Abstract 156: Prognostic significance of distance travelled to the cancer center in women treated with adjuvant trastuzumab.
Authors: Roberts Sarah , Sarker Sabuj , Lee-Ying Richard , Ubhi Charanpreeti , Ahmed Shahid 
Published: August 2014

Background: Adjuvant trastuzumab therapy (ATT) in women with HER2 positive breast cancer has significantly improved survival. The current standard duration of ATT is one year. In order to prevent symptomatic cardiac dysfunction, periodic cardiac monitoring is recommended during ATT. Rural residents have to travel in excess of several hundred kilometers both for cardiac monitoring and treatment. The study aims to determine relationship between distance travelled to the cancer center and disease free survival (DFS) and overall survival (OS) in women with HER2 positive breast cancer.

Methods: Retrospective cohort study of women with early stage HER2 positive breast cancer treated in the province of Saskatchewan from 2005 to 2009. The study cohort was divided into two groups: group I (distance travelled &lt;100 km) and group II (distance travelled 100 km). Kaplan-Meier methods were used for survival estimation and Log Rank testing was done for survival comparison. Cox proportional hazard models were performed and various clinico-pathological variables were examined for their prognostic significance.

Results: A total of 211 eligible women with median age of 54 yrs (range: 27-80) were identified. 70% were postmenopausal, 52% had node positive disease and 60% had ER or PR positive disease. 57% women were rural residents. A statistically significant difference was noted between the 2 groups with respect to age, rural residence, comorbid illness and delay in start of therapy. All women received adjuvant chemotherapy and ATT. 97% women completed adjuvant chemotherapy and 83% completed planned ATT. During the median follow-up period of 37.1 months, 30 women developed recurrent disease and 26 died. Median DFS of Group II was 63.09 months and has not reached in Group I (p=0.5). Median OS of both groups has not reached. 5 years estimated DFS of group I was 77% compared with 57% in Group II (p=0.5). ER/PR negative disease, hazard ratio (HR) 2.53 (95% CI: 1.14-5.64) and discontinuation of ATT, HR 2.3 (95% CI: 1.06-5.00) were significantly correlated with an increased risk of recurrence. With respect to survival younger age, HR 5.33 (95% CI: 1.72-16.52); ER/PR negative tumors, HR 6.6 (95% CI: 2.23-19.37); and premenopausal status, HR 8.18 (95% CI: 2.27-29.51) were correlated with an increased mortality.

Conclusions: Although there was a trend toward increased risk of recurrence in women travelled longer distance, it was not statistically significant. Younger age, premenopausal status, ER/PR - tumors and discontinuation of ATT were correlated with inferior outcomes.

Citation Format: Sarah Roberts, Sabuj Sarker, Richard Lee-Ying, Charanpreeti Ubhi, Shahid Ahmed. Prognostic significance of distance travelled to the cancer center in women treated with adjuvant trastuzumab. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 156. doi:10.1158/1538-7445.AM2013-156