| Abstract [eng] |
Cancer is a major and growing public health burden in Europe, with breast cancer being the most common malignancy among women. Although anticancer treatment options have expanded substantially, access to innovative medicines differs between European countries. In Lithuania, evidence on anticancer medicine utilization and its association with breast cancer mortality remains limited. AIM To evaluate the utilization of anticancer medicines and breast cancer mortality rates in Lithuania from 2019-2024. OBJECTIVES 1. To describe the changes in utilization of anticancer medicines used for breast cancer treatment from 2019 to 2024 in Lithuania. 2. To investigate differences in the use of anticancer medicines used for breast cancer treatment related to socioeconomical and clinical factors. 3. To analyze the trend in mortality from breast cancer from 2019 to 2024 in Lithuania and to assess association between anticancer medicine utilization and breast cancer mortality rates. METHODS This retrospective cohort study used non-identifiable patient-level data provided by the State Data Agency through Palantir Foundry. The study included data of patients diagnosed with breast cancer (ICD C50.*) between 2019 and 2024. Data on diagnosis, mortality, administered anticancer medicine, surgery, radiotherapy, income, marital status, education, comorbidities, and metastatic status were linked using unique patient codes. Anticancer medicine utilization was defined as the proportion of patients receiving at least one anticancer medicine (ATC L01 & L02) within the first year after breast cancer diagnosis. Medicines were grouped into chemotherapy, endocrine therapy, targeted therapy, and immunotherapy. Trends in utilization and mortality were visualized using charts. Logistic regression was used to assess factors associated with choice of treatment. Cox proportional hazards regression and Kaplan–Meier survival analysis were used to evaluate factors associated with breast cancer survival. RESULTS AND CONCLUSIONS Studies’ cohort included 12,371 breast cancer patients with mean age of 62 years. Breast cancer incidence in Lithuania remained relatively stable between 2019 and 2024, although a temporary decline in diagnosed cases was observed in 2020. During the study period, the proportion of patients who did not receive systemic anticancer treatment decreased from 19% to 11%, indicating increased utilization of anticancer medicines. Endocrine therapy alone remained the most commonly used systemic treatment option (~37% of patients treated within the first year of diagnosis), while utilization of combination treatment regimens with targeted therapy increased over time. Among targeted therapies, trastuzumab remained the most frequently used targeted therapy medicine (56% of patients treated with targeted therapy received trastusumab); however, utilization of newer agents, including trastuzumab emtansine, pertuzumab combined with trastuzumab, and abemaciclib, increased between 2019 and 2024. Older age was associated with lower odds of receiving chemotherapy, targeted therapy, radiotherapy, and surgery, while metastatic disease was associated with higher use of systemic therapies. Mortality within the first year after breast cancer diagnosis decreased from 6.5% in 2019 to 4.7% in 2024. Patients receiving anticancer treatment demonstrated lower mortality and improved survival compared with untreated patients. The strongest associations with improved survival outcomes were observed for targeted therapy and combination treatment regimens. Surgery and radiotherapy were also associated with significantly better survival outcomes. These findings suggest that increasing utilization and diversification of anticancer treatment in Lithuania were associated with improved short-term breast cancer outcomes during the study period. |
