Sociodemographic Disparities in HER2+ Breast Cancer Trastuzumab Receipt: An English Population-Based Study

Abstract

Background: Socio-demographic disparities in traditional breast cancer treatment receipt in non-publicly funded healthcare systems are well documented. This study investigated trastuzumab receipt by socio-demographic factors within a female, HER2+ breast cancer population in England’s publicly funded National Health Service. Methods: The English national population-based cancer registry and linked Systemic Anti-Cancer Therapy (SACT) database identified 36,985 women with HER2+ invasive breast cancer diagnosed 01/01/2012–31/12/2017. Multivariable logistic regression determined likelihood of trastuzumab receipt in (i) early and (ii) metastatic disease by deprivation category of area of residence and other socio-demographic characteristics. Results: Early-stage trastuzumab receipt followed a socio-economic gradient. Women residing in the most deprived areas were 10% less likely to receive trastuzumab (multivariable OR 0.90, (95% CI) 0.83, 0.98) compared to women residing in the least deprived areas. In both early and metastatic disease, trastuzumab receipt was less likely in older women with more comorbidities, ER positive disease, and who were not discussed at a multidisciplinary team meeting. Conclusions: Despite provision of free at the point of delivery care in England, socio-demographic disparities in early-stage HER2+ trastuzumab receipt occur. Further research determining how inequities contribute to disparities in outcomes is warranted to ensure optimized trastuzumab use for all. Impact: Fair access to novel cancer treatments regardless of place of residence, socio-demographic characteristics, and/or cancer stage requires prioritization in future cancer improvement policies.