Burden of breast cancer with brain metastasis: a French national hospital database analysis

Figures & data

Figure 1.  Algorithm used for the selection of the study population. The shaded boxes indicate the patient groups analyzed.

Table 1.  Characteristics of the study population.

Population (n, %)	Total (n = 2,099)		Group 1 (without trastuzumab) (n = 1,843)		Group 2 (with trastuzumab) (n = 256)		p-value
Age at diagnosis
Mean (SD)	57.8	(13.6)	58.5	(13.6)	52.5	(12.5)	<0.001
Median	60.0		60.0		50.0
Range	20–98		20–98		20–90
Duration of follow-up, months
Mean (SD)	3.6	(4.1)	2.9	(3.7)	8.1	(4.3)	<0.001
Median (Min–Max)	1.4	(0–12)	1.1	(0–12)	10.0	(0–12)
Localization of metastases
Brain metastases only	440	21.0%	414	22.5%	26	10.2%	<0.001
Brain metastases associated with extracranial metastases:	1,659	79.0%	1,429	77.5%	230	89.8%	<0.001
Multiple^a	915	43.6%	784	42.5%	131	51.2%
Liver	360	17.2%	315	17.1%	45	17.6%
Bone	219	10.4%	189	10.3%	30	11.7%
Lung	78	3.7%	69	3.7%	9	3.5%
Lymph node	56	2.7%	44	2.4%	12	4.7%
Other	31	1.5%	28	1.5%	3	1.2%
Patient’s destination at the end of follow-up period							0.006
Death and return home^b	1,765	84.1%	1,529	83.0%	236	92.2%
Post-acute rehabilitation unit	180	8.6%	166	9.0%	14	5.5%
Acute care unit	107	5.1%	102	5.5%	5	2.0%
Home hospitalization	23	1.1%	22	1.2%	1	0.4%
Long-term care unit	23	1.1%	23	1.2%	0	0.0%
Psychiatric institution	1	0.0%	1	0.1%	0	0.0%
Treatment pattern							<0.001
Chemotherapy^c	735	35.0%	510	27.7%	225	87.9%
General medical care^d	852	40.6%	760	41.2%	92	35.9%
Palliative care	995	47.4%	920	49.9%	75	29.3%
Radiotherapy	455	21.7%	381	20.7%	74	28.9%
Surgery	151	7.2%	130	7.1%	21	8.2%

^aMore than two extracranial metastases localizations.

^bIn 2008, the information on ‘death’ and ‘return home’ was coded in the hospital database as a single variable entitled ‘death or return to home’. The distinction between ‘death’ and ‘return to home’ has only been available since 2009.

^cExpensive innovative drugs are excluded.

^dMedical care included follow-up explorations and physician consultations.

Figure 2.  Distribution of treatment use during the 1-year follow-up period for the whole population (n = 2,099). This figure presents the distribution of treatment use by 3-month period. For instance, at 3 months of follow-up, 38% of patients had received general medical care, 37% palliative care, 36% chemotherapy and 28% radiotherapy and surgery. The total exceeds 100% since patients may have received one or more types of treatments over the period. Expensive innovative drugs are included in the category chemotherapy.

Figure 3.  Box and whisker plot of the distribution of healthcare costs (n = 2,099). The cost shown on the graph is the median cost per treatment category. From top to bottom of the graph: the largest observation (♦), the upper quartile, the median (–), the lower quartile and the smallest observation (▪).

Table 2.  Healthcare costs over 1 year of follow-up.

Mean annual cost per treatment category (€), SD	Total (n = 2,099)	Group 1 Patients not treated with trastuzumab	Group 2 Patients treated with trastuzumab
Chemotherapy	14,523 ± 14,732	9,090 ± 12,257	23,363 ± 14,157
Surgery	1,044 ± 3,267	1,195 ± 3,684	800 ± 2,434
Radiotherapy	945 ± 2,154	954 ± 2,264	931 ± 1,972
General medical care	2,606 ± 4,467	2,809 ± 4,612	2,275 ± 4,216
Palliative care	2,919 ± 6,096	3,591 ± 6,829	1,826 ± 4,476
Total	22,591 ± 14,726	18,039 ± 13,587	29,995 ± 13,484

Table 3.  Multivariate regression analyses performed on the mean cost of treatment.

R-Square = 0.36 Parameters	Estimate	Standard Error	95% Confidence Interval		p
Age	−0.0005	0.0008	−0.0020	0.0011	0.5392
Metastatic localization:
BM only	0.0000	–	–	–	–
BM + one extracranial localization	0.0788	0.0293	0.0213	0.1363	0.0072
BM + multiple extracranial localization	0.1519	0.0292	0.0946	0.2092	<0.0001
HER2 status (trastuzumab vs no trastuzumab)	−0.5797	0.0344	−0.6472	−0.5122	<0.0001
Treatment pattern:
Chemotherapy	−0.2446	0.0341	−0.3114	−0.1778	<0.0001
Surgery	−0.5517	0.0414	−0.6329	−0.4706	<0.0001
General medical care	−0.1867	0.0235	−0.2328	−0.1406	<0.0001
Palliative care	−0.2475	0.0254	−0.2974	−0.1976	<0.0001
Para-clinical care	−0.2881	0.1664	−0.6142	0.0380	0.0833
Expensive innovative drugs	−0.2628	0.0299	−0.3214	−0.2042	<0.0001
Mean duration of stay	0.0015	0.0010	−0.0005	0.0036	0.1434