{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T16:40:11Z","timestamp":1756744811445,"version":"3.44.0"},"reference-count":49,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T00:00:00Z","timestamp":1693785600000},"content-version":"unspecified","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100024396","name":"Healthcare Quality Improvement Partnership","doi-asserted-by":"crossref","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100024396","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Cancer Research UK and the Dutch Cancer Society","award":["C7827\/A27366"],"award-info":[{"award-number":["C7827\/A27366"]}]},{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["C8225\/A21133"],"award-info":[{"award-number":["C8225\/A21133"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015846","name":"Llywodraeth Cymru","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100015846","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NHS England","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjonc"],"accepted":{"date-parts":[[2023,8,16]]},"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Although adjuvant trastuzumab-based treatment (TBT) improves survival for patients with HER2-positive early invasive breast cancer (EIBC), risk of toxicity grows as patient age increases. We examined use of TBT and associated severe acute toxicity event (SATE) rates to understand the real-world impact.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and analysis<\/jats:title>\n                  <jats:p>Women (50+ years), newly diagnosed with HER2-positive EIBC in England, 2014\u20132019, were identified from Cancer Registry data, linked to the Systemic Anti-Cancer Therapy dataset for TBT information. SATEs were measured using hospital administrative data. Statistical models were developed to identify potential predictors of SATE.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 5087\u2009women who received trastuzumab, with median duration 11.7 months, 47.4% (95% CI 46.0% to 48.7%) completed treatment. Women aged 70+ years made up 20.2% of patients aged 50+ who received adjuvant TBT in routine care, compared with 5% of women aged 50+ across trials. 32.8% (95% CI 31.5% to 34.1%) had a record of any SATE. 6.8% (95% CI 6.1% to 7.5%) had a cardiovascular SATE. Congestive cardiac failure rate was 0.5% (95% CI 0.3% to 0.7%). High deprivation, anthracycline use, increasing frailty were associated with increased odds of any SATE. Older age, sequential chemotherapy, history of myocardial infarction\/chronic pulmonary disorder\/liver disease were associated with increased odds of cardiovascular SATE. Among two-thirds of women not eligible for trial cohorts SATE rates were lower than for trial-eligible patients, explained by baseline differences in patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Evidence of treatment-related SATE among patients treated in routine care is needed to inform treatment decisions and counsel older patients. This study provides information on SATE rates for adjuvant TBT, and common types, overall and by age for such discussions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjonc-2023-000081","type":"journal-article","created":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T12:25:17Z","timestamp":1693830317000},"page":"e000081","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Treatment-related acute toxicity with adjuvant systemic treatment among patients with HER2-positive early invasive breast cancer: a national population-based cohort study"],"prefix":"10.1136","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9163-0571","authenticated-orcid":false,"given":"Melissa Ruth","family":"Gannon","sequence":"first","affiliation":[{"name":"Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK"},{"name":"Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Dodwell","sequence":"additional","affiliation":[{"name":"Nuffield Department of Population Health, University of Oxford, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katie","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK"},{"name":"Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jibby","family":"Medina","sequence":"additional","affiliation":[{"name":"Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK"},{"name":"Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen","family":"Clements","sequence":"additional","affiliation":[{"name":"National Cancer Registration and Analysis Service, NHS England, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kieran","family":"Horgan","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery, St James's University Hospital, Leeds, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Min Hae","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK"},{"name":"Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David Alan","family":"Cromwell","sequence":"additional","affiliation":[{"name":"Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK"},{"name":"Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,9,4]]},"reference":[{"doi-asserted-by":"publisher","key":"2025090109084604000_2.1.e000081.1","DOI":"10.1016\/S0140-6736(16)32417-5"},{"key":"2025090109084604000_2.1.e000081.2","doi-asserted-by":"crossref","first-page":"v8","DOI":"10.1093\/annonc\/mdv298","article-title":"Primary breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up","volume":"26 Suppl 5","author":"Senkus","year":"2015","journal-title":"Ann Oncol"},{"unstructured":"NICE . 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