DISEASE FREE SURVIVAL, QUALITY OF LIFE AND DIRECT COST MEDICAL HER2-POSITIVE BREAST CANCER PATIENTS STADIUM ARE UNDERGOING INITIAL ANTI-HER2 adjuvant chemotherapy IN DR Sardjito 2007-2014
ABSTRACT: Background: HER2 positive breast cancer was reported to be 15-20% among all cases of breast cancer worldwide. In Indonesia, it is estimated that the incidence is higher, around 30%-40%, and occurred in population which is ten years younger than Caucasian. HER2 positive breast cancer is associated with worse therapy outcome. However, the development of anti HER2 monoclonal antibody as therapy gives a better prognosis. AntiHER2 therapy is administered for 6 months (8 times) or 12 months (16 times). Disease free survival in patients who received 12 months therapy (93,8%)is better than those who received 6 months therapy (91,1%) (HR 1,28, 95% CI 1,05-1,56, p=0,29). In 2007-2014, ASKES covered antiHER2 therapy for 8 times. Although the management of early stage HER2 positive breast cancer using antiHER2 is effective, there are several factors interfering therapy outcomes, such as patients factors, diseases, pathology results, radiotherapy, surgery, and chemotherapy. Aim: To learn the difference in disease free survival, quality of life, and direct medical cost between early stage breast cancer patients who received antiHER2 therapy for 6 months (suboptimal)compared with 12 months (optimal). Method: This study is an observational, retrospective cohort study. The subjects are early stage positive HER2 breast cancer patients who received transtuzumab. Subjects are classified into two categories. The first group consists of patients who received antiHER2 therapy for less than or equal to 6 months (suboptimal) and the second group are patients who received antiHER2 therapy for more than 6 months (optimal). Result: The disease free survival of early stage HER2 positive breast cancer patients who received transtuzumab at Dr. Sardjito Hospital in 2007-2014 is 68.7%. The disease free survival in the second group is better than the first group (72.1%; vs 65% log rank=5.012; p=0.082). Between 2 groups, the quality of life in early stage breast cancer patients who received antiHER2 therapy which was measured before chemotherapy until this study was conducted is not significantly different (p=0.290). The cost for chemotherapy is the highest (92.89%), followed by radiotherapy (2.61%). The direct medical cost in the second group is higher than the first group Summary: The disease free survival between early stage breast cancer patients in first group (suboptimal) and second group (optimal) is not significantly different. There is no significant difference in quality of life in early stage breast cancer patients who received suboptimal and optimal antiHER2 therapy which was measured before chemotherapy until this study was conducted. The direct medical cost in early stage breast cancer patients who received optimal antiHER2 therapy is higher compared to those who received suboptimal antiHER2 therapy.
