Patterns of trastuzumab (T) use in three Canadian provinces
Bibliographic record
Abstract
633 Background: New therapies for breast cancer are not always readily and appropriately adopted in clinical practice. The objective of this study was to examine patterns of T use in three Canadian provinces: Ontario (ON), Quebec (QC) and British Columbia (BC). While all 3 provinces have publicly funded health care systems, the care delivery models are different. ON has a centralized cancer system with the use of evidence based guidelines and the requirement for completion of new drug eligibility forms. BC has a more centralized system with less restrictive guidelines and implementation requirements. QC has none of these factors. In 1999 the federal regulatory agency approved T for use as a single agent or combined with chemotherapy in HER 2 positive metastatic breast cancer (MBC). ON and BC guidelines recommended T for use in combination with paclitaxel (P) or vinorelbine (V) (the latter in BC only) after anthracycline failure or as a single agent after taxane failure. Methods: Case specific data were collected on all patients treated with T for 3 years from 1999–2002. Patients on a T clinical trial were excluded. Information was collected from provincial cancer registries and patient charts. Patients were evaluated for consistency with federal agency recommendations and provincial guidelines. Results: T was used in 398 women in ON; 322 in QC; and 205 in BC representing respectively 6.6%; 7.4% and 10.7% of the estimated number of women who died of MBC in those provinces during the study period. Patients in ON and BC were more likely to be treated consistent with federal agency recommendations and provincial guidelines (Table). Response rates were higher in BC which was associated with earlier use in patients with fewer sites of MBC and less prior treatment. Conclusions: The presence of a centralized cancer system led to better adherence to federal agency recommendations. Less restrictive guidelines may facilitate earlier use of T. No significant financial relationships to disclose.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.006 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| 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".