN 8.8% vs 14.8%, respectively [p=0.017]. The distribution of HR+, HER2+ and TN BC was consistent between the SEER insured, Medicaid and uninsured groups. AB cohort estimated 2 yr OS was 70.1%, similar to the insured group of 66.0% and significantly better than the Medicaid or uninsured pts [53.2% and 50.9%; p<0.0001]. Subgroup analysis based on biomarker status, surgery and age group showed similar results. Adjusting for these variables, AB OS remained similar to the insured group [HR=0.92 (0.74-1.15) p=0.474] with worse OS noted in the Medicaid and uninsured populations [HR=1.44 (1.32-1.56) and HR=1.53 (1.33-1.77) p<0.001, respectively]. HR+HER2+TNNo SurgerySurgery18-4950-64InsuredReference Group: HR=1.00AB0.92 (0.68-1.24) p=0.5841.15 (0.76-1.72) p=0.5090.84 (0.49-1.42) p=0.5070.91 (0.71-1.17) p=0.4660.71 (0.45-1.11) p=0.1330.84 (0.56-1.27) p=0.4080.87 (0.67-1.12) p=0.284Medicaid1.43 (1.27-1.61) p<0.0011.57 (1.32-1.87) p<0.0011.37 (1.18-1.60) p<0.0011.46 (1.33-1.59) p<0.0011.55 (1.33-1.81) p<0.0011.75 (1.52-2.00) p<0.0011.47 (1.34-1.61) p<0.001Uninsured1.76 (1.44-2.15) p<0.0011.64 (1.20-2.22) p<0.0011.56 (1.20-2.05) p=0.0011.56 (1.34-1.80) p<0.0011.59 (1.16-2.18) p=0.0041.76 (1.35-2.29) p<0.0011.67 (1.43-1.94) p<0.001 Conclusion: OS in women with de novo stage IV BC in AB was similar to US insured. AB and US insured experienced superior OS compared with US Medicaid and uninsured. Citation Format: Kornaga EN, Matutino AR, Pereira AA, Verma S, Lupichuk S. Survival in women with de novo metastatic breast cancer: Comparison of real-world evidence from publicly-funded Canadian province and the United States by insurance status [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-13.
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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 | 0.004 | 0.019 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.003 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".