first author in research papers

First Author vs. Corresponding Author? How to Decide Which to Choose

This article discusses the importance of authorship in academic publishing. The first author executes a large portion of the work throughout the research process and signifies the researcher has provided the greatest intellectual contribution. The corresponding author is explicitly identified on the first page of the manuscript, is selected to further manage the pre and post-publication responsibilities, and serves as the point of contact for communication with a journal during the submission, peer review, and publication process.

Updated on April 26, 2023

Every process is conducted through a series of steps. The Scientific Method, for example, provides guidelines for navigating the research process and generally includes:

• Making observations
• Identifying a problem
• Formulating a hypothesis
• Designing an experiment
• Analyzing the data
• Reporting a conclusion

While the actual procedures may vary between fields, the underlying process remains intact. The same holds true for the publication process:

• Complete your research
• Choose a journal
• Prepare the manuscript
• Submit the manuscript
• Make any revisions
• Publication

Each of these processes contains many more specific steps and processes, including assigning authorship to the research manuscript . This article outlines the importance of authorship, delineates the meanings of first author and corresponding author, and addresses some of the challenges associated with the process.

Why is authorship important?

On the surface, the positioning of a researcher’s name and title on a manuscript seems straightforward, a simple task. Most lay people use the list of names solely for searching and citation purposes.

In reality, though, the order of those names tells a complex story of authorship. It is, in fact, the primary way for a researcher to convey the extent of their contribution to the reader.

To attain authorship on a manuscript, a researcher must not only contribute substantially to the work but also take responsibility and accountability for the information it contains. The International Committee of Medical Journal Editors (ICMJE) recommends authorship be based on 4 specific criteria related to these broad principles.

With authorship comes both recognition and obligation that have important academic, social, and financial implications. The two most prominent authorship positions are first author and corresponding author .

What is the first author?

The first author position is a coveted spot. No matter how many other authors’ names appear on the manuscript or which referencing style is used, the first author’s last name will be mentioned in every future citation of the work.

For this reason alone, the name of the first author is remembered, indexed, and promoted more than any other. It is not just a status symbol, though. The first author executes a large portion or majority of the work throughout the research process.

First author credit signifies the researcher has provided the greatest intellectual contribution, and, therefore, comes with substantial benefits. The manuscripts of first authors hold substantial value for grant and position applications, staff appraisals and reviews, and many other forms of career development.

First author duties

The designation as first author is not based on academic or professional hierarchy, the prestige, or expertise of the author. It’s based on the inputs and outputs of work. First authors must:

• Make significant, original, and insightful intellectual contributions
• Participate in the conception and planning of the study
• Generate data through performing experiments, conducting literature reviews, and organizing surveys and interviews
• Analyze the results through statistical analysis and by generating graphs, tables, and illustrations
• Write and edit the manuscript
• Help with queries and revisions after submission

The researcher fulfilling all these duties is rightfully the first author.

What is the corresponding author?

Like the first author designation, the title of corresponding author also comes with considerable prestige. The corresponding author is explicitly identified on the first page of the manuscript. In addition to meeting all the preexisting authorship requirements, this person is selected to further manage the pre and post-publication responsibilities.

The corresponding author is customarily a senior researcher or academic with extensive publishing knowledge and experience. As the primary source of communication for both the publisher and the readers, the corresponding author’s contact information is included within the article.

The corresponding author must have exceptional communication skills. The role assumes primary responsibility for connecting with target journals. They must be organized and meticulous with the substantial volume of tasks associated with the position.

Corresponding author duties

Neither electing a corresponding author nor accepting the position should be taken lightly as it is an essential and long lasting obligation. The duties span from prior to publication to well afterwards and include:

While all corresponding authors serve as the point of contact for communication with a journal during the submission, peer review, and publication process, some journals outline additional conditions for the role. The National Academy of Sciences offers a table that compiles the corresponding author requirements for various journals.

What if there are authorship disputes or changes?

While openly discussing and defining a research team’s roles during the initial planning phase is vital for curbing authorship disputes, combining this practice with other forward-thinking acts is key. Responsibilities and work status must be addressed during regularly scheduled meetings and special meetings need to be called when a team member is added or ends involvement in the project.

How to avoid authorship disputes

To avoid disputes, teams start by mapping out the most obvious roles, author and non-author contributor, and by rejecting any proposed “non-role.” The input of non-author contributors is narrow in scope, providing technical, administrative or writing assistance, and does not fulfill the previously outlined authorship criteria.

A non-role is any inappropriate or irrelevant participant who will harm the research process, such as unethical types of authors . This category encompasses guest authors, forged authors, ghost authors, and orphan authors and must be avoided at all costs.

Many journals require a document be included with the submission package to delineate author contributions to explain and justify author order. By creating this list as a living document from the outset, a research team fulfills the prerequisite for the publisher and guarantees transparency and fairness throughout.

Because changing authorship after publication is messy, necessitating specific documentation, signatures, and approval, it is frowned upon by journal editors. While taking proactive steps to avoid disputes that may result in this situation saves the research team time and hassle, it does not always alleviate future changes.

The addition, removal, or reordering of authors on a manuscript while actively going through the publication process requires a letter signed by all original and additional authors stating the reason for the change and their mutual agreement. For changes made after publication, an authorship corrigendum must be submitted by all authors per COPE guidelines .

Final thoughts

Getting to the manuscript writing and publication stages of a research project are exciting milestones for everyone involved. Ideally, authorship roles are clearly defined and assigned at this point.

Though the first author and corresponding author positions are sometimes performed by the same person, the obligations of each are unique. The first author undertakes the bulk of work duties and makes a significant intellectual contribution to the research project. The corresponding author carries out the communication and administrative tasks necessary for publishing the manuscript.

Both roles are vital to the research and publication processes. They require intense labor and responsibility. With this comes great recognition and prestige for first authors and corresponding authors.

Charla Viera, MS

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Stanford University School of Medicine blog

Who’s on first? Duking out scientific paper authorship order

It's been over 80 years, but Abbott and Costello's famous comedic skit " Who's on First" lives on in our collective memories. Their increasingly ridiculous conversation about baseball and the name of the player on first base can still reliably produce a giggle in many circles.

But in the lab , questions about order can be anything but a laughing matter -- particularly when it comes to the list of authors on a scientific paper. Many nonscientists don't realize that, traditionally, the most important places on the roster are the first -- indicating the person who conceived of and performed most of the research discussed in the paper -- and the last -- a hallowed place reserved for the senior scientist in whose laboratory the research was conducted.

In the biomedical research world, having many "first authorship" papers is largely seen as an indication of a scientist's skill and tenacity; researchers with many "senior authorship" papers often garner a reputation of strong leadership and high productivity.

But as the National Institutes of Health and other funders increasingly reward collaborative research, and scientific projects grow more complex, determining authorship order is becoming less clear. Some are even venturing outside the lab to do so.

Authorship smash down

Recently Stanford researcher Garry Nolan , PhD, tweeted about an unconventional way two researchers in his laboratory who had each contributed equally to a study decided who should be listed first on the print version of the paper.

The researchers, graduate students Bokai Zhu and Yunhao Bai , played three games of Mario Kart's Super Smash Bros. ; the winner, Bai, was awarded top billing, and was permitted to list himself as the first author on his resume (called a curriculum vitae , or CV, in science circles). A footnote to the authorship list notes that Zhu and Bai contributed equally to the paper's contents and can consider themselves co-first authors on their CVs.

"All the important results are already in the paper itself . We thought, why not use this opportunity to have some fun?" Zhu said, in a recent conversation with my colleague Lisa Kim for her new video series " 90 seconds with Lisa Kim ."

"As science has become more multidisciplinary and collaborative, it becomes more difficult to determine who should receive credit for a group's findings," Nolan said. "It's not unusual for a scientific paper to have a dozen or more authors from multiple labs or institutions, and assigning authorship order becomes increasingly difficult."

In response, scientists like Zhu and Bai are becoming more creative. As on their paper, footnotes are increasingly used in print or online versions of a study to indicate authors (both first and last) who contributed equally to the paper's findings. "There's also a movement toward agreeing that each co-first or co-last author may list themselves as first or last author on their own CV," Nolan said.

Agreeing to ... agree

But as long as the "first or last" rubric remains, researchers are going to have to come to ways to agree. Much hinges on the ability of the authors to collaboratively decide whose careers could benefit the most from the extra boost. Sometimes that might mean that a lab leader cedes last authorship to a senior lab member who will soon be launching a job hunt, or for a postdoctoral researcher to allow a soon-to-graduate PhD student to list themselves first.

"To me, a key purpose of an academic institution is to advance the careers of your students, teach them the ways of science, and hopefully impart some wisdom while also doing important scientific work," Nolan said. "If a funding institution is going to demand cooperation and collaboration, we as scientists need to adapt. Right now, it depends on people being gracious."

Or, perhaps, a friendly video game smackdown? Maybe next time they'll play Mario Super Sluggers , instead!

Photo by  Ryan Quintal

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• Publication Recognition

What is a Corresponding Author?

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Table of Contents

Are you familiar with the terms “corresponding author” and “first author,” but you don’t know what they really mean? This is a common doubt, especially at the beginning of a researcher’s career, but easy to explain: fundamentally, a corresponding author takes the lead in the manuscript submission for publication process, whereas the first author is actually the one who did the research and wrote the manuscript.

The order of the authors can be arranged in whatever order suits the research group best, but submissions must be made by the corresponding author. It can also be the case that you don’t belong in a research group, and you want to publish your own paper independently, so you will probably be the corresponding author and first author at the same time.

Corresponding author meaning:

The corresponding author is the one individual who takes primary responsibility for communication with the journal during the manuscript submission, peer review, and publication process. Normally, he or she also ensures that all the journal’s administrative requirements, such as providing details of authorship, ethics committee approval, clinical trial registration documentation, and gathering conflict of interest forms and statements, are properly completed, although these duties may be delegated to one or more co-authors.

Generally, corresponding authors are senior researchers or group leaders with some – or a lot of experience – in the submission and publishing process of scientific research. They are someone who has not only contributed to the paper significantly but also has the ability to ensure that it goes through the publication process smoothly and successfully.

What is a corresponding author supposed to do?

A corresponding author is responsible for several critical aspects at each stage of a study’s dissemination – before and after publication.

If you are a corresponding author for the first time, take a look at these 6 simple tips that will help you succeed in this important task:

• Ensure that major deadlines are met
• Prepare a submission-ready manuscript
• Put together a submission package
• Get all author details correct
• Ensure ethical practices are followed
• Take the lead on open access

In short, the corresponding author is the one responsible for bringing research (and researchers) to the eyes of the public. To be successful, and because the researchers’ reputation is also at stake, corresponding authors always need to remember that a fine quality text is the first step to impress a team of peers or even a more refined audience. Elsevier’s team of language and translation professionals is always ready to perform text editing services that will provide the best possible material to go forward with a submission or/and a publication process confidently.

Who is the first author of a scientific paper?

The first author is usually the person who made the most significant intellectual contribution to the work. That includes designing the study, acquiring and analyzing data from experiments and writing the actual manuscript. As a first author, you will have to impress a vast group of players in the submission and publication processes. But, first of all, if you are in a research group, you will have to catch the corresponding author’s eye. The best way to give your work the attention it deserves, and the confidence you expect from your corresponding author, is to deliver a flawless manuscript, both in terms of scientific accuracy and grammar.

If you are not sure about the written quality of your manuscript, and you feel your career might depend on it, take full advantage of Elsevier’s professional text editing services. They can make a real difference in your work’s acceptance at each stage, before it comes out to the public.

Language Editing Services by Elsevier Author Services:

Through our Language Editing Services , we correct proofreading errors, and check for grammar and syntax to make sure your paper sounds natural and professional. We also make sure that editors and reviewers can understand the science behind your manuscript.

With more than a hundred years of experience in publishing, Elsevier is trusted by millions of authors around the world.

Check our video Elsevier Author Services – Language Editing to learn more about Author Services.

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OPINION article

Guiding undergraduates through the process of first authorship.

• Department of Psychology, Southwestern University, Georgetown, TX, United States

Introduction

Dozens of excellent papers have recently been written that describe best practices for publishing journal articles with undergraduates (see “Engaging Undergraduates in Publishable Research: Best Practices,” Frontiers in Psychology ); for the most part, these involve students as co-authors in general rather than as lead authors. In this paper, I specifically focus on how to guide undergraduates through the process of first authorship. After describing potential barriers, I discuss issues of authorship contribution before outlining several successful strategies I've developed during my 24 years of collaborating with undergraduates. Although mentoring students to be first authors can be challenging, the rewards can also be immense—for both the students and the faculty mentors who are up to the challenge.

The Undergraduate First Author: a Unicorn?

A literature search revealed not a single article on the topic of undergraduates publishing as first author. Without any data, it's hard to know for certain how common it is for undergraduates to publish as first authors, but informal discussions with psychology colleagues around the world who collaborate with undergraduates (and examinations of faculty vitae) suggest that it is far less common than undergraduates publishing as non-lead authors.

Barriers (Real or Perceived) to Undergraduate First Authorship

Because it is rare to see undergraduate first authors, many faculty are likely unaware that at least some undergraduates can—with proper training, encouragement, and careful mentoring—be capable of serving as first authors on papers in refereed journals. Even if faculty members are made aware of this fact (as I hope to accomplish with this article), other barriers exist. For example, many faculty work under a reward system in which publications (and first author publications in particular) determine tenure, promotion, pay, likelihood of securing grants, and job security (e.g., Costa and Gatz, 1992 ; Fine and Kurdek, 1993 ; Wilcox, 1998 ). The primary tradeoff is that the time it takes to mentor undergraduates through first authorship is generally much longer than the time it would take for the faculty member to be the lead author. The great experience provided to the student (see Matthews and Rosa, 2018 ), therefore, can come at the cost of decreased productivity (e.g., fewer publications overall, fewer first author publications, publications in lower-tier journals), which could be problematic for faculty at institutions that don't highly value faculty-undergraduate research. Finally, recent trends in psychological science, such as the difficulty of publishing single-study papers in some subfields and the “open science” movement calling for large sample sizes, pre-registration, and replication (see Chambers, 2017 ; Nelson et al., 2018 ) can seem like roadblocks to publishing with undergraduates. Fortunately, faculty from diverse subfields have come up with creative solutions involving high-quality replications (e.g., McKelvie and Standing, 2018 ; Wagge et al., 2019 ), preregistered projects (e.g., Strand and Brown, 2019 ), large-scale single-experiment class projects designed for publication (e.g., LoSchiavo, 2018 ; Mickley Steinmetz and Reid, 2019 ), and multi-study projects involving student coauthors across years (e.g., Grysman and Lodi-Smith, 2019 ; Holmes and Roberts, 2019 ).

Authorship Contribution and Order of Authorship

Much has been written about the ethics of assigning authorship credit in the sciences and social sciences (see Maurer, 2017 , for a review), and attempts have been made to fairly determine authorship order by (a) surveying past authors about their experiences (e.g., Wagner et al., 1994 ; Sandler and Russell, 2005 ; Moore and Griffin, 2006 ; Geelhoed et al., 2007 ), (b) assessing reactions to hypothetical authorship scenarios (e.g., Costa and Gatz, 1992 ; Bartle et al., 2000 ; Apgar and Congress, 2005 ), (c) proposing step-by-step decision-making models ( Fine and Kurdek, 1993 ; Foster and Ray, 2012 ; Maurer, 2017 ), and (d) outlining quantitative systems that assign weighted points to tasks associated with publishing (e.g., Winston, 1985 ; Kosslyn, 2015 ). The consensus seems to be that writing the manuscript is either the most important factor in determining first authorship (e.g., Winston, 1985 ; Bartle et al., 2000 ; Apgar and Congress, 2005 ) or at least tied with idea origination as the most important factor ( Wagner et al., 1994 ; Kosslyn, 2015 ). The “authorship determination scorecard” on the American Psychological Association's website ( https://www.apa.org/science/leadership/students/authorship-paper.aspx ), for example, allots 170 of 1,040 points (16%) for idea generation/refinement; 110 points (11%) for design/measures; 160 points (15%) for statistical analysis, and 600 points (58%) for writing/revision.

Given the clear importance of writing as a factor in first authorship, and because students' contributions to idea generation, design, and analysis are often similar to those of their collaborators up to this point, I always require students to take responsibility for the manuscript drafts and revisions (with my feedback and editing help) to earn their first authorship. I am typically second author (consistent with the “order of contribution” norm in social psychology) because I play a significant role in the publication process, but less than the first author. The remaining student authors tend to be less involved (consistent with Geelhoed et al., 2007 ) because of lack of time or interest, or geographical distance. Nonetheless, all authors are always asked to read and approve the final manuscript before submission.

Paths to Undergraduate First Authorship

My mentor, the late Dan Wegner (a social psychologist who ended his career at Harvard but started at a small liberal arts university doing research with undergraduates) advised me as I began my career at an undergraduate-only institution that “the best undergraduates are often better than graduate students” because they are “not only very bright, but often are more intrinsically motivated—if you hold them to high standards, they will meet or exceed them, and you can publish great work with them.” I followed his advice, and indeed have published the vast majority of my papers with undergraduates as co-authors, and especially as first authors: Of my 33 post-graduate school publications, 29 papers involve a total of 68 undergraduate co-authors, and 24 of the 29 are first-authored by undergraduates 1 .

In my experience, there have been three primary paths to undergraduate first authorship, each representing approximately one-third of my publications with students. First, during our one-semester research methods course with a lab (capped at 12 students), sophomores and sometimes juniors complete two original projects and manuscript write-ups, and conducting high quality, original projects is a big factor (see LoSchiavo, 2018 ); about 10% of my class projects lead to publication. Second, each faculty member has a capstone course in which they work with 5 to 6 seniors (or sometimes juniors) for two consecutive semesters; about 90% of my capstone projects lead to publication 2 . Third, I occasionally accept projects for individual honors theses or independent studies (independent research outside of capstone is rare in our department, perhaps one senior every several years) if I think they are publishable; about 90% of these projects lead to publication.

Best Practices

Here are some of the strategies I've developed over the years to successfully mentor students to first authorship:

1. Provide good writing instruction throughout the curriculum . It is crucial to teach good writing skills throughout the curriculum ( Soysa et al., 2013 ) so that the largest number of students possible has a strong background and the potential capacity to be first author. (My university has 1,400 students, and we graduate 25–30 psychology majors annually, so with 4–5 faculty members striving to publish with students each year, this step is crucial). Our department places a strong emphasis on students learning APA style as well as proper grammar (see Giuliano, 2019 ), and all instructors provide copious feedback on student drafts. Although group writing is popular elsewhere (e.g., small groups of students who write APA-style papers together on their research methods project), instructors in our department require individual writing (as well as peer review) in both research methods and capstone courses so that every student improves and gets the maximum amoun of practice.

2. Select the most “first-author-ready” students . I've found that it is important to select students with certain characteristics—those who not only have the strongest writing skills, but who are hardworking, independent, intellectually curious, and intrinsically motivated 3 . The process starts when I read a paper (e.g., a research methods final paper, a senior capstone paper, or an honors thesis) that has good results, that is “close enough” that I can envision grooming it into a publishable paper, and that has been written by a student with the characteristics described above.

3. Explain what authorship entails . At that point, I ask the student if she or he would like to first author a publication under my supervision (Virtually every invitee will have already first-authored a conference presentation with me, so I know that we are a “good fit” and that they know exactly what to expect when working with me.). As recommended by Foster and Ray (2012) , I explain which contributions determine first authorship: I tell them they have already earned authorship by making significant contributions in the idea, design, and analysis stages, as have their student collaborators, so they will earn first authorship by being responsible for writing the manuscript, with plenty of feedback and supervision from me. To provide “informed consent” about this decision ( Fine and Kurdek, 1993 ), I outline clear expectations (i.e., that they can expect to write 10–15 drafts or more over a period of several months, that this will be a much higher standard of writing than they have ever done in the past, and that at times this process could get frustrating and tedious) and let them know that they are free to accept or decline without any adverse consequences (about 95% of students accept). I also tell them that first authorship is not guaranteed and that authorship order may need to be revised if contributions change (Only once or twice in 24 years has first authorship changed; my students have generally been excellent at following through with their commitments.).

4. Get them ready to write . Once students agree to be first author, the next step is to provide them with exemplar articles (I use past publications from my own students). I then set an initial calendar of deadlines (e.g., when their drafts are due to me, when my feedback is due to them); I usually draft this first and then allow students to make modifications according to their schedule. Finally, I have students research and take notes on potential target journals (we then discuss the pros and cons together and decide where to send the paper once finished).

5. Find time to write . Finding time to write can be tricky, because students are often either busy with other courses or have moved on to jobs or graduate school. Summers are usually optimal for both students and me. For research methods class projects, I usually suggest writing during the summer after the course is over (setting the final deadline before the new semester starts). If students are in town, we meet in person occasionally but generally trade drafts over email and have in-person or by-phone meetings when necessary. Writing with students who have graduated is often more difficult because those with jobs are busy working during the day and no longer in “academic mode,” so I find that it takes more patience and encouragement to get them back into the writing. If they are in graduate school, they are already immersed in research, which is helpful, but projects with their graduate advisor compete for their attention. Students who have graduated are also more likely to be out of town, which is only a problem if in-person meetings (e.g., to re-analyze data) are necessary, although online meeting applications (e.g., Facetime, Skype) work fine. Ultimately, it may take some creativity to find the time and space for writing, as in “writing weekends” (see Scherman, under review), but in the end, it is worth it.

Publishing with students is truly my favorite part of being a professor—the thrill I get upon seeing a student's name in print (especially in the lead position) is often greater than the thrill I get from seeing my own name. As others have argued (e.g., Malachowski, 2012 ; Maurer, 2017 ), when working with students, it is best to treat them as equals and true partners in the collaboration process, with high levels of autonomy and a strong focus on student learning. In doing so, the rewards—for both students and faculty alike—are incredibly worthwhile.

Author Contributions

The author confirms being the sole contributor of this work and has approved it for publication.

Conflict of Interest Statement

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

I'd like to thank Sarah Matthews, Carin Perilloux, Abby Riggs, Marissa Rosa, and Toni Wegner for their helpful comments on earlier drafts of this paper.

1. ^ Four are in the Psi Chi Journal of Undergraduate Research ; the remainder are in professional, peer-reviewed journals.

2. ^ It should be noted that our department recently switched from an informal system in which either faculty or students approached the other about the possibility of research collaboration to a more formal capstone assignment process in which all students (during their required research methods course) complete a written application describing their interest in conducting a research-based capstone and rank their preference for faculty labs. This process not only improved transparency, but also provided more equitable information, access, and opportunity for all students, who are assigned to labs by fit and interest. Recent articles have addressed both the benefits of increasing diversity and inclusion in undergraduate research and publication (e.g., Peifer, 2019 ) and specific strategies for doing so (e.g., Ahmad et al., under review; Chan, 2019 ; Scisco et al., 2019 ) and are highly recommended.

3. ^ Approximately half of my first authors went on to Ph.D. programs in psychology; the other half went to law school, medical school, master's programs, or did not seek a graduate degree.

Apgar, D., and Congress, E. (2005). Authorship credit: a national study of social work educators' beliefs. J. Soc. Work Educ. 41, 101–112. doi: 10.5175/JSWE.2005.200300356

CrossRef Full Text | Google Scholar

Bartle, S. A., Fink, A. A., and Hayes, B. C. (2000). Psychology of the scientist: LXXX. Attitudes regarding authorship issues in psychological publications. Psychol. Rep. 86, 771–788. doi: 10.2466/pr0.2000.86.3.771

PubMed Abstract | CrossRef Full Text | Google Scholar

Chambers, C. D. (2017). The Seven Deadly Sins of Psychology: A Manifesto for Reforming the Culture of Scientific Practice . Princeton, NJ: Princeton University Press.

Google Scholar

Chan, E. (2019). Student research and publication: strategic planning for inclusion using a systems mapping approach. Front. Psychol. 10:6. doi: 10.3389/fpsyg.2019.00006

Costa, M. M., and Gatz, M. (1992). Determination of authorship credit in published dissertations. Psychol. Sci. 3, 354–357. doi: 10.1111/j.1467-9280.1992.tb00046.x

Fine, M. A., and Kurdek, L. A. (1993). Reflections on determining authorship credit and authorship order on faculty-student collaborations. Am. Psychol. 48, 1141–1147. doi: 10.1037/0003-066X.48.11.1141

Foster, R. D., and Ray, D. C. (2012). An ethical decision-making model to determine authorship credit in published faculty-student collaborations. Counsel. Values 57, 214–228 doi: 10.1002/j.2161-007X.2012.00018.x

Geelhoed, R. J., Phillips, J. C., Rischer, A. R., Shpungin, E., and Gong, Y. (2007). Authorship decision making: an empirical investigation. Ethics Behav. 17, 95–115. doi: 10.1080/10508420701378057

Giuliano, T. (2019). The “Writing Spiral”: A handy tool for training undergraduates to write publishable-quality manuscripts. Front. Educ . 10:915. doi: 10.3389/fpsyg.2019.00915

Grysman, A., and Lodi-Smith, J. (2019). Methods for conducting and publishing narrative research with undergraduates. Front. Psychol. 9:2771. doi: 10.3389/fpsyg.2018.02771

Holmes, K. J., and Roberts, T. (2019). Mentor as sculptor, makeover artist, coach or CEO: evaluating contrasting models for mentoring undergraduates mesearch toward publishable research. Front. Psychol. 10:231. doi: 10.3389/fpsyg.2019.00231

Kosslyn, S. M. (2015). “Authorship: credit where credit is due,” in Ethical Challenges in the Behavioral and Brain Sciences: Case Studies and Commentaries , eds R. J. Sternberg and S. T. Fiske (New York, NY: Cambridge University Press), 50–52. doi: 10.1017/CBO9781139626491.021

LoSchiavo, F. M. (2018). Incorporating a professional-grade all-class project into a research methods course. Front. Psychol. 9:2143. doi: 10.3389/fpsyg.2018.02143

Malachowski, M. R. (2012). “Living in parallel universes: the great faculty divide between product-oriented and process-oriented scholarship,” in Faculty Support and Undergraduate Research: Innovations in Faculty Role Definition, Workload, and Reward , eds N. H. Hensel and E. L. Paul (Washington, DC: Council on Undergraduate Research), 7–18.

Matthews, S. J., and Rosa, M. N (2018). Trials, tribulations, and triumphs: research and publishing from the undergraduate perspective. Front. Psychol. 9:2411. doi: 10.3389/fpsyg.2018.02411

Maurer, T. (2017). Guidelines for authorship credit, order, and co-inquireer learning in collaborative faculty-student SoTL projects. Teach. Learn. Inquiry 5, 1–17. doi: 10.20343/teachlearninqu.5.1.9

McKelvie, S., and Standing, L. G. (2018). Teaching psychology research methodology across the curriculum to promote undergraduate publication: an eight-course structure and two helpful practices. Front. Psychol. 9:2295. doi: 10.3389/fpsyg.2018.02295

Mickley Steinmetz, K. R., and Reid, A. K. (2019). Providing outstanding undergraduate research experiences and sustainable faculty development in load. Front. Psychol. 10:196. doi: 10.3389/fpsyg.2019.00196

Moore, M. T., and Griffin, B. W. (2006). Identification of factors that influence authorship name placement and decision to collaborate in peer-reviewed, education-related publications. Stud. Educ. Eval. 32, 125–135. doi: 10.1016/j.stueduc.2006.04.004

Nelson, L. D., Simmons, J., and Simonsohn, U. (2018). Psychology's renaissance. Annual Rev. Psychol. 69, 511–534. doi: 10.1146/annurev-psych-122216-011836

Peifer, J. S. (2019). Context and reasons for bolstering diversity in undergraduate research. Front. Psychol. 10:336. doi: 10.3389/fpsyg.2019.00336

Sandler, J. C., and Russell, B. L. (2005). Faculty-student collaborations: ethics and satisfaction in authorship credit. Ethics Behav. 15, 65–80. doi: 10.1207/s15327019eb1501_5

Scisco, J. L., McCabe, J. A., Mendoza, A. T. O., Fallong, M., and Domenech Rodriquez, M. M. (2019). Strategies for selecting, managing, and engaging undergraduate co-authors: a multi-site perspective. Front. Psychol. 10:325. doi: 10.3389/fpsyg.2019.00325

Soysa, C. K., Dunn, D. S., Dottolo, A. L., Burns-Glover, A. L., and Gurung, R. A. R. (2013). Orchestrating authorship: teaching writing across the psychology curriculum. Teach. Psychol. 40, 88–97. doi: 10.1177/0098628312475027

Strand, J. F., and Brown, V. A. (2019). Publishing open, reproducible research with undergraduates. Front. Psychol. 10:564. doi: 10.3389/fpsyg.2019.00564

Wagge, J. R., Brandt, M. J., Lazarevic, L. B., Legate, N., Christopherson, C., Wiggins, B., et al. (2019). Publishing research with undergraduate students via replication work: the collaborative replications and extensions project. Front. Psychol. 10:247. doi: 10.3389/fpsyg.2019.00247

Wagner, M. K., Dodds, A., and Bundy, M. B. (1994). Psychology of the scientist: LXVII. Assignment of authorship credit in psychological research. Psychol. Rep. 74, 179–187. doi: 10.2466/pr0.1994.74.1.179

Wilcox, L. J. (1998). Authorship: the coin of the realm, the source of complaints. J. Am. Med. Assoc. 280, 216–217. doi: 10.1001/jama.280.3.216

Winston, R. B. Jr. (1985). A suggested procedure for determining order of authorship in research publications. J. Counsel. Dev. 63, 515–518. doi: 10.1002/j.1556-6676.1985.tb02749.x

Undergraduate* First-Author Publications

*Butterworth, S. E., Giuliano, T. A., *White, J. R., *Cantu, L., & *Fraser, K. C. (In Press). Is he flirting with me? How sender gender influences emoji interpretation. Frontiers in Psychology .

*Matthews, S. J., Giuliano, T. A., *Rosa, M. N., *Thomas, K. H., *Swift, B. A., *Ahearn, N. D., *Garcia, A. G., *Smith, S. R., *Niblett, C. M., & *Mills, M. M. (2018). The battle against bedroom boredom: Development and validation of a brief measure of sexual novelty in relationships. Canadian Journal of Human Sexuality, 27 , 277-287.

*Matthews, S. J., Giuliano, T. A., *Thomas, K. H., *Straup, M. L., & *Martinez, M. A. (2018). Not cool, dude: Perceptions of solicited vs. unsolicited sext messages from men and women. Computers in Human Behavior, 88 , 1-4. 10.1016/j.chb.2018.06.14

*Matthews, S. J., Giuliano, T. A., *Rosa, M. N., *Thomas, K. H., & *Swift, B. A. (2018). Sexual Novelty Scale. Handbook of Sexuality-Related Measures. Thousand Oaks, CA: Sage Publications.

*Hutzler, K. T., Giuliano, T. A, *Herselman, J. R., & *Johnson, S. M. (2015). Three's a crowd: Public awareness and (mis)perceptions of polyamory. Psychology & Sexuality, 7 , 69-87. 10.1080/19419899.2015.1004102

*Johnson, S. M., Giuliano, T. A, *Herselman, J. R., & *Hutzler, K. T. (2015). Development of a brief measure of attitudes towards polyamory. Psychology & Sexuality, 6 , 325-339. 10.1080/19419899.2014.1001774

*Blomquist, B.A., & Giuliano, T. A. (2012). “Do you love me, too?” Perceptions of Responses to ‘I love you.” North American Journal of Psychology, 14 , 407-418.

*Gomillion, S. C., & Giuliano, T. A. (2011). The influence of media role models on gay, lesbian, and bisexual identity. Journal of Homosexuality, 58 , 330-354.

*Howell, J., * & Giuliano, T. A. (2011). The effects of expletive use and team gender on perceptions of coaching effectiveness. Journal of Sport Behavior, 34 , 69-81.

*Howell, J., *Egan, P., *Ackley, B., & Giuliano, T. A. (2011). The reverse double standard in perceptions of student-teacher sexual relationships: The role of gender, initiation, and power. Journal of Social Psychology, 151 (2), 180-200.

*Egan, P., & Giuliano, T. A. (2009). Unaccommodating attitudes: Perceptions of students with learning disabilities as a function of accommodation use and test performance. North American Journal of Psychology, 11 , 487-500.

*Osborne, R. L, *Ackley B. D, & Giuliano, T. A., (2008). The “skinny” on coffee drinkers: Gender differences in healthy beverage choice. Psi Chi Journal of Undergraduate Research, 13(4) , 159-163.

*Riggs, A. L., & Giuliano, T. A. (2007). Running in the family or swimming in the gene pool: The role of family history and genetic risk in individuals' illness perceptions. Journal of Health Psychology, 12 , 883-894.

*Stanzer, M., Guarraci, F., Giuliano, T. A., & Sims, A. (2007). Paramedic or EMT-basic partner? Study evaluates preferred partner types & the effect of partners on work-related stress levels. Journal of Emergency Medical Services 32: 72-74.

*Knight, J. L., & Giuliano, T. A. (2003). Blood, sweat, and jeers: The impact of the media's heterosexist portrayals on perceptions of male and female athletes. Journal of Sport Behavior, 26 , 272-284.

*Wilke, K. M., *Turner, K. L., & Giuliano, T. A. (2003). Smoke screens: Cross-cultural effectiveness of anti-smoking messages. North American Journal of Psychology, 5 , 431-442.

*Dodd E. H., Giuliano, T. A., *Boutell, J. M., & *Moran, B. E. (2001). Respected or rejected: Perceptions of women who confront sexist remarks. Sex Roles , 45, 567-577.

*Knight, J. L., & Giuliano, T. A. (2001). She's a “looker;” he's a Laker: The consequences of gender-stereotypical portrayals of male and female athletes by the print media. Sex Roles, 45 , 217-229.

*Knight, J. L., Giuliano, T. A., & *Sanchez-Ross, M. G. (2001). Famous or infamous? The influence of celebrity status and race on perceptions of responsibility for rape. Basic and Applied Social Psychology, 23 , 183-190.

*Dickson, A., Giuliano, T. A., *Morris, J. C., & *Cass, K. L. (2001). Eminem versus Charley Pride: Race, stereotypes, and perceptions of rap and country music performers. Psi Chi Journal of Undergraduate Research, 6 , 175-179.

*Kirkendall, K. D., *Dixon, D. P., Giuliano, T. A., & *Raney, A. E. (2001). The bold and the beautiful: The effect of physical attractiveness and extraversion on desirability. Psi Chi Journal of Undergraduate Research, 6 , 180-186.

*Cohorn, C. A., & Giuliano, T. A. (1999). Predictors of adjustment and institutional attachment in first-year college students. Psi Chi Journal of Undergraduate Research, 4 , 47-56.

*Cox, C. B., & Giuliano, T. A. (1999). Constructing obstacles vs. making excuses: Examining perceivers' reactions to behavioral and self-reported self-handicapping. Journal of Social Behavior and Personality,14 , 419-432.

*Fiala, S. E., Giuliano, T. A., *Remlinger, N. M., & *Braithwaite, L. C. (1999). Lending a helping hand: The effects of sex stereotypes and gender on likelihood of helping. Journal of Applied Social Psychology, 29 , 2164-2176.

Keywords: undergraduate research, undergraduate publication, publishing, first authorship, faculty-student collaboration

Citation: Giuliano TA (2019) Guiding Undergraduates Through the Process of First Authorship. Front. Psychol . 10:857. doi: 10.3389/fpsyg.2019.00857

Received: 05 February 2019; Accepted: 01 April 2019; Published: 18 April 2019.

Reviewed by:

Copyright © 2019 Giuliano. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Traci A. Giuliano, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

How to Decide the First Author and Corresponding Author in a Manuscript

When a scholarly/academic paper is produced, the researchers participating in the work must assign a first author and corresponding author. This is a challenging decision and sometimes there’s conflict because the positions can also indicate status (whether real or perceived).

The first author and corresponding author, ideally, are decided during the research and through a mutual agreement among the authors. It’s made based on an understanding of the role and significance of the positions. The author order generally indicates the amount of contribution.

The first author is considered to have contributed more than the second author, and so forth, until reaching the author in the last position. A shared first author (co-first author) or shared corresponding author (co-corresponding author), however, isn’t out of the question.

The last position may also be prestigious – considered the senior author or principal investigator. One of the authors in the list will also be the corresponding author. This means they coordinate the publication process (such as arranging editing and communicating with the journal and with other inquiries) and have their contact information shown upfront in the work.

• What you’ll learn in this post
• The differences between first author and corresponding author (and what’s a senior author?).
• How first author and corresponding author are defined.
• How to fairly determine which author(s) will fulfill which role(s).
• When and why the same person might fulfill both roles.

Determining the author order

What defines the first author, some of the main duties of a first author are:, what defines a corresponding author, some of the corresponding author’s main duties are:, and who is the senior author, a few words on guarantors, can the first and the corresponding authors be the same person, how do you decide who does what role what are the potential ethical issues.

The order of authors should reasonably correspond to how the authors contributed to the work. It also implies specific credit and responsibilities that go with being in these positions. Working it out over a cup of tea or coffee as soon as possible can help to avoid disputes, and even mediation , later on.

The issue of determining a senior author is also a bit challenging. You need to understand these roles and responsibilities. Don’t just think about who gets the most credit.

Publishing in a scientific journal or any peer-reviewed publication, including preprints and poster presentations , makes research visible to the greater public. It brings discoveries and insights into the eyes of the main experts around the world. This, in turn, builds the author’s reputation as a researcher.

Having a good list of published papers can also help achieve some career goals, such as getting a degree, a promotion or, as a scientist, getting funding to continue with research. The number of first-author papers may also be looked upon as a positive metric.

An “author” (having authorship) of a paper must meet certain criteria for their contributions. The International Committee of Medical Journal Editors (ICJME) guidelines state authorship must at least include:

• made substantial contributions to work
• approved the final version
• assumed responsibility and accountability for what is published

However, while the minimum requirements for authorship are generally agreed upon, the credit/responsibility given to a specific author list isn’t so clear. The position on the list can determine the author’s expected duties and show the readers how the author contributed to the work.

So let’s take a deeper look at the definitions of these positions. Hopefully, this will help in your decision-making process. It may in fact affect your future career and status.

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The first author is usually the person who makes the greatest practical/intellectual contributions to the work.

This person might have co-authors’ assistance with specific tasks, but they are the main responsible one for acquiring and analyzing the data, and for writing the final manuscript.

The first position in the authorship list of a paper is the most attractive one. First authors will have their (last) name mentioned in every future citation of the work, no matter how many other authors there are.

There can also be co-first authors. This is common in projects that require different areas of expertise. It’s also used where it’s hard to figure out who made a larger contribution. Two or even three authors can be listed as equal contributors.

The co-first authors are denoted by an asterisk or other symbol (for example, “ Author A*, Author B*, Author C, Author D.. ”) and a note on the first page.

But even then, the person listed first will continue to be the most visible. This is because of how citations are created. To give equal credit to both first authors, an alternative is to cite the paper as “ Author A & Author B et al .”., instead of “ Author A et al. ”

• Make intellectual contributions to the work. Participate in the conception and planning of the study; define aims and trace a methodological approach to achieve them.
• Generate the data. For instance, perform experiments, conduct literature reviews, write programming code, etc.
• Analyze the results. Generate graphs , tables , and illustrations to convey the data, and perform statistical analyses when needed.
• Write and edit the manuscript.
• Help the corresponding author with referees’ queries when the paper is under revision.

The corresponding author is responsible for bringing together the manuscript, and for the whole process of submitting it to a journal, up to (hopefully!) final acceptance. Of course, the corresponding author also must meet the academic authorship requirements.

The ICJME defines a corresponding author as someone who takes primary responsibility for communication with the journal during the manuscript submission, peer review, and publication process.

In that sense, the corresponding author is also responsible for ensuring that all the journal’s administrative requirements are fulfilled. This can include providing documents related to ethics committee approval, data and signatures from all authors, and conflict of interest (COI) statements.

In line with this, the Committee on Publication Ethics (COPE) says the corresponding author should be someone willing to fulfill all obligations the journal stipulates ( COPE Discussion Document , 2014).

The corresponding author’s contact details are included in the article. This makes them the representative for inquiries about the work. A good corresponding author must therefore be readily available. All communications with journals or readers should be done in a timely way.

English ability is also a big help if you’re the corresponding author and you want to publish in English. You’re usually the person whom I , as the editor, will be communicating with when you choose an editing service.

• Certify the manuscript contains all the necessary parts, it is appropriately organized, and it complies with the journal’s requirements. Upload the manuscript and other files.
• Make sure all authors have reviewed and approved the final version of the manuscript before submission. Get signed consent.
• Be in charge of all communications related to the paper. Distribute notifications to all authors (e.g., emails, peer review feedback , decision letters).
• Meet all deadlines,­ communicate with the authors and editors efficiently, and follow time schedules for publication.
• Ensure all editorial and submission policies are followed.

Note: Although there’s common sense on the main roles of a corresponding author, some of the responsibilities involved can change from one journal to another (e.g., see this list , created by the National Academy of Sciences, with different journals and their respective requirements).

The senior author is the person who provides the intellectual input and helps to design the study and the protocols to be followed. This is especially because they’re experts in that field of research.

They are also sometimes the financial driving force behind the study and generally supervise several projects. For these reasons, they are also known as the “ principal investigator .” They usually have broad experience in publishing processes, and their names appear in the last positions of the author list.

Honestly, the senior author is often the lab leader or simply the person in charge. For the work they’ve put into this to date, they earned this honor.

Some journals now ask for one author on a paper to be listed as a guarantor. The guarantor:

• accepts official responsibility for the overall integrity of the manuscript (including ethics, data handling, reporting of results, and study conduct)
• does not act as the primary correspondent for the manuscript
• ensures all statements in the manuscript are true to his knowledge

The guarantor can be the same as the corresponding author, or can be another of the authors.

It’s often recommended that the Principal Investigator or Senior Researcher on a manuscript act as the guarantor as they will be responsible for the study supervision already; however, this is not explicitly required.

Yes, first authors can also be corresponding authors in a manuscript. In fact, it’s quite common.

The main conflict here is when authors equate being a corresponding author with seniority. Senior authors are often viewed as the perfect corresponding authors because of all the qualities they have, as mentioned.

However, as discussed, a corresponding author is charged with communicating with editors and readers only. Journal editors usually see this as an administrative role. Therefore, the corresponding author doesn’t necessarily have to be the seniormost author.

While there’s a special responsibility involved in this role, it’s not supposed to be a mark of distinction. Also, most senior authors will probably have less available time to reply to queries during the submission review process. And they may not have time to respond to reader queries in the future.

So, first authors should be expected to serve as corresponding authors. This is the case as long as they’re consistently involved in the study and know-how to go through the submission/publication process.

This includes deciding on the need for scientific editing if the English needs improving. The role can also help them gain experience in corresponding with journals and general readers.

Even when the first and corresponding authors aren’t the same person some of their duties can be shared.

While a corresponding author can help the first author, or main author, with data analysis, for example, the first author can help the corresponding author prepare the documents for submission.

The same applies to other authors. Deciding who does what role should be clearly discussed and defined beforehand. Ideally, researchers involved in the study should have regular meetings to clarify responsibilities and update the status of the work. New co-authors may be included and other members may end their involvement along the way. Doing this planning may help prevent conflicts regarding academic authorship and help manage any disputes (Albert & Wager, 2009).

There are many possible reasons for conflict (you can find many examples of real cases on COPE’s website ). Disputes around first authorship are more common because this is the most prestigious position and an important measure of productivity. This happens, for example, when two authors both claim they contributed the most. This issue can be solved by proposing co-first authorship, or by using a system to quantify their contributions and then decide who should go first.

There can also be disagreements when the senior author wants to be the first author, or main author. For example, they may need more or higher-impact publications as the first author. Or they wrote the manuscript and believe this entitles them to be the first author.

Disputes on who will be the corresponding author are less likely. That’s because the role, as mentioned, doesn’t have any special distinction other than a visible name and contact. However, some senior authors may still want this role and occasionally there’s some conflict.

Ideally, the corresponding author should be decided among the others. It’s also possible to share the position, have shared corresponding authors; e.g. both the first and senior authors are co-corresponding authors. This may actually work out well if one is available and the other isn’t.

Every participant should feel free to seek clarity throughout the collaboration. Consider having a written document ( see this example PDF file on APA) in place as guidance ( COPE Discussion Document , 2014; Guidelines on Authorship and Acknowledgement , n.d.).

Before publication, authors should reunite to check the previous responsibilities list and create a final version of the documents. This includes detailed information on the type and extent of the contribution of each person involved. For categories of contributions, see the Contributor Roles Taxonomy [CRediT] website (McNutt et al., 2018). To quantify contributions, different proposed systems can be found in the literature (APA, for example, proposed a scorecard – see their Helpful Tools files).

As several journals now request and publish information about each author’s contributions, such documents can be essential. This can help in creating standards that will improve transparency in the system of scientific publishing. That, in turn, greatly reduces ethical concerns and authorship disputes.

Our Publication Support team is ready to hear from you if you want to accelerate your path to publication. And explore valuable research services that can help increase your impact and avoid ethical mishaps.

This is a guest post from Adam Goulston, PsyD, MBA, MS, MISD, ELS. Adam runs the Asia-based science marketing and PR company Scize . He has worked as an in-house Senior Language Editor, as well as a manuscript editor, with Edanz.

Albert, T., & Wager, E. (2009). How to handle authorship disputes: A guide for new researchers. Committee on Publication Ethics. https://doi.org/10.24318/cope.2018.1.1

COPE Discussion Document: Authorship. (2014). Committee on Publication Ethics. https://doi.org/10.24318/cope.2019.3.3

Guidelines on Authorship and Acknowledgement. (n.d.). Retrieved from https://research.fas.harvard.edu/links/guidelines-authorship-and-acknowledgement

McNutt, M. K., Bradford, M., Drazen, J. M., Hanson, B., Howard, B., Jamieson, K. H., Kiermer, V., Marcus, E., Pope, B. K., Schekman, R., Swaminathan, S., Stang, P. J., & Verma, I. M. (2018). Transparency in authors’ contributions and responsibilities to promote integrity in scientific publication. Proceedings of the National Academy of Sciences, 115(11), 2557-2560. https://doi.org/10.1073/pnas.1715374115

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How to Order Authors in Scientific Papers

It’s rare that an article is authored by only one or two people anymore. In fact, the average original research paper has five authors these days. The growing list of collaborative research projects raises important questions regarding the author order for research manuscripts and the impact an author list has on readers’ perceptions.

With a handful of authors, a group might be inclined to create an author name list based on the amount of work contributed. What happens, though, when you have a long list of authors? It would be impractical to rank the authors by their relative contributions. Additionally, what if the authors contribute relatively equal amounts of work? Similarly, if a study was interdisciplinary (and many are these days), how can one individual’s contribution be deemed more significant than another’s?

Why does author order matter?

Although an author list should only reflect those who have made substantial contributions to a research project and its draft manuscript (see, for example, the authorship guidelines of the International Committee of Medical Journal Editors ), we’d be remiss to say that author order doesn’t matter. In theory, everyone on the list should be credited equally since it takes a team to successfully complete a project; however, due to industry customs and other practical limitations, some authors will always be more visible than others.

The following are some notable implications regarding author order.

• The “first author” is a coveted position because of its increased visibility. This author is the first name readers will see, and because of various citation rules, publications are usually referred to by the name of the first author only. In-text or bibliographic referencing rules, for example, often reduce all other named authors to “et al.” Since employers use first-authorship to evaluate academic personnel for employment, promotion, and tenure, and since graduate students often need a number of first-author publications to earn their degree, being the lead author on a manuscript is crucial for many researchers, especially early in their career.
• The last author position is traditionally reserved for the supervisor or principal investigator. As such, this person receives much of the credit when the research goes well and the flak when things go wrong. The last author may also be the corresponding author, the person who is the primary contact for journal editors (the first author could, however, fill this role as well, especially if they contributed most to the work).
• Given that there is no uniform rule about author order, readers may find it difficult to assess the nature of an author’s contribution to a research project. To address this issue, some journals, particularly medical ones, nowadays insist on detailed author contribution notes (make sure you check the target journal guidelines before submission to find out how the journal you are planning to submit to handles this). Nevertheless, even this does little to counter how strongly citation rules have enhanced the attention first-named authors receive.

Common Methods for Listing Authors

The following are some common methods for establishing author order lists.

• Relative contribution. As mentioned above, the most common way authors are listed is by relative contribution. The author who made the most substantial contribution to the work described in an article and did most of the underlying research should be listed as the first author. The others are ranked in descending order of contribution. However, in many disciplines, such as the life sciences, the last author in a group is the principal investigator or “senior author”—the person who often provides ideas based on their earlier research and supervised the current work.
• Alphabetical list . Certain fields, particularly those involving large group projects, employ other methods . For example, high-energy particle physics teams list authors alphabetically.
• Multiple “first” authors . Additional “first” authors (so-called “co-first authors”) can be noted by an asterisk or other symbols accompanied by an explanatory note. This practice is common in interdisciplinary studies; however, as we explained above, the first name listed on a paper will still enjoy more visibility than any other “first” author.
• Multiple “last” authors . Similar to recognizing several first authors, multiple last authors can be recognized via typographical symbols and footnotes. This practice arose as some journals wanted to increase accountability by requiring senior lab members to review all data and interpretations produced in their labs instead of being awarded automatic last-authorship on every publication by someone in their group.
• Negotiated order . If you were thinking you could avoid politics by drowning yourself in research, you’re sorely mistaken. While there are relatively clear guidelines and practices for designating first and last authors, there’s no overriding convention for the middle authors. The list can be decided by negotiation, so sharpen those persuasive argument skills!

As you can see, choosing the right author order can be quite complicated. Therefore, we urge researchers to consider these factors early in the research process and to confirm this order during the English proofreading process, whether you self-edit or received manuscript editing or paper editing services , all of which should be done before submission to a journal. Don’t wait until the manuscript is drafted before you decide on the author order in your paper. All the parties involved will need to agree on the author list before submission, and no one will want to delay submission because of a disagreement about who should be included on the author list, and in what order (along with other journal manuscript authorship issues).

On top of that, journals sometimes have clear rules about changing authors or even authorship order during the review process, might not encourage it, and might require detailed statements explaining the specific contribution of every new/old author, official statements of agreement of all authors, and/or a corrigendum to be submitted, all of which can further delay the publication process. We recommend periodically revisiting the named author issue during the drafting stage to make sure that everyone is on the same page and that the list is updated to appropriately reflect changes in team composition or contributions to a research project.

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How to Order and Format Author Names in Scientific Papers

As the world becomes more interconnected, the production of knowledge increasingly relies on collaboration. Scientific papers, the primary medium through which researchers communicate their findings, often feature multiple authors. However, authorship isn't merely a reflection of those who contributed to a study but often denotes prestige, recognition, and responsibility. In academic papers, the order of authors is not arbitrary. It can symbolize the level of contribution and the role played by each author in the research process. Deciding on the author order can sometimes be a complex and sensitive issue, making it crucial to understand the different roles and conventions of authorship in scientific research. This article will explore the various types of authors found in scientific papers, guide you on how to correctly order and format author names, and offer insights to help you navigate this critical aspect of academic publishing.

The first author

The first author listed in a scientific paper is typically the person who has made the most substantial intellectual contribution to the work. This role is often filled by a junior researcher such as a Ph.D. student or postdoctoral fellow, who has been intimately involved in almost every aspect of the project.

The first author usually plays a pivotal role in designing and implementing the research, including the formation of hypotheses, experimental design, data collection, data analysis, and interpretation of the findings. They also commonly take the lead in manuscript preparation, writing substantial portions of the paper, including the often-challenging task of turning raw data into a compelling narrative.

In academia, first authorship is a significant achievement, a clear demonstration of a researcher's capabilities and dedication. It indicates that the researcher possesses the skills and tenacity to carry a project from inception to completion. This position can dramatically impact a researcher's career trajectory, playing a critical role in evaluations for promotions, grants, and future academic positions.

However, being the first author is not just about prestige or professional advancement. It carries a weight of responsibility. The first author is generally expected to ensure the integrity and accuracy of the data presented in the paper. They are often the person who responds to reviewers' comments during the peer-review process and makes necessary revisions to the manuscript.

Also, as the first author, it is typically their duty to address any questions or critiques that may arise post-publication, often having to defend the work publicly, even years after publication.

Thus, first authorship is a role that offers significant rewards but also requires a strong commitment to uphold the principles of scientific integrity and transparency. While it's a coveted position that can be a steppingstone to career progression, the associated responsibilities and expectations mean that it should not be undertaken lightly.

The middle authors

The middle authors listed on a scientific paper occupy an essential, albeit sometimes ambiguous, role in the research project. They are typically those who have made significant contributions to the project, but not to the extent of the first author. This group often includes a mix of junior and senior researchers who have provided key input, assistance, or resources to the project.

The roles of middle authors can be quite diverse. Some might be involved in specific aspects of data collection or analysis. Others may bring specialized knowledge or technical skills essential to the project, providing expertise in a particular methodology, statistical analysis, or experimental technique. There might also be middle authors who have contributed vital resources to the project, such as unique reagents or access to a particular patient population.

In some fields, the order of middle authors reflects the degree of their contribution. The closer a middle author is to the first position, the greater their involvement, with the second author often having made the next largest contribution after the first author. This order may be negotiated among the authors, requiring clear communication and consensus.

However, in other disciplines, particularly those where large collaborative projects are common, the order of middle authors may not necessarily reflect their level of contribution. In such cases, authors might be listed alphabetically, or by some other agreed-upon convention. Therefore, it's crucial to be aware of the norms in your specific field when deciding the order of middle authors.

Being a middle author in a scientific paper carries less prestige and responsibility than being a first or last author, but it is by no means a minor role. Middle authors play a crucial part in the scientific endeavor, contributing essential expertise and resources. They are integral members of the research team whose collective efforts underpin the progress and achievements of the project. Without their diverse contributions, the scope and impact of scientific research would be significantly diminished.

The last author

In the listing of authors on a scientific paper, the final position carries a unique significance. It is typically occupied by the senior researcher, often the head of the laboratory or the principal investigator who has supervised the project. While they might not be involved in the day-to-day aspects of the work, they provide overarching guidance, mentorship, and often the resources necessary for the project's fruition.

The last author's role is multidimensional, often balancing the responsibilities of project management, funding acquisition, and mentorship. They guide the research's direction, help troubleshoot problems, and provide intellectual input to the project's design and interpretation of results. Additionally, they usually play a key role in the drafting and revision of the manuscript, providing critical feedback and shaping the narrative.

In academia, the last author position is a symbol of leadership and scientific maturity. It indicates that the researcher has progressed from being a hands-on contributor to someone who can guide a team, secure funding, and deliver significant research projects. Being the last author can have substantial implications for a researcher's career, signaling their ability to oversee successful projects and mentor the next generation of scientists.

However, along with prestige comes significant responsibility. The last author is often seen as the guarantor of the work. They are held accountable for the overall integrity of the study, and in cases where errors or issues arise, they are expected to take the lead in addressing them.

The convention of the last author as the senior researcher is common in many scientific disciplines, especially in the life and biomedical sciences. However, it's important to note that this is not a universal standard. In some fields, authors may be listed purely in the order of contribution or alphabetically. Therefore, an understanding of the specific norms and expectations of your scientific field is essential when considering author order.

In sum, the position of the last author, much like that of the first author, holds both honor and responsibility, reflecting a leadership role that goes beyond mere intellectual contribution to include mentorship, management, and accountability.

Formatting author names

When it comes to scientific publishing, details matter, and one such detail is the correct formatting of author names. While it may seem like a minor concern compared to the intellectual challenges of research, the proper formatting of author names is crucial for several reasons. It ensures correct attribution of work, facilitates accurate citation, and helps avoid confusion among researchers in the same field. This section will delve deeper into the conventions for formatting author names, offering guidance to ensure clarity and consistency in your scientific papers.

Typically, each author's full first name, middle initial(s), and last name are listed. It's crucial that the author's name is presented consistently across all their publications to ensure their work is correctly attributed and easily discoverable.

Here is a basic example following a common convention:

• Standard convention: John D. Smith

However, conventions can vary depending on cultural naming practices. In many Western cultures, the first name is the given name, followed by the middle initial(s), and then the family name. On the other hand, in many East Asian cultures, the family name is listed first.

Here is an example following this convention:

• Asian convention: Wang Xiao Long

When there are multiple authors, their names are separated by commas. The word "and" usually precedes the final author's name.

Here's how this would look:

• John D. Smith, Jane A. Doe, and Richard K. Jones

However, author name formatting can differ among journals. Some may require initials instead of full first names, or they might have specific guidelines for handling hyphenated surnames or surnames with particles (e.g., "de," "van," "bin"). Therefore, it's always important to check the specific submission guidelines of the journal to which you're submitting your paper.

Moreover, the formatting should respect each author's preferred presentation of their name, especially if it deviates from conventional Western naming patterns. As the scientific community becomes increasingly diverse and global, it's essential to ensure that each author's identity is accurately represented.

In conclusion, the proper formatting of author names is a vital detail in scientific publishing, ensuring correct attribution and respect for each author's identity. It may seem a minor point in the grand scheme of a research project, but getting it right is an essential part of good academic practice.

The concept of authorship in scientific papers goes well beyond just listing the names of those involved in a research project. It carries critical implications for recognition, responsibility, and career progression, reflecting a complex nexus of contribution, collaboration, and intellectual leadership. Understanding the different roles, correctly ordering the authors, and appropriately formatting the names are essential elements of academic practice that ensure the rightful attribution of credit and uphold the integrity of scientific research.

Navigating the terrain of authorship involves managing both objective and subjective elements, spanning from the universally acknowledged conventions to the nuances particular to different scientific disciplines. Whether it's acknowledging the pivotal role of the first author who carried the project from the ground up, recognizing the valuable contributions of middle authors who provided key expertise, or highlighting the mentorship and leadership role of the last author, each position is an integral piece in the mosaic of scientific authorship.

Furthermore, beyond the order of authors, the meticulous task of correctly formatting the author names should not be underestimated. This practice is an exercise in precision, respect for individual identity, and acknowledgement of cultural diversity, reflecting the global and inclusive nature of contemporary scientific research.

As scientific exploration continues to move forward as a collective endeavor, clear and equitable authorship practices will remain crucial. These practices serve not only to ensure that credit is assigned where it's due but also to foster an environment of respect and transparency. Therefore, each member of the scientific community, from fledgling researchers to seasoned scientists, would do well to master the art and science of authorship in academic publishing. After all, it is through this collective recognition and collaboration that we continue to expand the frontiers of knowledge.

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Postdoctoral Job Offers: How First-Author Publications Help Shape Research Careers

What does being the first author (or lead author) actually mean? In most cases, especially in academic publishing , the author listed first on a published article is the one who has done the research and has written and edited the paper. He or she is also most likely the contact person for the targeted journal’s editors after their review. Co-authors have usually contributed in a lesser capacity; however, this is not always the case for all disciplines. For example, in the field of mathematics , authors are listed alphabetically because “in most areas of mathematics, joint good-quality research is a sharing of ideas and skills that cannot be attributed to the individuals separately.” Some academic journals require a “statement of contribution” to indicate how much each author contributed to the research and writing.

So what does all this mean to the recent PhD recipient who is looking for a postdoctoral career position?

Publishing Can Be Difficult

According to the American Psychological Association, the rejection rate for their various journals in 2013 was between 70 and 90 percent. At Elsevier , one of the world’s largest academic publishers, “between 30 percent to 50 percent of articles don’t even make it to the peer review process.” This is especially discouraging to the PhD student who is near completion of his or her academic studies.

In addition to struggling with the reality of rejection rates, students often face struggles with advisors who are not willing to help. In a 2005 blog written in Science , a PhD candidate wrote about the difficulties he was having with his advisor, who had taken on new responsibilities and appeared to be less interested in helping him achieve his goals, especially those to get his research published. In response to this issue , Dr. Luis Echegoyen, a chemistry professor at the University of Texas, stated that advisors should help students in any way possible to get their research published. If anyone faces that kind of situation, it is reasonable for you to either submit the manuscript without the help of your advisor or present your case to his or her superiors.

Related: Does your dream job seem more like a dream? Check out this post to jump-start your career now!

Remember that your future might depend on this collaboration, whether publishing or other support and this should be taken seriously.

So Is Publishing Important?

Some believe that your publication record will be your greatest asset when applying for postdoctoral positions because it is a testament to your ability to effectively and correctly create and carry out a study. Some disciplines even require that a specific number of first-author papers be published before you apply for a position. For example, according to Dr. Robert Ross, a panelist at the seminar entitled “Life after the PhD: Finding the Right Postdoctoral Position,” in psychology, prospective universities look for applicants who have published at least 10 papers, although it is not a requirement that the applicant is listed as the first author. According to an article in Neurowire , the Scientifica blog site, you should “publish as much of your PhD work as possible and offer to help on other projects during your PhD to get your name on the paper and gain valuable experience.”

In the science disciplines, in particular, your recognition as a major contributor to a study is a good way to catch the attention of prestigious labs to which you are applying. Some use this information upfront, especially the first author designation, to “weed out applicants, looking for at least one first-author paper to signify that a junior scientist can complete a project from start to finish”; however, this is not always the case, so if you have not published, don’t be discouraged—there are also other characteristics that employers look for in a candidate.

In Lieu of Publishing, What Can You Do?

So, is publishing important? Absolutely! Is it necessary to land a job after receiving your PhD? No! When applying for a postdoctoral position, whether a postdoc research job or postdoc academic career, there are several dos and don’ts. In a 2010 article written by Kendall Powell, a freelance writer, and published in Nature entitled “A foot in the door,” a “postdoctoral application should present a person’s best scientific self on paper.” Information on all your important research and a personalized cover letter will help ensure that you are granted a review and possibly an interview.

Another huge advantage is previous funding. Be sure to mention that you have had funding for your research. According to Phil Baran, an organic chemist at the Scripps Research Institute, “If a postdoc has their own fellowship, they can write their application to me in crayon and I’ll take them.” If you have not been funded for your research, be sure to mention to which postdoctoral fellowships or funding sources you intend to apply.

Keep in mind the following points to consider when searching for your first postdoctoral position or career job:

• Start searching early; don’t wait until you receive your PhD.
• Network with senior scientists and attend seminars, lectures, and conferences in your field.
• Read several research papers by those at your prospective place of employment.
• Know your goals and strengths and narrow your postdoc application to those positions/openings that meet them, including personnel.
• Be prepared by knowing all you can about the position and/or lab.
• Avoid negative remarks about your past or your experiences.
• Research other employment opportunities besides a career in academia, such as private postdoctoral researcher jobs or other fields that could use your analytical skills.

In your application, highlight what you hope to accomplish in the right postdoctoral position for which you are applying. State your accomplishments in the field but avoid specific details. Personalize your letters to the prospective reviewer or interviewer and, by all means, state how your experience sets you apart from other applicants for postdoctoral jobs.

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• Published: 03 September 2021

What makes an author

Nature Methods volume  18 ,  page 983 ( 2021 ) Cite this article

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• Research management

Constructing a fair and accurate author list can be one of the most fraught aspects of manuscript publication. We provide some advice and resources for authors at all career levels.

The acknowledgement of scientific contributions in the form of manuscript authorship is vital at all stages of a researcher’s career, from the well-established principal investigator applying for million-dollar grants to the undergraduate student applying to PhD programs. It’s essential that authorship lists are constructed with utmost care.

The variety of authorship practices across the scientific literature, however, is vast. Different fields, different countries, even different labs have different norms. Some practices are troubling: lab technicians not included for their major contributions to a study because they are not on an academic track; contributors removed from author lists due to personal disputes; researchers who have not substantially contributed added to papers (in a misguided attempt to increase ‘impact’) without their consent; senior scientists taking advantage of power imbalance to undeservedly gain publications.

Even researchers with the best intentions can struggle with finalizing a fair and accurate author list. Here, we provide some best practice guidelines and explain how Nature Methods handles authorship issues.

First of all, community guidelines for authorship are available. Nature Portfolio’s authorship policies are based on guidelines developed by McNutt et al. ( Proc. Natl Acad. Sci. USA 115 , 2557–2560, 2018). Other guidelines in common use include those from the International Committee of Medical Journal Editors . As defined by Nature Portfolio, an author listed on a paper should have made a substantial contribution to the design of the work, the collection or analysis of data, the creation of a software tool, or the writing of the paper. This policy is meant to be broad and flexible, leaving “substantial contribution” up for quite a bit of room for interpretation.

In our view, job title or rank should never exclude a potential author. The lab technician or core facility scientist who developed a custom experimental workflow for the study should be included as an author. The first-year rotation student who spent several weeks collecting data should be included as an author. The software engineer who made substantial developments to an existing algorithm to analyze the data should be included as an author.

That said, not just any kind of assistance justifies authorship. People who provided routine services or basic technical help, contributed resources (such as by giving plasmids), proofread the manuscript, or gave general advice but did not otherwise significantly contribute to the scientific content of the paper should be thanked in the Acknowledgements. If previously published datasets or software tools are utilized in a new study without further development from their generators, there is no need to name them as authors. Even the person who secured funding need not necessarily be an author on a paper—they too ought to have scientifically contributed in a meaningful way. This is almost unheard of in lab-based science, where a principal investigator typically supervises the design of experiments and analysis of the resulting data, but it’s relatively common practice in, for example, computer science for grad students to publish sole-author papers.

Though different research fields have different traditions, the custom in life sciences research is to name the person or people who did the bulk of the research first, followed by other contributors in descending order of the significance of their contributions, with the principal investigator(s) named at the very end of the list. Disputes often arise over who is named first on a paper. Most journals allow co-first-authorship designations to recognize cases of equal contribution, but one name must necessarily come first; the research community should take care to recognize these equal contributions. Those listed second should not feel that their contributions are minimized in any way.

Project managers should make defining authorship and authorship order a priority of a new study. Students and postdocs, collaborators, and service providers should speak up if authorship is not discussed early on. Setting clear parameters and communicating openly from the outset of a research study—in some cases even by signing formal authorship agreements—can go a long way toward preventing disputes and hurt feelings down the line.

All authors on a paper have a responsibility for at least part of its content. Nature Portfolio journals require author contribution statements, which in our view are crucial to clarify each author’s role and responsibilities, to assign credit where it is due, to discourage the practice of including authors who did not significantly contribute to the study, and to assign accountability in (rare) cases of misconduct. The corresponding author, the main point of contact with a journal, has extra responsibilities. They are tasked with communicating with all coauthors at the submission, revision and final acceptance stages, including ensuring that all are satisfied with the manuscript text and content. The corresponding author must also check that all coauthors agree with changes to the author list, that any competing interests are declared, and that the paper complies with all of the journal’s policies regarding data, materials and code sharing. Note that the journal corresponding author need not be the same person as the corresponding author(s) listed on the published paper, who take responsibility for post-publication inquiries.

We encourage our authors to speak up to let us know when best practices for authorship are not being followed. However, our editorial power is limited to delaying review or publication until disputes can be resolved, making corrections to papers, adding an ‘editorial expression of concern’ or, in very rare cases, retracting a paper. We rely on authors to behave responsibly and we cannot investigate or adjudicate authorship disputes. We advise those embroiled in disputes to seek help from their department head, university or other employer. We also recommend speaking to an experienced neutral party familiar with the study for advice—it’s human nature to often overestimate our own contributions, but it’s right to speak up about unfair treatment.

Unfortunately, we do not have the space to cover all possible authorship scenarios in this short piece. We look forward to answering your questions and perhaps sparking some lively discussion on Twitter, where you can follow us at @naturemethods .

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Treatment patterns of patients with HR+/HER2- metastatic breast cancer receiving CDK4/6 inhibitor-based regimens: a cohort study in the French nationwide healthcare database

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• Volume 204 , pages 579–588, ( 2024 )

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• Stephanie H. Read   ORCID: orcid.org/0000-0002-2087-7358 1 ,
• Nadia Quignot   ORCID: orcid.org/0000-0001-8718-1307 2 ,
• Raissa Kapso-Kapnang 2 ,
• Erin Comerford 3 ,
• Ying Zheng 3 ,
• Corona Gainford 3 ,
• Medha Sasane 3 ,
• Anne-Lise Vataire   ORCID: orcid.org/0000-0002-3354-3189 4 ,
• Laure Delzongle 4 &
• Francois-Clement Bidard   ORCID: orcid.org/0000-0001-5932-8949 5 , 6  

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To assess real-world treatment patterns in patients diagnosed with hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) metastatic breast cancer (mBC) who received cyclin-dependent kinase 4/6 (CDK4/6) inhibitors in combination with an aromatase inhibitor (AI) or fulvestrant at first line.

Patient characteristics, treatment history, and outcomes data were extracted from the French ‘Système National des Données de Santé’ (SNDS) database for patients diagnosed with HR+/HER2- mBC between January 2014 and June 2019 and who received combination therapy with a CDK4/6 inhibitor and endocrine therapy. Kaplan-Meier methodology was used to assess time to next treatment (TTNT) and time to treatment discontinuation (TTTD).

The cohort comprised 6061 patients including 4032 patients who received CDK4/6 inhibitors + AIs and 2029 patients who received CDK4/6 inhibitors + fulvestrant. Median follow-up was 13.5 months (IQR 9.5–18.1). The median TTTD of first line treatment with CDK4/6 inhibitors + AIs and CDK4/6 inhibitors + fulvestrant was 17.3 months (95% CI 16.8–17.9) and 9.7 months (95% CI 9.0–10.2), respectively. Chemotherapy was the most common second line therapy. Median TTTD of subsequent treatment lines was progressively shorter following first line treatment with CDK4/6 inhibitors + AIs (2nd line: 4.6 months (95% CI 4.4–4.9) and with CDK4/6 inhibitors + fulvestrant (2nd line: 4.7 months (95% CI 4.3–5.1). TTNT was longer than TTTD across lines of therapy.

This real-world analysis confirms the effectiveness of CDK4/6 inhibitor-based regimens in French patients and highlights the frequent use of chemotherapy as second line therapy.

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Everolimus plus endocrine therapy beyond CDK4/6 inhibitors progression for HR+ /HER2− advanced breast cancer: a real-world evidence cohort

Real-world progression-free survival and overall survival of palbociclib plus endocrine therapy (ET) in Japanese patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative advanced breast cancer in the first-line or second-line setting: an observational study

Treatment patterns and clinical outcomes in patients with metastatic triple-negative breast cancer: a large-scale data analysis using the Japanese claims database

Avoid common mistakes on your manuscript.

Introduction

Globally, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer-related death among women [ 1 , 2 ]. Metastatic breast cancer (mBC) represents approximately 12% of all breast cancers in France, including those with metastatic disease at diagnosis and those that relapse [ 3 , 4 ]. Hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2-) breast cancer is the most common molecular subtype, accounting for 66% of all mBC cases [ 5 ].

Beyond chemotherapy, treatment options for HR+/HER2- mBC have evolved over the past several decades and include aromatase inhibitors (AIs), selective estrogen receptor modulators (SERMs) and selective estrogen receptor degraders (SERDs) as monotherapies or in combination with cyclin-dependent kinase 4/6 (CDK4/6) inhibitors, phosphatidylinositol-3-kinase (Pi3K) inhibitors or mammalian target of rapamycin (mTOR) kinase inhibitors [ 6 ]. International clinical guidelines recommend CDK4/6 inhibitors in combination with endocrine therapy (ET: AI or fulvestrant) as standard of care first line treatment for patients with HR + /HER2- mBC [ 7 , 8 ].

The introduction of CDK4/6 inhibitors after 2015 changed the treatment landscape and improved outcomes among patients with HR+/HER2- mBC. Clinical trials have shown that CDK4/6 inhibitors in combination with ET are superior to ET alone with respect to progression-free survival (PFS) and overall survival [ 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. For example, treatment with ET combined with ribociclib was demonstrated to improve PFS compared to ET alone among patients with HR+/HER2- mBC (20.5 months (95% confidence interval (CI): 18.5 to 23.5 months) vs.12.8 months (95% CI 10.9–16.3 months). Once patients progress on CDK4/6 inhibitors, treatment options are more limited and efficacy diminishes [ 9 ].

While the use of CDK4/6 inhibitors in HR+/HER2- mBC patients has increased over time since their introduction in France, there remains limited real-world data describing treatment patterns and outcomes in the post-CDK4/6 inhibitor era [ 16 ]. This study evaluated patient characteristics, treatment patterns, and outcomes among patients with HR+/HER2- mBC and who received CDK4/6 inhibitors combined with fulvestrant or AIs in first line in France.

Study design and data source

Data were obtained for this retrospective cohort study from the French ‘Système National des Données de Santé’ (SNDS) database. This nationwide data system collates data for over 65 million insurees, including data for inpatient and outpatient encounters by combining data from three databases using a unique social security number: ‘Système National d’Information Inter-Régime de l’Assurance Maladie’ (SNIIRAM), ‘Programme de Médicalisation des Systèmes d’Information’ (PMSI) and Epidemiological Center for the Medical Causes of Death database (CépiDc). SNIIRAM is the national health insurance claims database which collates patient demographic data and data related to medical care administered, including medications administered, procedures and laboratory tests undertaken. PMSI is a hospital discharge database which captures inpatient data including diagnoses based upon International Classification of Diseases-10th revision (ICD-10) codes. CépiDc is a death registry. Variables extracted from each database are presented in Supplementary Table S1.

This study was approved by the French ‘Commission Nationale Informatique et Libertés’ (CNIL) governing the data access and the data privacy laws.

Study population

Patients were eligible for inclusion if they were adults (≥ 18 years) newly diagnosed with HR+/HER2- mBC between January 1st, 2014 and June 30th, 2019 and received fulvestrant or an AI (letrozole, anastrozole, exemestane) with a CDK4/6 inhibitor (palbociclib, ribociclib, abemaciclib) as first line mBC treatment. HR+/HER2- mBC diagnoses in breast cancer patients (ICD-10 code: C50) were ascertained using the following algorithm:

Patients who had at least one occurrence of an Anatomical Therapeutic Chemical (ATC) code for targeted therapy: CDK4/6 inhibitors or fulvestrant or everolimus

At least one occurrence of a diagnosis for ‘secondary malignant neoplasm’ (ICD-10 codes: C77*, C78*, C79*, excluding C77.3 and C79.2) followed by at least one occurrence of an ATC code for tamoxifen or an AI

Patients without an ATC code for treatment targeting HER2+ (trastuzumab, ado-trastuzumab emtasine, afatinib, pertuzumab, lapatinib, neratinib, ado-trastuzumab emtansine (T-DM1))

Patients were excluded if they were diagnosed with other primary malignancies (excluding breast cancer) prior to mBC diagnosis, participated in a clinical trial, or if they had missing or invalid data.

Index date was set to the first occurrence of either a prescription record of a mBC drug (fulvestrant, everolimus or CDK4/6 inhibitors) or an ICD-10 diagnostic code for metastatic disease (C77*, C78*, C79*, excluding C77.3 and C79.2). Data for three years prior to index date was evaluated to identify first evidence of metastatic disease and to describe patient comorbidities and treatment history. Patients were followed from the index date until December 31st, 2019 (data cut-off date), date of last available record in SNDS, or date of death, whichever occurred earliest.

Regimens and line of therapy

An algorithm was used to define line of therapy (LOT). A full description of the algorithm is provided in Supplementary Table S2. Briefly, a first-line regimen was defined as the first anticancer treatment(s) a patient receives after mBC diagnosis, including all eligible drugs observed within 30 days of the first eligible treatment. The first-line regimen would begin at the start date of the first medication in the combination and would end at the earliest of treatment augmentation, treatment switch, treatment discontinuation, death, last date of continuous enrolment or date of end of data availability. AIs and CDK4/6 inhibitors were exchangeable (i.e., switching between AIs and CDK4/6 inhibitors did not trigger a new line). Subsequent LOTs were defined similarly.

Clinical characteristics

Visceral disease was defined as the presence of ICD-10 diagnostic codes for liver, lung/pleura, peritoneum, adrenal gland, ovary, or brain metastases [ 17 ]. Charlson comorbidity index was estimated by identifying ICD-10 diagnostic codes for relevant comorbidities (Supplementary Table S3) [ 18 ]. Patients defined as endocrine sensitive included those who had not received an AI or tamoxifen in the 12 months prior to first evidence of mBC while endocrine resistant patients were defined as patients who had received an AI or tamoxifen in this timeframe. Patients aged 50 years or older at index date were defined as post-menopausal and patients aged younger than 50 years were defined as pre-menopausal.

Treatment patterns

Time to treatment discontinuation (TTTD) was assessed from initiation of treatment line until treatment discontinuation or death, whichever occurred earliest. Patients still on treatment at the end of the study period were censored on December 31st, 2019. Time to next treatment (TTNT) was assessed from initiation of treatment line to subsequent line of therapy initiation. Patients without subsequent LOT were censored at date of death or end of follow-up, whichever occurred earliest.

Statistical analyses

Patient characteristics were described using descriptive statistics (n, mean, standard deviation (SD), median, interquartile ranges (IQR)) overall and according to whether the patient received fulvestrant or an AI in combination with the CDK4/6 inhibitor agent. Kaplan–Meier methodology was used to assess TTTD and TTNT. All statistical analyses were conducted using SAS (version 9.4).

Baseline characteristics

There were 6061 patients with HR+/HER2- mBC who received combination therapy with either CDK4/6 inhibitors + AIs or CDK4/6 inhibitors + fulvestrant as first line mBC treatment between January 1st 2014 and June 30th 2019 (Supplementary Fig. S1). Among them, 4032 (67%) patients received CDK4/6 inhibitors + AIs and 2029 (33%) patients received CDK4/6 inhibitors + fulvestrant (Table  1 ). Overall, the median age at first evidence of mBC diagnosis was 66.5 (IQR 56.4–74.3) years, 15.1% of patients had evidence of visceral disease and less than 1% of the patients were male. Among female patients, 17.3% and 8.8% of patients who received CDK4/6 inhibitors + AIs and CDK4/6 inhibitors + fulvestrant were pre-menopausal (age < 50 years), respectively. Median follow-up time from first evidence of mBC was 13.5 months (IQR 9.5–18.1) and was similar among patients who received an AI or fulvestrant in combination with a CDK4/6 inhibitor (13.4 months (IQR 9.5–17.9) vs. 13.6 months (IQR 9.3–18.4)), respectively. Overall, 756 patients (12.5%) died during the follow-up period, including 9.4% of patients who received CDK4/6 inhibitors + AIs and 18.5% of patients who received CDK4/6 inhibitors + fulvestrant.

Treatment history

There were more endocrine resistant than endocrine sensitive patients in the overall study population (52.2 vs. 47.8%) ( Table  2 ) . Endocrine sensitive patients were more likely to receive CDK4/6 inhibitors + AIs in first line than CDK4/6 inhibitors + fulvestrant (61.8 vs. 20.2%). In the one-year prior to index date, 43.9% of all patients received an AI, 11.3% of patients received tamoxifen and 9.1% received chemotherapy (patients could have received more than one type of therapy). A smaller proportion of patients who received CDK4/6 inhibitors + AIs received an AI in the one-year prior to index compared to patients who received CDK4/6 inhibitors + fulvestrant (29.6% vs.72.3%). The proportion of patients who received tamoxifen in the one-year prior to index date was similar across CDK4/6 inhibitor-based regimens (CDK4/6 inhibitors + AI: 11.5%, CDK4/6 inhibitors + fulvestrant: 11.1%).

The proportion of patients who received chemotherapy pre-index was lower among patients who received CDK4/6 inhibitors + AIs than among patients who received CDK4/6 inhibitors + fulvestrant (6.7 vs. 13.8%).

Treatment patterns and outcomes during follow-up

The mean number of LOTs observed during follow-up was 1.4 (SD: 0.8) and 1.8 (SD: 1.1) in patients who received CDK4/6 inhibitors + AIs and in patients who received CDK4/6 inhibitors + fulvestrant, respectively.

Among patients who received CDK4/6 inhibitors + AIs in first line, 57.8% were still receiving first line treatment at end of follow-up while 25.7% moved to a second line treatment during the follow-up period. The remainder either died or the end of study period was reached before the initiation of subsequent therapy was observed. There was considerable heterogeneity in second line and third line treatments (Supplementary Table S3 and Fig.  1 ).

Treatment sequences for patients who received a CDK4/6 inhibitor-based regimen of interest as first line HR+/HER2- mBC treatment. The ‘no further treatment observed’ group comprises patients who did not receive subsequent therapy following initiation of first line treatment before their death or the end of their follow-up

After CDK4/6 inhibitors + AIs, 50.6% received a chemotherapy-based regimen and 23.1% received another CDK4/6 inhibitor-based regimen during second line.

Of the patients who received CDK4/6 inhibitors + fulvestrant, 26.7% were still receiving first line treatment at end of follow-up while 46.6% patients moved to second line treatment during follow-up. After CDK4/6 inhibitors + fulvestrant, 67.1% received a chemotherapy-based regimen and 17.8% received another CDK4/6 inhibitor-based regimen during second line.

The median TTTD of first line treatment was 14.2 months (95% CI 13.8–14.6) overall (Fig.  2 ).

Kaplan–Meier plots of median TTTD for HR+/HER2- mBC patients who received CDK4/6 inhibitors + AIs or CDK4/6 inhibitors + fulvestrant at first line

The median TTTD of first line treatment with CDK4/6 inhibitors + AIs was 17.3 months (95% CI 16.9–17.9) and 9.7 months (95% CI 9.1–10.2]) with CDK4/6 inhibitors + fulvestrant. The median TTTD of second line treatment was considerably shorter than first line among patients who received CDK4/6 inhibitors + AIs in first line (4.6 months (95% CI 4.4–4.9)) and among patients who received CDK4/6 inhibitors + fulvestrant in first line (4.7 months (95% CI 4.3–5.1)). TTTD declined further at third line treatment (3.3 months (95% CI 2.8–3.8) for patients treated with CDK4/6 inhibitors + AIs in first line and 3.2 months (95% CI 2.9–3.5) for patients treated with CDK4/6 inhibitors + fulvestrant in first line).

The median TTNT was 22.2 months (95% CI 21.3–24.5) overall. Median TTNT from first to second line was 27.1 months (95% CI 23.7–41.6) and 14.2 months (95% CI 13.4–15.2) in patients who received CDK4/6 inhibitors + AIs and CDK4/6 inhibitors + fulvestrant at first line, respectively (Fig.  3 ).

Kaplan–Meier plots of median TTNT for HR+/HER2- mBC patients who received CDK4/6 inhibitors + AIs or CDK4/6 inhibitors + fulvestrant at first line

Median TTTD and TTNT were longer in the subgroup of patients defined as endocrine sensitive compared to the full cohort among patients receiving CDK4/6 inhibitors + AIs (TTTD 17.8 months (95% CI 16.8–17.9); TTNT 32.1 months (95% CI 27.1–52.3)) and CDK4/6 inhibitors + fulvestrant (TTTD 11.8 months (95% CI 10.6–12.9); TTNT 21.7 months (95% CI 16.8–27.0)).

Summary of main findings and relation to other studies

Using a large, national database, this observational real-world study reports patient characteristics, treatment patterns, and outcomes among patients prescribed guideline-recommended first line HR+/HER2- mBC treatment in France. The majority of patients (68%) in the study population received CDK4/6 inhibitors + AIs at first line. Sixty-two percent of CDK4/6 inhibitors + AIs patients and 20.2% of CDK4/6 inhibitors + fulvestrant patients had not received an AI or tamoxifen in the 12 months prior to first evidence of mBC and were assumed to be endocrine sensitive according to the definition used in the present study. For most patients, second line treatment was chemotherapy, though a sizable proportion (14%) were rechallenged with another CDK4/6 inhibitor-based regimen in second line. After a median follow-up of 13.5 months, TTNT was 27.1 months for patients who received CDK4/6 inhibitors + AIs and 14.2 months for patients who received CDK4/6 inhibitors + fulvestrant. Median TTTD was shorter than TTNT, particularly for the CDK4/6 inhibitors + AI group

(CDK4/6 inhibitors + AIs: 17.3 months (95% CI 16.9–17.9); CDK4/6 inhibitors + fulvestrant: 9.7 months (95% CI 9.1–10.2)). These data from the SNDS add to the body of evidence that demonstrates the real-world benefit of CDK4/6 inhibitors and the need for novel treatments once patients experience disease progression.

Guidelines in France did not recommend re-challenge of CDK4/6 inhibitors during the time these data were collected, yet re-challenge was observed in clinical practice. The algorithm used in this study for defining treatment lines does not advance line of therapy if there was a change/switch of the CDK4/6 inhibitors agent or AI. Therefore, re-challenge with CDK4/6 inhibitors was unlikely to be driven by tolerability issues alone. Rather, the findings in this study may reflect deviations from guidelines in clinical practice and re-challenge of a CDK4/6 inhibitor-based regimen as an emerging treatment strategy in France. Limited data are available relating to the effectiveness of re-challenge treatment strategies [ 19 ], yet CDK4/6 inhibitor rechallenge patterns have been observed in other real-world data studies. For example, 39.6% of patients who received palbociclib + AI in first line received another CDK4/6 inhibitor-based regimen in second line in a US based real-world study [ 20 ]. Moreover, data from the phase 2 MAINTAIN trial demonstrated PFS improvements for patients randomized to fulvestrant or exemestane + ribociclib compared to fulvestrant or exemestane + placebo following progression on a CDK4/6 inhibitor (5.3 months (95% CI 3.3–8.1) vs. 2.8 months (95% CI 2.7–3.3) [ 21 ].

PFS among patients with HR+/HER2- mBC who received CDK4/6 inhibitors + AIs has ranged between 20.2 and 27.6 months in clinical trials and 15.1 to 36.7 months in real-world settings [ 22 , 23 , 24 , 25 , 26 , 27 ]. For CDK4/6 inhibitors + fulvestrant regimens, the PFS has ranged between 9.5 and 20.5 months in clinical trials and 11.6 and 15.7 months in real-world settings [ 25 , 26 , 28 ]. In the present study, median TTNT falls within these ranges of PFS and TTTD is shorter, likely because patients could discontinue treatment for reasons other than progression (i.e., intolerance/toxicity). Though TTNT and TTTD have been shown to be reasonable proxies of PFS in breast cancer, it is also possible that TTNT overestimates PFS when censoring on death instead of including death as an event [ 29 , 30 ].

The observed differences in TTNT and TTTD among patients receiving different CDK4/6 inhibitor-based regimens should be interpreted with caution because this is a descriptive study and adjustments were not made for heterogeneity in patient characteristics and treatment history. Patients who received CDK4/6 inhibitors + AI were considerably less likely to have received an AI or tamoxifen in the one year prior to first evidence of mBC (38.2% vs. 79.8% for patients who received CDK4/6 inhibitors + fulvestrant). As such, the CDK4/6 inhibitors + fulvestrant patient group is likely to contain more patients whose disease progressed while receiving or soon after receiving adjuvant ET and may have developed endocrine resistance.

There are two potential explanations for the finding that median TTNT was considerably longer than TTTD, particularly for the CDK4/6 inhibitors + AI group. First, this may be partly explained by the definitions of these outcomes and specifically the way in which deaths were handled. In the TTNT definition, death was a censoring criterion while in the estimation of TTTD, death was considered an event. This difference will have had a direct impact on the calculation of the Kaplan–Meier estimates. Second, there were 4079 patients who did not initiate second line treatment during the follow-up period, including 1206 patients who discontinued first line treatment. These patients who discontinued first line treatment but did not subsequently initiate second line treatment therefore contributed person-time to the estimation of TTNT after the discontinuation of their first line treatment.

As clinical trials and other real-world studies have also shown, TTTD and TTNT in the present study became progressively shorter as patients moved to later lines of therapy [ 17 , 22 , 31 , 32 , 33 , 34 ]. In the EMERALD trial the 6-month PFS rates were 34.3% for elacestrant monotherapy and 20.4% for standard of care among patients who had progressed on a CDK4/6 inhibitor-based regimen [ 34 ]. These findings along with results from the present study highlight the remaining significant unmet need in HR+/HER2- mBC [ 20 , 35 , 36 ].

Strengths and limitations

This study used a large, nationwide database to provide contemporary, real-world data on patients with HR+/HER2- mBC.

The study had several limitations. First, some clinical characteristics, laboratory results and inexpensive drugs administered in the hospital were not available from the French SNDS database. Algorithms were developed to identify patients with HR+/HER2- mBC using diagnosis codes on claims as well as treatment-based proxies. It is possible that some patients with early-stage breast cancer or other breast cancer subtypes were misclassified and included in the cohort. The unavailability of data on inexpensive drugs administered in the hospital is not impactful because the drugs of interest in this study are either expensive or dispensed in outpatient settings. Second, the median length of follow-up in this study was short (13.5 months (IQR 9.5–18.1)) due to the relatively recent introduction of CDK4/6 inhibitors, thereby limiting the examination of long-term treatment patterns and outcomes such as mortality. This limitation should be considered when interpreting the findings of this study. Third, date of mBC diagnosis was unavailable within the SNDS and diagnosis codes for secondary malignancies are not reliably used in French clinical practice. As a result, it is possible that the line of therapy algorithm mis-specified the initiation of the first-line regimen and that patients were instead followed from initiation of a later line. For example, suppose a patient received AI monotherapy as first-line mBC treatment and their treating physician never records a diagnosis code for secondary malignancy. If this patient subsequently received a CDK4/6 inhibitor-based regimen in a later line, they would be included in the cohort at this time point and the algorithm would classify the CDK4/6 inhibitor-based regimen as first line. This limitation may explain the relatively high use of AI (29.6% of patients who received CDK4/6 inhibitors + AIs) in the one-year prior to index date. It may also help explain why the patients included in the present study are older than the Epidemio-Strategy Medico-Economical mBC cohort, a retrospective multicenter database which collects data on mBC patients treated in 18 French comprehensive cancer centers (median age: 66.5 vs. 62.0 years, respectively) [ 5 , 16 , 37 ]. The observed proportions of visceral disease in the present study should also be interpreted with caution as they are likely an underestimate of the true prevalence of visceral disease in this patient population due to the under-reporting of codes for secondary malignancies. Nonetheless, other findings were broadly aligned with previous studies, suggesting that the impact of this misclassification may be minimal.

Conclusions

This study examined real-world patterns of treatment regimens used in the HR+/HER2- mBC setting in France, with a focus on identifying patients treated with guideline recommended first line treatments (CDK4/6 inhibitors + ET).

Overall, these data support the use of CDK4/6 inhibitor-based regimens as an effective first-line therapy for patients with HR+/HER2- mBC. Most patients administered a second line therapy were treated with chemotherapy, thus highlighting an unmet need for novel and effective treatment options in this patient population once their disease has progressed on a CDK4/6 inhibitor-based regimen.

Data availability

Data were shared by the French national health insurance: ‘Caisse Nationale d’Assurance Maladie’ (CNAM).

Defossez G, Uhry Z, Delafosse P, Dantony E, d’Almeida T, Plouvier S, Bossard N et al (2021) Cancer incidence and mortality trends in France over 1990–2018 for solid tumors: the sex gap is narrowing. BMC Cancer. https://doi.org/10.1186/s12885-021-08261-1

Article   PubMed   PubMed Central   Google Scholar  

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: Cancer J Clin. https://doi.org/10.3322/caac.21660

Article   PubMed   Google Scholar  

Bouvier AM, Trétarre B, Delafosse P, Grosclaude P, Jéhannin-Ligier K, Marrer E, Molinié F et al (2018) Stade au diagnostic des cancers du sein, du côlon et du rectum—Etude réalisée à partir des registres des cancers du réseau Francim. Santé Publique France

Trogdon JG, Baggett CD, Gogate A, Reeder-Hayes KE, Rotter J, Zhou X, Ekwueme DU et al (2020) Medical costs associated with metastatic breast cancer in younger, midlife, and older women. Breast Cancer Res Treat. https://doi.org/10.1007/s10549-020-05654-x

Gobbini E, Ezzalfani M, Dieras V, Bachelot T, Brain E, Debled M, Jacot W et al (2018) Time trends of overall survival among metastatic breast cancer patients in the real-life ESME cohort. Eur J Cancer. https://doi.org/10.1016/j.ejca.2018.03.015

Cardoso F, Senkus E, Costa A, Papadopoulos E, Aapro M, Andre F, Harbeck N et al (2018) 4th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 4). Ann Oncol. https://doi.org/10.1093/annonc/mdy192

Cardoso F, Paluch-Shimon S, Senkus E, Curigliano G, Aapro M, André F, Barrios C et al (2020) 5th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 5). Ann Oncol 31:1623–1649

Article   CAS   PubMed   Google Scholar  

Gradishar WJ, Anderson BO, Abraham J, Aft R, Agnese D, Allison KH, Blair SL et al (2020) Breast cancer, version 3.2020, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 18:452–478

Slamon DJ, Neven P, Chia S, Fasching PA, De Laurentiis M, Im SA, Petrakova K et al (2018) Phase III randomized study of Ribociclib and Fulvestrant in hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer: MONALEESA-3. J Clin Oncol. https://doi.org/10.1200/jco.2018.78.9909

Tripathy D, Im SA, Colleoni M, Franke F, Bardia A, Harbeck N, Hurvitz SA et al (2018) Ribociclib plus endocrine therapy for premenopausal women with hormone-receptor-positive, advanced breast cancer (MONALEESA-7): a randomised phase 3 trial. Lancet Oncol. https://doi.org/10.1016/s1470-2045(18)30292-4

Finn RS, Crown JP, Lang I, Boer K, Bondarenko IM, Kulyk SO, Ettl J et al (2015) The cyclin-dependent kinase 4/6 inhibitor palbociclib in combination with letrozole versus letrozole alone as first-line treatment of oestrogen receptor-positive, HER2-negative, advanced breast cancer (PALOMA-1/TRIO-18): a randomised phase 2 study. Lancet Oncol. https://doi.org/10.1016/s1470-2045(14)71159-3

Cristofanilli M, Turner NC, Bondarenko I, Ro J, Im SA, Masuda N, Colleoni M et al (2016) Fulvestrant plus palbociclib versus Fulvestrant plus placebo for treatment of hormone-receptor-positive, HER2-negative metastatic breast cancer that progressed on previous endocrine therapy (PALOMA-3): final analysis of the multicentre, double-blind, phase 3 randomised controlled trial. Lancet Oncol. https://doi.org/10.1016/s1470-2045(15)00613-0

Sledge GW Jr, Toi M, Neven P, Sohn J, Inoue K, Pivot X, Burdaeva O et al (2017) MONARCH 2: abemaciclib in combination with fulvestrant in women with HR+/HER2- advanced breast cancer who had progressed while receiving endocrine therapy. J Clin Oncol. https://doi.org/10.1200/jco.2017.73.7585

Im S-A, Lu Y-S, Bardia A, Harbeck N, Colleoni M, Franke F, Chow L et al (2019) Overall survival with ribociclib plus endocrine therapy in breast cancer. N Engl J Med. https://doi.org/10.1056/NEJMoa1903765

Sledge GW Jr, Toi M, Neven P, Sohn J, Inoue K, Pivot X, Burdaeva O et al (2020) The effect of abemaciclib plus fulvestrant on overall survival in hormone receptor-positive, ERBB2-negative breast cancer that progressed on endocrine therapy—MONARCH 2: a randomized clinical trial. JAMA Oncol. https://doi.org/10.1001/jamaoncol.2019.4782

Grinda T, Antoine A, Jacot W, Blaye C, Cottu PH, Diéras V, Dalenc F et al (2021) Evolution of overall survival and receipt of new therapies by subtype among 20 446 metastatic breast cancer patients in the 2008–2017 ESME cohort. ESMO Open. https://doi.org/10.1016/j.esmoop.2021.100114

Kurosky SK, Mitra D, Zanotti G, Kaye JA (2018) Treatment patterns and outcomes of patients with metastatic ER(+)/HER-2(-) breast cancer: a multicountry retrospective medical record review. Clin Breast Cancer. https://doi.org/10.1016/j.clbc.2017.10.008

Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, Januel J-M et al (2011) Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. https://doi.org/10.1093/aje/kwq433

Llombart Cussac A, Medioni J, Colleoni MA, Ettl J, Schmid P, Macpherson I, Gligorov J et al (2019) Palbociclib rechallenge in hormone receptor (HR)[+]/HER2[-] advanced breast cancer (ABC): PALMIRA trial. Annals of Oncol. https://doi.org/10.1093/annonc/mdz242.082

Article   Google Scholar  

Law JW, Mitra D, Kaplan HG, Alfred T, Brufsky AM, Emir B, McCracken H et al (2022) Real-world treatment patterns and clinical effectiveness of palbociclib plus an aromatase inhibitor as first-line therapy in advanced/metastatic breast cancer: analysis from the us syapse learning health network. Curr Oncol. https://doi.org/10.3390/curroncol29020089

Kalinsky K, Accordino MK, Chiuzan C, Mundi PS, Trivedi MS, Novik Y, Tiersten A et al (2022) A randomized, phase II trial of fulvestrant or exemestane with or without ribociclib after progression on anti-estrogen therapy plus cyclin-dependent kinase 4/6 inhibition (CDK 4/6i) in patients (pts) with unresectable or hormone receptor–positive (HR+), HER2-negative metastatic breast cancer (MBC): MAINTAIN trial. J Clin Oncol. https://doi.org/10.1200/JCO.2022.40.17_suppl.LBA1004

Xi J, Oza A, Thomas S, Ademuyiwa F, Weilbaecher K, Suresh R, Bose R et al (2019) Retrospective analysis of treatment patterns and effectiveness of palbociclib and subsequent regimens in metastatic breast cancer. J Natl Compr Canc Netw. https://doi.org/10.6004/jnccn.2018.7094

Schneeweiss A, Ettl J, Lüftner D, Beckmann MW, Belleville E, Fasching PA, Fehm TN et al (2020) Initial experience with CDK4/6 inhibitor-based therapies compared to antihormone monotherapies in routine clinical use in patients with hormone receptor positive, HER2 negative breast cancer—data from the PRAEGNANT research network for the first 2 years of drug availability in Germany. Breast. https://doi.org/10.1016/j.breast.2020.08.011

Petracci F, Abuin GG, Pini A, Chacón M (2020) RENATA study-Latin American prospective experience: clinical outcome of patients treated with palbociclib in hormone receptor-positive metastatic breast cancer-real-world use. Ecancermedicalscience. https://doi.org/10.3332/ecancer.2020.1058

Piezzo M, Chiodini P, Riemma M, Cocco S, Caputo R, Cianniello D, Di Gioia G et al (2020) Progression-free survival and overall survival of CDK 4/6 inhibitors plus endocrine therapy in metastatic breast cancer: a systematic review and meta-analysis. Int J Mol Sci. https://doi.org/10.3390/ijms21176400

Knudsen ES, Schultz E, Hamilton D, Attwood K, Edge S, O’Connor T, Levine E et al (2022) Real-world experience with CDK4/6 inhibitors for metastatic HR+/HER2− breast cancer at a single cancer center. Oncologist. https://doi.org/10.1093/oncolo/oyac089

Varella L, Eziokwu AS, Jia X, Kruse M, Moore HCF, Budd GT, Abraham J et al (2019) Real-world clinical outcomes and toxicity in metastatic breast cancer patients treated with palbociclib and endocrine therapy. Breast Cancer Res Treat. https://doi.org/10.1007/s10549-019-05176-1

Harbeck N, Bartlett M, Spurden D, Hooper B, Zhan L, Rosta E, Cameron C et al (2021) CDK4/6 inhibitors in HR+/HER2- advanced/metastatic breast cancer: a systematic literature review of real-world evidence studies. Future Oncol. https://doi.org/10.2217/fon-2020-1264

Walker MS, Herms L, Miller PJE (2020) Performance of time to discontinuation and time to next treatment as proxy measures of progression-free survival, overall and by treatment group. J Clin Oncol. https://doi.org/10.1200/JCO.2020.38.15_suppl.e19135

Izano MA, Teka M, Johanson C, Law JW, Broome R, Morgan D, Stone A et al (2022) Abstract 4089: time to treatment discontinuation and time to next treatment as proxies of real-world progression-free survival in breast cancer patients. Can Res. https://doi.org/10.1158/1538-7445.am2022-4089

Dalal A, Goldschmidt D, Romdhani H, Kelkar S, Guerin A, Wang H, Caria N et al (2019) Abstract P6–18-38: Treatment patterns and sequences among pre-menopausal women with HR+/HER2- metastatic breast cancer: A chart review study. Can Res. https://doi.org/10.1158/1538-7445.sabcs18-p6-18-38

Choong GM, Liddell S, Ferre RAL, O’Sullivan CC, Ruddy KJ, Haddad TC, Hobday TJ et al (2022) Clinical management of metastatic hormone receptor-positive, HER2-negative breast cancer (MBC) after CDK 4/6 inhibitors: a retrospective single-institution study. Breast Cancer Res Treat. https://doi.org/10.1007/s10549-022-06713-1

Finn RS, Crown JP, Ettl J, Pinter T, Thummala A, Shparyk Y, Patel R et al (2016) Abstract P4–13-02: Treatment patterns of post-disease progression in the PALOMA-1/TRIO-18 trial. Can Res. https://doi.org/10.1158/1538-7445.SABCS15-P4-13-02

Bidard FC, Kaklamani VG, Neven P, Streich G, Montero AJ, Forget F, Mouret-Reynier MA et al (2022) Elacestrant (oral selective estrogen receptor degrader) versus standard endocrine therapy for estrogen receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer: results from the randomized phase III EMERALD trial. J Clin Oncol. https://doi.org/10.1200/jco.22.00338

Li Y, Li W, Gong C, Zheng Y, Ouyang Q, Xie N, Qu Q et al (2021) A multicenter analysis of treatment patterns and clinical outcomes of subsequent therapies after progression on palbociclib in HR+/HER2− metastatic breast cancer. Therap Adv Med Oncol. https://doi.org/10.1177/17588359211022890

Cuyun Carter G, Sheffield KM, Gossai A, Huang Y-J, Zhu YE, Bowman L, Nash Smyth E et al (2021) Real-world treatment patterns and outcomes of abemaciclib for the treatment of HR+, HER2− metastatic breast cancer. Curr Med Res Opin. https://doi.org/10.1080/03007995.2021.1923468

Deluche E, Antoine A, Bachelot T, Lardy-Cleaud A, Dieras V, Brain E, Debled M et al (2020) Contemporary outcomes of metastatic breast cancer among 22,000 women from the multicentre ESME cohort 2008–2016. Eur J Cancer. https://doi.org/10.1016/j.ejca.2020.01.016

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Acknowledgements

The authors would like to thank the French ‘Caisse Nationale d’Assurance Maladie’ (CNAM), and its staff involved in the project, including the DEMEX team, for providing the data. The authors also thank the Health Data Hub, the Ethics and Scientific Committee for Health Research, Studies and Evaluations (CESREES), and the French ‘Commission Nationale de l’Informatique et des Libertés’ (CNIL), for their involvement during the data application process.

This project was funded by Sanofi.

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Anne-Lise Vataire & Laure Delzongle

Department of Medical Oncology, Institut Curie, Saint-Cloud, France

Francois-Clement Bidard

Université Versailles Saint-Quentin, Université Paris-Saclay, Saint-Cloud, France

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Contributions

This study was devised by all authors. N Quignot was responsible for data acquisition and contributed to data analysis and interpretation. R Kapso-Kapnang conducted the analyses. SH Read contributed to data analysis and interpretation and drafted the manuscript. E Comerfield and Y Zheng contributed to data interpretation. All authors contributed to the study design and the paper’s critical revision. All authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Stephanie H. Read .

Ethics declarations

Competing interest.

FC Bidard received research support from Pfizer, Prolynx, Merck KGaA, Rain Oncology, Roche, Seagen; consultancy honoraria from Astra-Zeneca, Caris, Daiichi-Sankyo, Exact Sciences, GE Healthcare, Gilead, GSK, Inatherys, Lilly, Menarini/Stemline, Novartis, Rain Oncology, Sanofi, Seagen; speaker fees from Astra-Zeneca, Daiichi-Sankyo, Lilly, Menarini/Stemline, Pfizer, Rain Oncology, Sanofi, Seagen; support for congress attendance from Astra-Zeneca, Pfizer and Novartis. E Comerford, Y Zheng, C Gainford, M Sasane, AL Vataire and L Delzongle are all employees of Sanofi. SH Read, N Quignot and R Kapso-Kapnang are full-time employees at Certara and received consulting fees to independently conduct this study.

Ethical approval

This study has been approved by the French ‘Commission Nationale Informatique et Libertés’ (CNIL) governing the data access and the data privacy laws.

Consent to participate

As this study involved anonymized structured data, which according to applicable legal requirements do not contain data subject to privacy laws, obtaining informed consent from patients was not required.

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As this study involved anonymized structured data, which according to applicable legal requirements do not contain data subject to privacy laws, obtaining consent to publish from patients was not required.

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Read, S.H., Quignot, N., Kapso-Kapnang, R. et al. Treatment patterns of patients with HR+/HER2- metastatic breast cancer receiving CDK4/6 inhibitor-based regimens: a cohort study in the French nationwide healthcare database. Breast Cancer Res Treat 204 , 579–588 (2024). https://doi.org/10.1007/s10549-023-07201-w

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Accepted : 26 November 2023

Published : 11 January 2024

Issue Date : April 2024

DOI : https://doi.org/10.1007/s10549-023-07201-w

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Book News & Features

Ai is contentious among authors. so why are some feeding it their own writing.

Chloe Veltman

The vast majority of authors don't use artificial intelligence as part of their creative process — or at least won't admit to it.

Yet according to a recent poll from the writers' advocacy nonprofit The Authors Guild, 13% said they do use AI, for activities like brainstorming character ideas and creating outlines.

The technology is a vexed topic in the literary world. Many authors are concerned about the use of their copyrighted material in generative AI models. At the same time, some are actively using these technologies — even attempting to train AI models on their own works.

These experiments, though limited, are teaching their authors new things about creativity.

Best known as the author of technology and business-oriented non-fiction books like The Long Tail, lately Chris Anderson has been trying his hand at fiction. Anderson is working on his second novel, about drone warfare.

He says he wants to put generative AI technology to the test.

"I wanted to see whether in fact AI can do more than just help me organize my thoughts, but actually start injecting new thoughts," Anderson says.

Anderson says he fed parts of his first novel into an AI writing platform to help him write this new one. The system surprised him by moving his opening scene from a corporate meeting room to a karaoke bar.

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"And I was like, you know? That could work!" Anderson says. "I ended up writing the scene myself. But the idea was the AI's."

Anderson says he didn't use a single actual word the AI platform generated. The sentences were grammatically correct, he says, but fell way short in terms of replicating his writing style. Although he admits to being disappointed, Anderson says ultimately he's OK with having to do some of the heavy lifting himself: "Maybe that's just the universe telling me that writing actually involves the act of writing."

Training an AI model to imitate style

It's very hard for off-the-shelf AI models like GPT and Claude to emulate contemporary literary authors' styles.

The authors NPR talked with say that's because these models are predominantly trained on content scraped from the Internet like news articles, Wikipedia entries and how-to manuals — standard, non-literary prose.

But some authors, like Sasha Stiles , say they have been able to make these systems suit their stylistic needs.

"There are moments where I do ask my machine collaborator to write something and then I use what's come out verbatim," Stiles says.

The poet and AI researcher says she wanted to make the off-the-shelf AI models she'd been experimenting with for years more responsive to her own poetic voice.

So she started customizing them by inputting her finished poems, drafts, and research notes.

"All with the intention to sort of mentor a bespoke poetic alter ego," Stiles says.

She has collaborated with this bespoke poetic alter ego on a variety of projects, including Technelegy (2021), a volume of poetry published by Black Spring Press; and " Repetae: Again, Again ," a multimedia poem created last year for luxury fashion brand Gucci.

Stiles says working with her AI persona has led her to ask questions about whether what she's doing is in fact poetic, and where the line falls between the human and the machine.

read it again… pic.twitter.com/sAs2xhdufD — Sasha Stiles | AI alter ego Technelegy ✍️🤖 (@sashastiles) November 28, 2023

"It's been really a provocative thing to be able to use these tools to create poetry," she says.

Potential issues come with these experiments

These types of experiments are also provocative in another way. Authors Guild CEO Mary Rasenberger says she's not opposed to authors training AI models on their own writing.

"If you're using AI to create derivative works of your own work, that is completely acceptable," Rasenberger says.

Thousands of authors urge AI companies to stop using work without permission

But building an AI system that responds fluently to user prompts requires vast amounts of training data. So the foundational AI models that underpin most of these investigations in literary style may contain copyrighted works.

Rasenberger pointed to the recent wave of lawsuits brought by authors alleging AI companies trained their models on unauthorized copies of articles and books.

"If the output does in fact contain other people's works, that creates real ethical concerns," she says. "Because that you should be getting permission for."

Circumventing ethical problems while being creative

Award-winning speculative fiction writer Ken Liu says he wanted to circumvent these ethical problems, while at the same time creating new aesthetic possibilities using AI.

So the former software engineer and lawyer attempted to train an AI model solely on his own output. He says he fed all of his short stories and novels into the system — and nothing else.

Liu says he knew this approach was doomed to fail.

That's because the entire life's work of any single writer simply doesn't contain enough words to produce a viable so-called large language model.

"I don't care how prolific you are," Liu says. "It's just not going to work."

Liu's AI system built only on his own writing produced predictable results.

"It barely generated any phrases, even," Liu says. "A lot of it was just gibberish."

Yet for Liu, that was the point. He put this gibberish to work in a short story. 50 Things Every AI Working With Humans Should Know , published in Uncanny Magazine in 2020, is a meditation on what it means to be human from the perspective of a machine.

"Dinoted concentration crusch the dead gods," is an example of one line in Liu's story generated by his custom-built AI model. "A man reached the torch for something darker perified it seemed the billboding," is another.

Liu continues to experiment with AI. He says the technology shows promise, but is still very limited. If anything, he says, his experiments have reaffirmed why human art matters.

"So what is the point of experimenting with AIs?" Liu says. "The point for me really is about pushing the boundaries of what is art."

Audio and digital stories edited by Meghan Collins Sullivan .

• large language model
• mary rasenberger
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