Breast cancer is the most common form of cancer in women. Over the last few decades, scientific advances in the care management of patients (also known as the patient pathway) have increased the chances of breast cancer patients recovering from the disease.
Currently, the patient pathway is generally determined by special medical boards or clinical trials. However, these pathways may not reflect what occurs in the real day-to-day management of such patients due to differences between patients. Some studies have also found that patients with similar forms of breast cancer receive different levels of treatment, particularly due to lifestyle factors (e.g. their body mass index, if they smoke, if they drink alcohol, etc) which may affect the chances of a patients recovery.
The aim of our study is to describe the patient pathway for breast cancer patients (e.g. number of visits to the GP prior to diagnosis, the average time for a patient to receive treatment following diagnosis, etc) using anonymised, routinely collected health information from primary care, hospital, cancer registration and treatment data. We will investigate whether lifestyle factors play a role in the allocation of treatment for such patients. We hope the results of this study will help to generate a patient pathway more reflective of what happens in real-life clinical settings and highlight possible areas for improvement.
The objective of this retrospective cohort study is to describe the clinical management and treatment of breast cancer patients by mapping the patient pathway and identifying differences in treatment by based on lifestyle factors. Additionally, we will identify the strengths and limitations of the Systemic Anti-Cancer Therapy (SACT) data in terms of what can/ cannot be ascertained by conducting a study
Incident breast cancer patients will be defined based on ICD-10 and Read coded information in a patients primary care and/ or cancer registration record and grouped according to cancer severity and subtype. They will then be followed up from their first symptom within the study period (from 01 Jan 2014 until the end of the latest database build). The outcomes of interest (which will be defined using primary care, hospital, cancer registration and treatment data) will include the proportion of patients who receive different types of treatment, the average time between each step in the patient pathway, the proportion of breast cancers detected by screening, number of outpatient visits, etc. These analyses will be stratified by several factors including, age, ethnicity, body max index, Smoking status, alcohol status, etc.
We will also explore differences in receipt and dose of systemic treatment received by breast cancer patients based on BMI, alcohol and smoking status using logistic regression.
Chemotherapy treatment
Trastuzumab treatment
Rachael Williams - Chief Investigator - CPRD
Jessie Oyinlola - Corresponding Applicant - CPRD
Anthony Matthews - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Eleanor Yelland - Collaborator - CPRD
HES Admitted Patient Care;HES Outpatient;NCRAS Cancer Registration Data;NCRAS Systemic Anti-Cancer Treatment (SACT) data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation