Immigration status and breast cancer surgery quality of care metrics: a population-level analysis
Parvez E, Bogach J, Kirkwood D, Pond G, Doumouras A, Hodgson N, Levine M. Ann Surg Oncol. 2024; Apr 18 [Epub ahead of print].
Background — Fewer than half of all patients with metastatic melanoma survive more than 1 year. Standard treatments have had little success, but recent therapeutic advances offer the potential for an improved prognosis. In the present study, we used population-based administrative data to establish real-world baseline estimates of survival outcomes and costs against which new treatments can be compared.
Methods — Data from administrative databases and patient registries were used to find a cohort of patients with metastatic melanoma in Ontario. To identify individuals most likely to receive new treatments, we focused on patients eligible for second-line treatment. The identified cohort had two characteristics: no surgical resection beyond primary skin excision, and receipt of first-line systemic therapy.
Results — Patient characteristics, Kaplan–Meier survival curves, and mean costs are reported. Of the 33,585 patients diagnosed with melanoma in Ontario from 1 January 1991 to 31 December 2010, 278 met the study inclusion criteria. Average age was 63 years, and 62% of the patients were men. Overall survival was estimated to be 19%, 12%, and 6% at 12, 24, and 60 months respectively. Mean survival time was 11.5 months, and mean cost was $30,685.
Conclusions — Our baseline estimates indicate that survival outcomes are poor and costs are high for patients receiving standard treatment. Understanding the relative improvement accruing from any new treatment requires a comparison with the existing standard of care.
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