title: Real world patterns of care in HER2-overexpressing breast cancer: Results of a survey of TEACH clinical trial investigators in 2011.
abstract: BACKGROUND
  HER2-overexpressing breast cancer (BC) is common among young patients and poses a public health burden. Adjuvant anti-HER2/neu therapy with trastuzumab reduces the risk of recurrence and improves survival.
  
  
  METHODS
  A web-based survey was sent to 386 physicians of the "TEACH" trial in 2011 to determine access to HER2/neu testing and treatment patterns for HER2-overexpressing BC.
  
  
  RESULTS
  There were 151 responders (39%) from 28 countries. Ninety-seven percent reported HER2/neu expression is routinely measured in their institutions by immunohistochemistry (85%), FISH (80%) and other methods (16%). Twenty percent of responders from Asia reported that the test was not routinely available. Forty-eight percent of participants reported instances when adjuvant HER2-directed therapy was recommended to a patient who eventually did not receive it. Reasons for not receiving trastuzumab was cost (73%, p < 0.0001) in low- and middle-income countries and co-morbidities in high-income countries (43%, p = 0.003).
  
  
  CONCLUSIONS
  This survey reflects the availability of HER2/neu testing and anti-HER2/neu therapy among physicians who participated in TEACH. A high proportion of women with HER2-overexpressing BC may not receive standard adjuvant therapy due to unavailability of the test and cost of therapy. Despite having some limitations, such as a possible selection bias of participating physicians, variable definitions of access to healthcare among respondents, and changes in trastuzumab availability since 2011, our results demonstrate that access to care and region of practice impact the implementation of cancer treatments.
authors.affiliation: Global Cancer Institute, Boston, MA 02114, USA; Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
authors.forename: Y
authors.initials: Y
authors.lastname: Chavarri-Guerra
authors.affiliation: Global Cancer Institute, Boston, MA 02114, USA; Avon International Breast Cancer Program, Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA.
authors.forename: J
authors.initials: J
authors.lastname: St Louis
authors.affiliation: Global Cancer Institute, Boston, MA 02114, USA; Avon International Breast Cancer Program, Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA.
authors.forename: A
authors.initials: A
authors.lastname: Bukowski
authors.affiliation: Global Cancer Institute, Boston, MA 02114, USA; Cancer Care in the Elderly Clinic, Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
authors.forename: E
authors.initials: E
authors.lastname: Soto-Perez-de-Celis
authors.affiliation: Global Cancer Institute, Boston, MA 02114, USA; Department of Clinical Oncology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Mae de Deus Cancer Institute, Hospital Mae de Deus, Porto Alegre, RS, Brazil.
authors.forename: P E R
authors.initials: PER
authors.lastname: Liedke
authors.affiliation: Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, USA.
authors.forename: H
authors.initials: H
authors.lastname: Symecko
authors.affiliation: Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA.
authors.forename: B
authors.initials: B
authors.lastname: Moy
authors.affiliation: Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: Higgins
authors.affiliation: Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Finkelstein
authors.affiliation: Global Cancer Institute, Boston, MA 02114, USA; Avon International Breast Cancer Program, Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA; Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA. Electronic address: pgoss@mgh.harvard.edu.
authors.forename: P E
authors.initials: PE
authors.lastname: Goss
mesh_terms: D000970:Antineoplastic Agents / Q000600:supply & distribution / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000737:chemistry / Q000628:therapy*; D017326:Clinical Trials, Phase III as Topic; D019049:Developed Countries / Q000706:statistics & numerical data*; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D016032:Randomized Controlled Trials as Topic; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis; D000068878:Trastuzumab / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab; C508053:ERBB2 protein, human
keywords: Breast neoplasm; HER2; Health care disparities; Molecular targeted therapy