ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2026
Factors associated with early death from de novo metastatic breast cancer in Ontario, Canada.
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12 authors.
Priya ThomasSchulich School of Medicine & Dentistry (Thomas), Western University; ICES Western (Carter, Shariff, Raphael, Blanchette), London, Ont.; ICES Central (Earle), Toronto, Ont.; Department of Medicine (Shariff), Western University, London, Ont.; Division of Medical Oncology, Department of Oncology (Raphael, Hezam, Blanchette), Verspeeten Family Cancer Centre, London Health Sciences Centre and Department of Epidemiology and Biostatistics (Raphael, Blanchette), London, Ont.; ICES Queen's (Mahar), Kingston, Ont.; Department of Surgery (Knowles, Brackstone), London Health Sciences Centre and St. Joseph's Hospital; and Division of Radiation Oncology, Department of Oncology (Lock), London Health Sciences Centre, Western University, London, Ont.; Division of Medical Oncology (Earle), Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Mahar), Sinclair Cancer Research Institute, Queen's University, Kingston, Ont.; Division of Medical Oncology (Eisen), Juravinski Cancer Centre, McMaster University, Hamilton, Ont.
Brooke CarterSchulich School of Medicine & Dentistry (Thomas), Western University; ICES Western (Carter, Shariff, Raphael, Blanchette), London, Ont.; ICES Central (Earle), Toronto, Ont.; Department of Medicine (Shariff), Western University, London, Ont.; Division of Medical Oncology, Department of Oncology (Raphael, Hezam, Blanchette), Verspeeten Family Cancer Centre, London Health Sciences Centre and Department of Epidemiology and Biostatistics (Raphael, Blanchette), London, Ont.; ICES Queen's (Mahar), Kingston, Ont.; Department of Surgery (Knowles, Brackstone), London Health Sciences Centre and St. Joseph's Hospital; and Division of Radiation Oncology, Department of Oncology (Lock), London Health Sciences Centre, Western University, London, Ont.; Division of Medical Oncology (Earle), Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Mahar), Sinclair Cancer Research Institute, Queen's University, Kingston, Ont.; Division of Medical Oncology (Eisen), Juravinski Cancer Centre, McMaster University, Hamilton, Ont.
Craig C EarleSchulich School of Medicine & Dentistry (Thomas), Western University; ICES Western (Carter, Shariff, Raphael, Blanchette), London, Ont.; ICES Central (Earle), Toronto, Ont.; Department of Medicine (Shariff), Western University, London, Ont.; Division of Medical Oncology, Department of Oncology (Raphael, Hezam, Blanchette), Verspeeten Family Cancer Centre, London Health Sciences Centre and Department of Epidemiology and Biostatistics (Raphael, Blanchette), London, Ont.; ICES Queen's (Mahar), Kingston, Ont.; Department of Surgery (Knowles, Brackstone), London Health Sciences Centre and St. Joseph's Hospital; and Division of Radiation Oncology, Department of Oncology (Lock), London Health Sciences Centre, Western University, London, Ont.; Division of Medical Oncology (Earle), Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Mahar), Sinclair Cancer Research Institute, Queen's University, Kingston, Ont.; Division of Medical Oncology (Eisen), Juravinski Cancer Centre, McMaster University, Hamilton, Ont.
Salimah Z ShariffSchulich School of Medicine & Dentistry (Thomas), Western University; ICES Western (Carter, Shariff, Raphael, Blanchette), London, Ont.; ICES Central (Earle), Toronto, Ont.; Department of Medicine (Shariff), Western University, London, Ont.; Division of Medical Oncology, Department of Oncology (Raphael, Hezam, Blanchette), Verspeeten Family Cancer Centre, London Health Sciences Centre and Department of Epidemiology and Biostatistics (Raphael, Blanchette), London, Ont.; ICES Queen's (Mahar), Kingston, Ont.; Department of Surgery (Knowles, Brackstone), London Health Sciences Centre and St. Joseph's Hospital; and Division of Radiation Oncology, Department of Oncology (Lock), London Health Sciences Centre, Western University, London, Ont.; Division of Medical Oncology (Earle), Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Mahar), Sinclair Cancer Research Institute, Queen's University, Kingston, Ont.; Division of Medical Oncology (Eisen), Juravinski Cancer Centre, McMaster University, Hamilton, Ont.
Jacques RaphaelSchulich School of Medicine & Dentistry (Thomas), Western University; ICES Western (Carter, Shariff, Raphael, Blanchette), London, Ont.; ICES Central (Earle), Toronto, Ont.; Department of Medicine (Shariff), Western University, London, Ont.; Division of Medical Oncology, Department of Oncology (Raphael, Hezam, Blanchette), Verspeeten Family Cancer Centre, London Health Sciences Centre and Department of Epidemiology and Biostatistics (Raphael, Blanchette), London, Ont.; ICES Queen's (Mahar), Kingston, Ont.; Department of Surgery (Knowles, Brackstone), London Health Sciences Centre and St. Joseph's Hospital; and Division of Radiation Oncology, Department of Oncology (Lock), London Health Sciences Centre, Western University, London, Ont.; Division of Medical Oncology (Earle), Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Mahar), Sinclair Cancer Research Institute, Queen's University, Kingston, Ont.; Division of Medical Oncology (Eisen), Juravinski Cancer Centre, McMaster University, Hamilton, Ont.
Alyson MaharSchulich School of Medicine & Dentistry (Thomas), Western University; ICES Western (Carter, Shariff, Raphael, Blanchette), London, Ont.; ICES Central (Earle), Toronto, Ont.; Department of Medicine (Shariff), Western University, London, Ont.; Division of Medical Oncology, Department of Oncology (Raphael, Hezam, Blanchette), Verspeeten Family Cancer Centre, London Health Sciences Centre and Department of Epidemiology and Biostatistics (Raphael, Blanchette), London, Ont.; ICES Queen's (Mahar), Kingston, Ont.; Department of Surgery (Knowles, Brackstone), London Health Sciences Centre and St. Joseph's Hospital; and Division of Radiation Oncology, Department of Oncology (Lock), London Health Sciences Centre, Western University, London, Ont.; Division of Medical Oncology (Earle), Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Mahar), Sinclair Cancer Research Institute, Queen's University, Kingston, Ont.; Division of Medical Oncology (Eisen), Juravinski Cancer Centre, McMaster University, Hamilton, Ont.
Sarah KnowlesSchulich School of Medicine & Dentistry (Thomas), Western University; ICES Western (Carter, Shariff, Raphael, Blanchette), London, Ont.; ICES Central (Earle), Toronto, Ont.; Department of Medicine (Shariff), Western University, London, Ont.; Division of Medical Oncology, Department of Oncology (Raphael, Hezam, Blanchette), Verspeeten Family Cancer Centre, London Health Sciences Centre and Department of Epidemiology and Biostatistics (Raphael, Blanchette), London, Ont.; ICES Queen's (Mahar), Kingston, Ont.; Department of Surgery (Knowles, Brackstone), London Health Sciences Centre and St. Joseph's Hospital; and Division of Radiation Oncology, Department of Oncology (Lock), London Health Sciences Centre, Western University, London, Ont.; Division of Medical Oncology (Earle), Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Mahar), Sinclair Cancer Research Institute, Queen's University, Kingston, Ont.; Division of Medical Oncology (Eisen), Juravinski Cancer Centre, McMaster University, Hamilton, Ont.
Muriel BrackstoneSchulich School of Medicine & Dentistry (Thomas), Western University; ICES Western (Carter, Shariff, Raphael, Blanchette), London, Ont.; ICES Central (Earle), Toronto, Ont.; Department of Medicine (Shariff), Western University, London, Ont.; Division of Medical Oncology, Department of Oncology (Raphael, Hezam, Blanchette), Verspeeten Family Cancer Centre, London Health Sciences Centre and Department of Epidemiology and Biostatistics (Raphael, Blanchette), London, Ont.; ICES Queen's (Mahar), Kingston, Ont.; Department of Surgery (Knowles, Brackstone), London Health Sciences Centre and St. Joseph's Hospital; and Division of Radiation Oncology, Department of Oncology (Lock), London Health Sciences Centre, Western University, London, Ont.; Division of Medical Oncology (Earle), Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Mahar), Sinclair Cancer Research Institute, Queen's University, Kingston, Ont.; Division of Medical Oncology (Eisen), Juravinski Cancer Centre, McMaster University, Hamilton, Ont.
Michael LockSchulich School of Medicine & Dentistry (Thomas), Western University; ICES Western (Carter, Shariff, Raphael, Blanchette), London, Ont.; ICES Central (Earle), Toronto, Ont.; Department of Medicine (Shariff), Western University, London, Ont.; Division of Medical Oncology, Department of Oncology (Raphael, Hezam, Blanchette), Verspeeten Family Cancer Centre, London Health Sciences Centre and Department of Epidemiology and Biostatistics (Raphael, Blanchette), London, Ont.; ICES Queen's (Mahar), Kingston, Ont.; Department of Surgery (Knowles, Brackstone), London Health Sciences Centre and St. Joseph's Hospital; and Division of Radiation Oncology, Department of Oncology (Lock), London Health Sciences Centre, Western University, London, Ont.; Division of Medical Oncology (Earle), Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Mahar), Sinclair Cancer Research Institute, Queen's University, Kingston, Ont.; Division of Medical Oncology (Eisen), Juravinski Cancer Centre, McMaster University, Hamilton, Ont.
Andrea EisenSchulich School of Medicine & Dentistry (Thomas), Western University; ICES Western (Carter, Shariff, Raphael, Blanchette), London, Ont.; ICES Central (Earle), Toronto, Ont.; Department of Medicine (Shariff), Western University, London, Ont.; Division of Medical Oncology, Department of Oncology (Raphael, Hezam, Blanchette), Verspeeten Family Cancer Centre, London Health Sciences Centre and Department of Epidemiology and Biostatistics (Raphael, Blanchette), London, Ont.; ICES Queen's (Mahar), Kingston, Ont.; Department of Surgery (Knowles, Brackstone), London Health Sciences Centre and St. Joseph's Hospital; and Division of Radiation Oncology, Department of Oncology (Lock), London Health Sciences Centre, Western University, London, Ont.; Division of Medical Oncology (Earle), Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Mahar), Sinclair Cancer Research Institute, Queen's University, Kingston, Ont.; Division of Medical Oncology (Eisen), Juravinski Cancer Centre, McMaster University, Hamilton, Ont.
Areej HezamSchulich School of Medicine & Dentistry (Thomas), Western University; ICES Western (Carter, Shariff, Raphael, Blanchette), London, Ont.; ICES Central (Earle), Toronto, Ont.; Department of Medicine (Shariff), Western University, London, Ont.; Division of Medical Oncology, Department of Oncology (Raphael, Hezam, Blanchette), Verspeeten Family Cancer Centre, London Health Sciences Centre and Department of Epidemiology and Biostatistics (Raphael, Blanchette), London, Ont.; ICES Queen's (Mahar), Kingston, Ont.; Department of Surgery (Knowles, Brackstone), London Health Sciences Centre and St. Joseph's Hospital; and Division of Radiation Oncology, Department of Oncology (Lock), London Health Sciences Centre, Western University, London, Ont.; Division of Medical Oncology (Earle), Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Mahar), Sinclair Cancer Research Institute, Queen's University, Kingston, Ont.; Division of Medical Oncology (Eisen), Juravinski Cancer Centre, McMaster University, Hamilton, Ont.
Phillip S BlanchetteSchulich School of Medicine & Dentistry (Thomas), Western University; ICES Western (Carter, Shariff, Raphael, Blanchette), London, Ont.; ICES Central (Earle), Toronto, Ont.; Department of Medicine (Shariff), Western University, London, Ont.; Division of Medical Oncology, Department of Oncology (Raphael, Hezam, Blanchette), Verspeeten Family Cancer Centre, London Health Sciences Centre and Department of Epidemiology and Biostatistics (Raphael, Blanchette), London, Ont.; ICES Queen's (Mahar), Kingston, Ont.; Department of Surgery (Knowles, Brackstone), London Health Sciences Centre and St. Joseph's Hospital; and Division of Radiation Oncology, Department of Oncology (Lock), London Health Sciences Centre, Western University, London, Ont.; Division of Medical Oncology (Earle), Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ont.; Division of Cancer Care and Epidemiology (Mahar), Sinclair Cancer Research Institute, Queen's University, Kingston, Ont.; Division of Medical Oncology (Eisen), Juravinski Cancer Centre, McMaster University, Hamilton, Ont. phillip.blanchette@lhsc.on.ca.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEarly death from female breast cancer is influenced by disease biology and factors such as age, marginalization, socioeconomic status, rurality, and access to primary care. Our objective was to investigate factors associated with early death in the subgroup of patients diagnosed with advanced de novo metastatic breast cancer, defined by the presence of distant metastatic disease at initial presentation.
methodsWe used linked health care administrative data from Ontario, Canada, from 2010 to 2019 to conduct a population-based retrospective cohort study. We identified adults diagnosed with de novo metastatic breast cancer through the Ontario Cancer Registry. The primary outcome was the frequency of early death, defined as death within 6 months of cancer diagnosis. We used a multivariable logistic regression model to determine the patient, cancer, and provider characteristics associated with early death.
resultsAmong 4004 patients diagnosed with de novo metastatic breast cancer, 22.9% (
interpretationMarginalization, access to a primary care physician, and geography play a role in early death in patients diagnosed with de novo metastatic breast cancer in Ontario. Improving access to primary care providers may help reduce early death in these patients.
Indexed as
Breast NeoplasmsAccess to Primary CareAdultAgedFemaleHumansMiddle AgedNeoplasm MetastasisOntarioRegistriesRetrospective StudiesRisk Factors
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