title: The impact of new chemotherapeutic and hormone agents on survival in a population-based cohort of women with metastatic breast cancer.
abstract: BACKGROUND
  Over the past decade, a number of new therapeutic agents have become available in the treatment of metastatic breast cancer (MBC). This study characterized the use and assessed the impact on survival of population-based access to new agents for the treatment of MBC.
  
  
  METHODS
  The dates of release in British Columbia of 7 new systemic agents for MBC during the 1990s were used to construct 4 time cohorts. All patients with a first diagnosis of distant metastases in each of the time cohorts were identified and characterized, and their survival was compared. Cox proportional regression modeling was used to assess for predictors of survival.
  
  
  RESULTS
  In total, 2150 patients with a first distant metastases diagnosed during 1 of the 4 cohort intervals were identified. Baseline characteristics between cohorts were similar, except a greater proportion of the later cohorts received adjuvant chemotherapy (P < .001), had positive estrogen receptor status (P = .01), and had a longer median time from initial diagnosis to MBC (P < .001). Survival in Cohort 1 (1991-1992) and Cohort 2 (1994-1995; median, 438 days and 450 days, respectively) was similar. Survival was longer in Cohort 3 (1997-1998; median, 564 days; P = .002) and improved further in Cohort 4 (1999-2001; median, 667 days; P = .05). In multivariate analysis, the later cohorts were associated independently with improved survival (P = .01 and P < .001, respectively).
  
  
  CONCLUSIONS
  Population-based access to new therapeutic agents for MBC appeared to be associated with improved survival. To the authors' knowledge, this is the first study to date that demonstrates, from a population-based perspective, improving survival over the past decade for women with MBC.
authors.affiliation: Division of Medical Oncology, British Columbia Cancer Agency and the University of British Columbia, Vancouver and Victoria, British Columbia, Canada. schia@bccancer.bc.ca
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Chia
authors.forename: Caroline H
authors.initials: CH
authors.lastname: Speers
authors.forename: Yulia
authors.initials: Y
authors.lastname: D'yachkova
authors.forename: Anna
authors.initials: A
authors.lastname: Kang
authors.forename: Suzanne
authors.initials: S
authors.lastname: Malfair-Taylor
authors.forename: Jeff
authors.initials: J
authors.lastname: Barnett
authors.forename: Andy
authors.initials: A
authors.lastname: Coldman
authors.forename: Karen A
authors.initials: KA
authors.lastname: Gelmon
authors.forename: Susan E
authors.initials: SE
authors.lastname: O'reilly
authors.forename: Ivo A
authors.initials: IA
authors.lastname: Olivotto
mesh_terms: D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000453:epidemiology* / Q000473:pathology; D001955:British Columbia / Q000453:epidemiology; D015331:Cohort Studies; D019992:Databases as Topic / Q000706:statistics & numerical data; D004358:Drug Therapy / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D011379:Prognosis; D016016:Proportional Hazards Models; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal