Survival Outcomes and Care Equity among Patients with Advanced Breast Cancer in Auckland, New Zealand

Abstract

Aim. The Auckland Advanced Breast Cancer Review (AABC) was a review of patients diagnosed with advanced inoperable/metastatic breast cancer (ABC) within the Auckland region of New Zealand, commissioned in response to a Breast Cancer Registry report (BCFNZR) that showed poor and inequitable survival outcomes. The review was aimed at assessing equity of care and identifying healthcare delivery gaps for patients with ABC in the Auckland region. Method. In this retrospective study, patients living within the Auckland region, diagnosed with ABC between the 1st January 2013 to the 31st December 2015 were identified from the Breast Cancer Registry. Data censorship date was 30th January 2019 to allow a minimum of 3 years of follow-up. Demographic, diagnostic, treatment, and survival data were extracted from electronic records for statistical analysis. Results. Of the 388 patients that met inclusion criteria for this study, median overall survival (medOS) was 18.9 months in the total population, with no difference between patients with de novo metastatic disease (dnMBC -18.9 m) and recurrent metastatic disease (rMBC -18.7 m). No statistically significant differences in medOS was found amongst Maori (16.2 m), Pacific People (17.3 m), and NZ European (18.9 m) or when patients were stratified according domicile district health board. Median number of lines of systemic treatment was two, with similar treatment exposure between ethnic groups. Conclusion. While treatment uptake and survival outcomes were generally comparable across ethnicity and district health boards, dnMBC survival outcomes were considerably poorer than expected, earmarking this subset of patients with ABC for more in-depth research.