Abstract
The risk of relapse for early breast cancer (BC) patients persists even after decades and to date, no specific and sensitive effective circulating biomarker for recurrence prediction has been identified yet. The international guidelines do not recommend the assessment of the serum tumor markers CEA and CA15-3 in the follow-up of asymptomatic early BC patients. In our institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, as part of the E.Pic.A study, which was designed to assess the economic appropriateness of integrated care pathways in early BC, the use of CEA and CA15-3 as circulating tumor biomarkers in early BC patients was evaluated in 1502 patients one year after surgery, from 2015 to 2018, with an overall expense of EUR 51,764. A total of EUR 47,780 (92%) was used for execution of circulating tumor markers in early BC patients with stage 0, I and II tumors, neglecting the current guidelines and considered inappropriate by our professional board. We found that no patients with stage I BC experienced relapse in the 365 days after surgery, and in any case examination of the circulating markers CEA and CA15-3 was considered crucial for diagnosis of relapse. Our findings suggest that this inadequacy is a low-value area, supporting the reallocation of economic resources for interventions of a higher value for patients.
Highlights
Amadori”), the E.Pic.A study, which was designed for breast cancer (BC) care, was performed to identify inadequacies in the diagnostic, therapeutic and care pathways with reproducible methods, to evaluate the economic appropriateness of integrated care pathways, to balance the best healthcare possible, and to identify areas of wastage to reallocate the economic resources to high-value activities for patients [23]
A board of professionals identified seven key performance indexes (KPIs) in the pattern of BC diagnosis and treatment based on the current guidelines from the Association of Medical Oncology (AIOM) [13] and the National Comprehensive Center Network (NCCN) [24]
KPIs were evaluated in terms of appropriateness and costs, showing that 2798 BC patients received a total of 2156 inappropriate examinations, accounting for EUR 573,510.80
Summary
The great clinical need emerges for the ability to use blood circulating markers that can guide physicians on a possible disease relapse. A lot of studies have been performed that investigate circulating biomarkers that are useful to predict disease relapse in patients who underwent surgery for early BC [2,3,4,5,6].
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