OBJECTIVES: Understand treatment patterns and quantify resource utilization of HR+ HER2– ABC, with the overall aim of comparing costs and disease burden as patients progress from hormonal therapy (HT) to chemotherapy (CT). METHODS: Chart audit in France, Germany, The Netherlands, Belgium, and Sweden of 375 living and deceased postmenopausal female patients diagnosed with estrogen- and/or progesterone-receptor–positive HER2– ABC in the past 4 years. Patients were required to have progressed on ≥1 line of prior HT in the adjuvant or advanced setting and to have completed ≥1 line of CT treatment (≥2 full cycles) in the ABC setting. The chart audit was completed online using a standardized form developed with the assistance of European academic physicians, pharmacy directors, and hospital administrators. Participation was sought from 12-21 oncologists per country, except in Germany (11 oncologists and 10 gynecologists to reflect local clinical practice). Data collection complied with European and country market research regulations. RESULTS: Preliminary analyses included 265 charts (>80% of patients between 40 and 69 years of age) with one-third having de novo ABC, one-third progressing during or within 1 year of adjuvant therapy, and one-third being late progressors. In the first-line ABC setting, 57% received HT (nearly 90% progressed to CT in second-line), 43% CT, and 15% also targeted therapy (mostly bevacizumab). The switch from HT to CT was associated with a marked increase in resource utilization and associated costs. Besides drug acquisition and administration costs, the main CT cost drivers were management for major CT side effects (low blood cell counts, febrile neutropenia, neurotoxicity, mucositis) and side-effect–related hospitalization events (14% and 7% of all hospitalization events in first- and second-line CT, respectively). CONCLUSIONS: Our results highlight the increased costs and disease burden for postmenopausal HR+ HER2– ABC patients treated with CT versus HT in EU countries.