Real-World Effectiveness Of Bevacizumab As Firstline Treatment For Women With Advanced Cervical Cancer In Ontario
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Authors
Zhou, Shi Jie
Date
2024-08-13
Type
thesis
Language
eng
Keyword
Bevacizumab , Cervical cancer , Overall survival , Uptake , Real-World
Alternative Title
Abstract
Background & Objective: Advanced cervical cancer is an aggressive disease with poor prognosis and stagnant treatment innovations. A potential shift occurred in 2016 when bevacizumab became publicly funded to treat this disease in Ontario driven by the promising results from the GOG-240 study. However, access and effectiveness of bevacizumab in everyday practice has not been explored since funding approval.
Approach: A retrospective cohort study, with a quasi-experimental component, was conducted using pre-linked administrative data held at the Division of Cancer Care and Epidemiology, Sinclair Cancer Research Institute. Provincial administrative data was used to identify all cervical cancer patients who received frontline palliative treatment in Ontario between January 2006 to December 2022. The funding approval event for bevacizumab – which occurred in January 2016- served as the separation event for the two study time eras defined as “pre-bevacizumab (2006-2015)” and “post-bevacizumab (2016-2022)”. Bevacizumab uptake was described in the post-funding approval era. Median overall survival (mOS) was computed using Kaplan-Meier curves; the rate of death (hazard) in each era was compared with a multivariable Cox proportional-hazards (PH) model and hazard ratio.
Results: Between January 2006 to December 2022, there were 208 adult women who met study inclusion. Bevacizumab uptake, post funding approval, was 44%; younger women and women with higher income were more likely to receive bevacizumab. Median OS was 9 months and 11 months in the pre- and post-funding approval era, respectively. The adjusted hazard ratio was 0.5 (95%CI: 0.4, 0.8; p=0.0004).
Conclusion: This study provides insight on the real-world effectiveness and potential uptake barriers for a costly cervical cancer therapy in Ontario. These findings can inform strategies to improve access to novel therapies for advanced cervical cancer patients, and guide practice changes for healthcare providers and funding parties.
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ProQuest PhD and Master's Theses International Dissemination Agreement
Intellectual Property Guidelines at Queen's University
Copying and Preserving Your Thesis
This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.