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Collin LJ, Jones J, Nash R, Switchenko JM, Ward KC, McCullough LE. Racial disparities in initiation of chemotherapy among breast cancer patients with discretionary treatment indication in the state of Georgia. Breast Cancer Res Treat 2024; 205:609-618. [PMID: 38517602 PMCID: PMC11101533 DOI: 10.1007/s10549-024-07279-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/07/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE The majority of breast cancer patients are diagnosed with early-stage estrogen receptor (ER) positive disease. Despite effective treatments for these cancers, Black women have higher mortality than White women. We investigated demographic and clinical factors associated with receipt of chemotherapy among those with a discretionary indication who are at risk for overtreatment. METHODS Using Georgia Cancer Registry data, we identified females diagnosed with ER positive breast cancer who had a discretionary indication for chemotherapy (2010-2017). We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) associating patient demographic and clinical characteristics with chemotherapy initiation overall, and comparing non-Hispanic Black (NHB) with non-Hispanic White (NHW) women within strata of patient factors. RESULTS We identified 11,993 ER positive breast cancer patients with a discretionary indication for chemotherapy. NHB patients were more likely to initiate chemotherapy compared with NHW women (OR = 1.41, 95% CI: 1.28, 1.56). Race differences in chemotherapy initiation were pronounced among those who did not receive Oncotype DX testing (OR = 1.47, 95% CI: 1.31, 1.65) and among those residing in high socioeconomic status neighborhoods (OR = 2.48, 95% CI: 1.70, 3.61). However, we observed equitable chemotherapy receipt among patients who received Oncotype DX testing (OR = 0.90, 95% CI: 0.71, 1.14), were diagnosed with grade 1 disease (OR = 1.00, 95% CI: 0.74, 1.37), and those resided in rural areas (OR = 1.01, 95% CI: 0.76, 1.36). CONCLUSION We observed racial disparities in the initiation of chemotherapy overall and by sociodemographic and clinical factors, and more equitable outcomes when clinical guidelines were followed.
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Affiliation(s)
- Lindsay J Collin
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA.
| | - Jade Jones
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, USA
| | - Rebecca Nash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jeffrey M Switchenko
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lauren E McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Olsson LT, Hamilton AM, Van Alsten SC, Lund JL, Stürmer T, Nichols HB, Reeder-Hayes KE, Troester MA. Patterns of chemotherapy receipt among patients with hormone receptor-positive, HER2-negative breast cancer. Breast Cancer Res Treat 2024; 204:107-116. [PMID: 38070094 PMCID: PMC10979654 DOI: 10.1007/s10549-023-07164-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/22/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Breast cancer chemotherapy utilization not only may differ by race and age, but also varies by genomic risk, tumor characteristics, and patient characteristics. Studies in demographically diverse populations with both clinical and genomic data are necessary to understand potential disparities by race and age. METHODS In the Carolina Breast Cancer Study Phase 3 (2008-2013), chemotherapy receipt (yes/no) and regimen type were assessed in association with age and race among hormone receptor (HR) positive and HER2-negative tumors (n = 1862). Odds ratios were estimated for the association between demographic factors and chemotherapy receipt. RESULTS Monotonic decreases in frequency of adjuvant chemotherapy receipt were observed over time during the study period, while neoadjuvant chemotherapy was stable. Younger age was associated with chemotherapy receipt (OR [95% CI]: 2.9 [2.4, 3.6]) and with anthracycline-based regimens (OR [95% CI]: 1.7 [1.3, 2.4]). Participants who had Medicaid (OR [95% CI]: 1.8 [1.3, 2.5]), lived in rural settings (OR [95% CI]: 1.4 [1.0, 2.0]), or were Black (OR [95% CI]: 1.5 [1.2, 1.8]) had slightly higher odds of chemotherapy, but these associations were non-significant with adjustment for stage and grade. Associations between younger age and chemotherapy receipt were strongest among women who did not receive genomic testing. CONCLUSIONS While race was not strongly associated with chemotherapy receipt, younger age remains a strong predictor of chemotherapy receipt, even with adjustment for clinical factors and among women who receive genomic testing.
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Affiliation(s)
- Linnea T Olsson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.
| | - Alina M Hamilton
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sarah C Van Alsten
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Jennifer L Lund
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Hazel B Nichols
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Katherine E Reeder-Hayes
- Division of Hematology/Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Melissa A Troester
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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3
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Rogers C, Cobb AN, Lloren JIC, Chaudhary LN, Johnson MK, Huang CC, Teshome M, Kong AL, Singh P, Cortina CS. National trends in neoadjuvant chemotherapy utilization in patients with early-stage node-negative triple-negative breast cancer: the impact of the CREATE-X trial. Breast Cancer Res Treat 2024; 203:317-328. [PMID: 37864105 PMCID: PMC10872271 DOI: 10.1007/s10549-023-07114-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/24/2023] [Indexed: 10/22/2023]
Abstract
PURPOSE Neoadjuvant chemotherapy (NAC) for triple-negative breast cancer (TNBC) allows for assessment of tumor pathological response and has survival implications. In 2017, the CREATE-X trial demonstrated survival benefit with adjuvant capecitabine in patients TNBC and residual disease after NAC. We aimed to assess national rates of NAC for cT1-2N0M0 TNBC before and after CREATE-X and examine factors associated with receiving NAC vs adjuvant chemotherapy (AC). METHODS A retrospective cohort study of women with cT1-2N0M0 TNBC diagnosed from 2014 to 2019 in the National Cancer Database (NCDB) was performed. Variables were analyzed via ANOVA, Chi-squared, Fisher Exact tests, and a multivariate linear regression model was created. RESULTS 55,633 women were included: 26.9% received NAC, 52.4% AC, and 20.7% received no chemotherapy (median ages 53, 59, and 71 years, p < 0.01). NAC utilization significantly increased over time: 19.5% in 2014-15 (n = 3,465 of 17,777), 27.1% in 2016-17 (n = 5,140 of 18,985), and 33.6% in 2018-19 (n = 6,337 of 18,871, p < 0.001). On multivariate analysis, increased NAC was associated with younger age (< 50), non-Hispanic white race/ethnicity, lack of comorbidities, cT2 tumors, care at an academic or integrated-network cancer program, and diagnosis post-2017 (p < 0.05 for all). Patients with government-provided insurance were less likely to receive NAC (p < 0.01). Women who traveled > 60 miles for treatment were more likely to receive NAC (p < 0.01). CONCLUSION From 2014 to 2019, NAC utilization increased for patients with cT1-2N0M0 TNBC. Racial, socioeconomic, and access disparities were observed in who received NAC vs AC and warrants interventions to ensure equitable care.
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Affiliation(s)
- Christine Rogers
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Adrienne N Cobb
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Jan I C Lloren
- Zibler School of Public Health, University of Wisconsin at Milwaukee, Milwaukee, WI, USA
| | - Lubna N Chaudhary
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA
| | - Morgan K Johnson
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Chiang-Ching Huang
- Zibler School of Public Health, University of Wisconsin at Milwaukee, Milwaukee, WI, USA
| | - Mediget Teshome
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amanda L Kong
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA
| | - Puneet Singh
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chandler S Cortina
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA.
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA.
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Njoku A, Sawadogo W, Frimpong P. Racial and Ethnic Disparities in Cancer Occurrence and Outcomes in Rural United States: A Scoping Review. Cancer Control 2024; 31:10732748241261558. [PMID: 38857181 PMCID: PMC11165954 DOI: 10.1177/10732748241261558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 05/09/2024] [Accepted: 05/21/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Cancer is the second-leading cause of death in the United States. Most studies have reported rural versus urban and Black versus White cancer disparities. However, few studies have investigated racial disparities in rural areas. OBJECTIVE We conducted a literature review to explore the current state of knowledge on racial and ethnic disparities in cancer attitudes, knowledge, occurrence, and outcomes in rural United States. METHODS A systematic search of PubMed and Embase was performed. Peer-reviewed articles published in English from 2004-2023 were included. Three authors independently reviewed the articles and reached a consensus. RESULTS After reviewing 993 articles, a total of 30 articles met the inclusion criteria and were included in the present review. Studies revealed that underrepresented racial and ethnic groups in rural areas were more likely to have low cancer-related knowledge, low screening, high incidence, less access to treatment, and high mortality compared to their White counterparts. CONCLUSION Underrepresented racial and ethnic groups in rural areas experienced a high burden of cancer. Improving social determinants of health may help reduce cancer disparities and promote health.
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Affiliation(s)
- Anuli Njoku
- Department of Public Health, College of Health and Human Services, Southern Connecticut State University, New Haven, CT, USA
| | - Wendemi Sawadogo
- Department of Public Health, College of Health and Human Services, Southern Connecticut State University, New Haven, CT, USA
| | - Princess Frimpong
- Department of Public Health, College of Health and Human Services, Southern Connecticut State University, New Haven, CT, USA
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5
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Kempton CL, Payne AB, Fedewa SA. Race, ethnicity, and immune tolerance induction in hemophilia A in the United States. Res Pract Thromb Haemost 2023; 7:102251. [PMID: 38193063 PMCID: PMC10772873 DOI: 10.1016/j.rpth.2023.102251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 01/10/2024] Open
Abstract
Background In racially diverse communities, treatment of chronic diseases can vary across racial and ethnic groups. Objectives To examine healthcare disparities in hemophilia care in the United States by evaluating receipt of immune tolerance induction (ITI) among different racial and ethnic groups. Methods In this cross-sectional study, people with severe hemophilia A with an inhibitor who entered the Center for Disease Control and Prevention Community Counts registry between 2013 and 2017, were aged ≥5 years at study entry, and had a history of an inhibitor (n = 614) were included. The proportion of participants receiving ITI was examined according to race and ethnicity in bivariable analysis and multivariable analysis adjusting for demographic and clinical covariates. Unadjusted and adjusted prevalence ratios and corresponding 95% CIs were computed. Results Among 614 participants included in the study, 56.4% were non-Hispanic (NH) White, 19.7% were NH Black, 18.4% were Hispanic, and 4.9% were Asian. ITI was received by 85.2% of participants. On bivariable analysis, ITI treatment did not vary by race or ethnicity. On multivariable analysis, NH Black and Hispanic participants were significantly less likely to receive ITI compared to NH White participants (adjusted prevalence ratio, 0.91 [95% CI, 0.84-0.99] and 0.84 [95% CI, 0.75-0.93], respectively). Conclusion Although the role of ITI may evolve with growing use of emicizumab and the introduction of new hemophilia treatment products, understanding characteristics that influence care, particularly race and ethnicity, where physician bias and patient mistrust can occur, will remain relevant and applicable to other complex therapies, including gene therapy.
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Affiliation(s)
- Christine L. Kempton
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
- Hemophilia of Georgia Center for Bleeding & Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Amanda B. Payne
- National Center on Birth Defects and Developmental Disabilities, Center for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stacey A. Fedewa
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
- Hemophilia of Georgia Center for Bleeding & Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, Georgia, USA
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6
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Williams AD, Moo TA. The Impact of Socioeconomic Status and Social Determinants of Health on Disparities in Breast Cancer Incidence, Treatment, and Outcomes. CURRENT BREAST CANCER REPORTS 2023. [DOI: 10.1007/s12609-023-00473-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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7
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Oppong BA, Rolle AA, Ndumele A, Li Y, Fisher JL, Bhattacharyya O, Adeyanju T, Paskett ED. Are there differences in outcomes by race among women with metastatic triple-negative breast cancer? Breast Cancer Res Treat 2022; 196:399-408. [PMID: 36152139 DOI: 10.1007/s10549-022-06736-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/03/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Black women have higher breast cancer mortality rates than other groups, with Triple-negative breast cancer (TNBC) being more common among AAs with a worse prognosis. Our study seeks to explore differences among Non-Hispanic Black (NHB) vs. White (NHW) women, with Stage IV TNBC, focusing on survival and treatment patterns. METHODS SEER database was queried for TNBC patients diagnosed with metastatic disease from 2012 to 2016. Neighborhood socioeconomic status (nSES) was defined using the Yost index based on income, education, housing, and employment. Univariate and multivariate analyses were performed to evaluate receipt of surgery, radiation, and chemotherapy. Overall survival was evaluated using Kaplan-Meier curve and Cox proportional hazards model analysis. RESULTS 25,761 TNBC cases were identified with 1420 being metastatic (5.5%). Bone was the most common site for metastasis, with patients' age being 63.7 years for NHW vs. 59.5 years for NHB. NHB women had the highest percentage of low nSES (62.3% vs 29.3%; p value = 0.001). On univariate analysis, fewer NHBs received radiation compared to NHWs (27.1 vs. 32.6%; p value = 0.040). On multivariate analysis, all women were less likely to undergo treatment if unmarried (p value < 0.01). NHB women had lower median survival compared to NHW women (13 vs. 15 months; p value < 0.01). Receipt of surgery and chemotherapy reduced the risk of mortality (p value < 0.01). CONCLUSION NHB women had lower median survival with metastatic TNBC. Race was associated with different treatment utilization. With a mortality differential between NHW and NHB women with metastatic TNBC, more investigation is needed to inform strategies to reduce this disparity.
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Affiliation(s)
- Bridget A Oppong
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.
| | | | - Amara Ndumele
- Wexner College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Yaming Li
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - James L Fisher
- James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, USA
| | - Oindrila Bhattacharyya
- James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, USA
| | - Toyin Adeyanju
- Department of Medicine, and Comprehensive Cancer Center, Ohio State University, Columbus, OH, USA
| | - Electra D Paskett
- Department of Medicine, and Comprehensive Cancer Center, Ohio State University, Columbus, OH, USA
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8
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Cho B, Han Y, Lian M, Colditz GA, Weber JD, Ma C, Liu Y. Evaluation of Racial/Ethnic Differences in Treatment and Mortality Among Women With Triple-Negative Breast Cancer. JAMA Oncol 2021; 7:1016-1023. [PMID: 33983438 DOI: 10.1001/jamaoncol.2021.1254] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance To our knowledge, there is no consensus regarding differences in treatment and mortality between non-Hispanic African American and non-Hispanic White women with triple-negative breast cancer (TNBC). Little is known about whether racial disparities vary by sociodemographic, clinical, and neighborhood factors. Objective To examine the differences in clinical treatment and outcomes between African American and White women in a nationally representative cohort of patients with TNBC and further examine the contributions of sociodemographic, clinical, and neighborhood factors to TNBC outcome disparities. Design, Setting, and Participants This population-based, retrospective cohort study included 23 123 women who received a diagnosis of nonmetastatic TNBC between January 1, 2010, and December 31, 2015, followed up through December 31, 2016, and identified from the Surveillance, Epidemiology, and End Results data set. The study was conducted from July 2019 to November 2020. The analyses were performed from July 2019 to June 2020. Exposures Race and ethnicity, including non-Hispanic African American and non-Hispanic White race. Main Outcomes and Measures Using logistic regression analysis and competing risk regression analysis, we estimated odds ratios (ORs) of receipt of treatment and hazard ratios (HRs) of breast cancer mortality in African American patients compared with White patients. Results Of 23 213 participants, 5881 (25.3%) were African American women and 17 332 (74.7%) were White women. Compared with White patients, African American patients had lower odds of receiving surgery (OR, 0.69; 95% CI, 0.60-0.79) and chemotherapy (OR, 0.89; 95% CI, 0.81-0.99) after adjustment for sociodemographic, clinicopathologic, and county-level factors. During a 43-month follow-up, 3276 patients (14.2%) died of breast cancer. The HR of breast cancer mortality was 1.28 (95% CI, 1.18-1.38) for African American individuals after adjustment for sociodemographic and county-level factors. Further adjustment for clinicopathological and treatment factors reduced the HR to 1.16 (95% CI, 1.06-1.25). This association was observed in patients living in socioeconomically less deprived counties (HR, 1.26; 95% CI, 1.14-1.39), urban patients (HR, 1.21; 95% CI, 1.11-1.32), patients having stage II (HR, 1.19; 95% CI, 1.02-1.39) or III (HR, 1.15; 95% CI, 1.01-1.31) tumors that were treated with chemotherapy, and patients younger than 65 years (HR, 1.24; 95% CI, 1.12-1.37). Conclusions and Relevance In this retrospective cohort study, African American women with nonmetastatic TNBC had a significantly higher risk of breast cancer mortality compared with their White counterparts, which was partially explained by their disparities in receipt of surgery and chemotherapy.
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Affiliation(s)
- Beomyoung Cho
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Yunan Han
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Min Lian
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri.,Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St Louis, Missouri
| | - Graham A Colditz
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri.,Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St Louis, Missouri
| | - Jason D Weber
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri.,Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St Louis, Missouri
| | - Cynthia Ma
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri.,Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St Louis, Missouri
| | - Ying Liu
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri.,Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St Louis, Missouri
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Zhang L, King J, Wu XC, Hsieh MC, Chen VW, Yu Q, Fontham E, Loch M, Pollack LA, Ferguson T. Racial/ethnic differences in the utilization of chemotherapy among stage I-III breast cancer patients, stratified by subtype: Findings from ten National Program of Cancer Registries states. Cancer Epidemiol 2018; 58:1-7. [PMID: 30415099 DOI: 10.1016/j.canep.2018.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The study aimed to examine racial/ethnic differences in chemotherapy utilization by breast cancer subtype. METHODS Data on female non-Hispanic white (NHW), non-Hispanic black (NHB), and Hispanic stage I-III breast cancer patients diagnosed in 2011 were obtained from a project to enhance population-based National Program of Cancer Registry data for Comparative Effectiveness Research. Hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) were used to classify subtypes: HR+/HER2-; HR+/HER2+; HR-/HER2-; and HR-/HER2 + . We used multivariable logistic regression models to examine the association of race/ethnicity with three outcomes: chemotherapy (yes, no), neo-adjuvant chemotherapy (yes, no), and delayed chemotherapy (yes, no). Covariates included patient demographics, tumor characteristics, Charlson Comorbidity Index, other cancer treatment, and participating states/areas. RESULTS The study included 25,535 patients (72.1% NHW, 13.7% NHB, and 14.2% Hispanics). NHB with HR+/HER2- (adjusted odds ratio [aOR] 1.22, 95% CI 1.04-1.42) and Hispanics with HR-/HER2- (aOR 1.62, 95% CI 1.15-2.28) were more likely to receive chemotherapy than their NHW counterparts. Both NHB and Hispanics were more likely to receive delayed chemotherapy than NHW, and the pattern was consistent across each subtype. No racial/ethnic differences were found in the receipt of neo-adjuvant chemotherapy. CONCLUSIONS Compared to NHW with the same subtype, NHB with HR+/HER2- and Hispanics with HR-/HER2- have higher odds of using chemotherapy; however, they are more likely to receive delayed chemotherapy, regardless of subtype. Whether the increased chemotherapy use among NHB with HR+/HER2- indicates overtreatment needs further investigation. Interventions to improve the timely chemotherapy among NHB and Hispanics are warranted.
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Affiliation(s)
- Lu Zhang
- Epidemiology Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States
| | - Jessica King
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Xiao-Cheng Wu
- Epidemiology Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States
| | - Mei-Chin Hsieh
- Epidemiology Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States
| | - Vivien W Chen
- Epidemiology Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States
| | - Qingzhao Yu
- Biostatistics Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States
| | - Elizabeth Fontham
- Epidemiology Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States
| | - Michelle Loch
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States
| | - Lori A Pollack
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Tekeda Ferguson
- Epidemiology Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States.
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Enewold L, Penn DC, Stevens JL, Harlan LC. Black/white differences in treatment and survival among women with stage IIIB-IV breast cancer at diagnosis: a US population-based study. Cancer Causes Control 2018; 29:657-665. [PMID: 29860614 DOI: 10.1007/s10552-018-1045-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/26/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Non-Hispanic black (NHB) women with breast cancer have poorer survival than non-Hispanic white (NHW) women. Although NHB women are more often diagnosed at later stages, it is less established whether racial disparities exist among women diagnosed with late-stage breast cancer, particularly when care is provided in the community setting. METHODS Treatment and survival were examined by race/ethnicity among women diagnosed in 2012 with stage IIIB-IV breast cancer using the National Cancer Institute's population-based Patterns of Care Study. Medical records were re-abstracted and treating physicians were contacted to verify therapy. Vital status was available through 2014. RESULTS A total of 533 women with stage IIIB-C and 625 with stage IV tumors were included; NHW women comprised about 70% of each group. Among women with stage IIIB-C disease, racial/ethnicity variations in systemic treatment were not observed but there was a borderline association indicating worse all-cause mortality among NHB women (hazard ratio 1.52; 95% confidence interval (CI) 0.96-2.41). In contrast, among women with stage IV disease, borderline associations indicating NHB women were more likely to receive chemotherapy (OR 1.44, 95% CI 0.90-2.30) and, among those with hormone receptor-positive tumors, less likely to receive endocrine therapy (OR 0.60, 95% CI 0.35-1.04). All-cause mortality did not vary by race/ethnicity for stage IV disease (hazard ratio 0.92; 95% CI 0.68-1.25). CONCLUSIONS More research is needed to identify additional factors associated with the potential survival disparities among women with stage IIIB-C disease and potential treatment disparities among women with stage IV disease.
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Affiliation(s)
- Lindsey Enewold
- NCI/DCCPS/HDRP/HARB, Bethesda, MD, 20892, USA. .,NCI/HDRP, Room 3E506, 9609 Medical Center Drive, MSC 9762, Bethesda, MD, 20892-9762, USA.
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11
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The preference to receive chemotherapy and cancer-related outcomes in older adults with breast cancer CALGB 49907 (Alliance). J Geriatr Oncol 2018; 9:221-227. [PMID: 29602735 DOI: 10.1016/j.jgo.2018.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/02/2018] [Accepted: 02/13/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Chemotherapy preference refers to a patient's interest in receiving chemotherapy. This study examined whether chemotherapy preference was associated with toxicity, efficacy, quality of life (QoL), and functional outcomes during and after completion of adjuvant chemotherapy in older women with breast cancer. MATERIALS AND METHODS This study is a secondary analysis of CALGB 49907, a randomized trial that compared standard adjuvant chemotherapy versus capecitabine in patients age 65 years or older with breast cancer. A subset of 145 patients completed a questionnaire to describe chemotherapy preference pre-treatment. The association of this pre-treatment preference with the patient's perception of self-health, predicted and actual QoL, patient- and professional-reported toxicity, mental health, self-rated function, and survival was studied during and after treatment. RESULTS The median age of patients was 71 years and 47% had a high preference for chemotherapy. On baseline demographics, the low preference group had a higher proportion of white patients (95% vs. 78%, p = 0.004). Before treatment, low chemotherapy preference was associated with greater nausea/vomiting (p = 0.008). Mid-treatment, low preference was associated with lower QoL, worse social, emotional and physical function (all p ≤ 0.02) and worse nausea/vomiting, cancer symptoms and financial worries (all p < 0.05). The association noted mid-treatment, resolved after treatment completion except with financial worries which persisted at 24 months. Low preference was associated with higher rates of grade 3-5 adverse events (53% vs. 34%, p = 0.02) but was not associated with survival. CONCLUSIONS Low chemotherapy preference prior to treatment initiation was associated with lower QoL, worse physical symptoms and self-rated function and more adverse events mid-treatment. There is no association of chemotherapy preference with survival.
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Kuijer A, Verloop J, Visser O, Sonke G, Jager A, van Gils C, van Dalen T, Elias S. The influence of socioeconomic status and ethnicity on adjuvant systemic treatment guideline adherence for early-stage breast cancer in the Netherlands. Ann Oncol 2017; 28:1970-1978. [DOI: 10.1093/annonc/mdx204] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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13
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Influence of comorbidity on chemotherapy use for early breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat 2017; 165:17-39. [DOI: 10.1007/s10549-017-4295-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 05/13/2017] [Indexed: 10/19/2022]
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He X, Ye F, Zhao B, Tang H, Wang J, Xiao X, Xie X. Risk factors for delay of adjuvant chemotherapy in non-metastatic breast cancer patients: A systematic review and meta-analysis involving 186982 patients. PLoS One 2017; 12:e0173862. [PMID: 28301555 PMCID: PMC5354309 DOI: 10.1371/journal.pone.0173862] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 02/28/2017] [Indexed: 01/11/2023] Open
Abstract
Purpose Delay performance of adjuvant chemotherapy (AC) after surgery has been presented to affect survival of breast cancer patients adversely, but the risk factors for delay in initiation remain controversial. Therefore, we conducted this systematic review of the literature and meta-analysis aiming at identifying the risk factors for delay of adjuvant chemotherapy (DAC) in non-metastatic breast cancer patients. Methods The search was performed on PubMed, Embase, Chinese National Knowledge Infrastructure and Wanfang Database from inception up to July 2016. DAC was defined as receiving AC beyond 8-week after surgery. Data were combined and analyzed using random-effects model or fixed-effects model for risk factors considered by at least 3 studies. Heterogeneity was analyzed with meta-regression analysis of year of publication and sample size. Publication bias was studied with Egger’s test. Results A total of 12 observational studies including 186982 non-metastatic breast cancer patients were eligible and 12 risk factors were analyzed. Combined results demonstrated that black race (vs white; OR, 1.18; 95% CI, 1.01–1.39), rural residents (vs urban; OR, 1.60; 95% CI, 1.27–2.03) and receiving mastectomy (vs breast conserving surgery; OR, 1.35; 95% CI, 1.00–1.83) were significantly associated with DAC, while married patients (vs single; OR, 0.58; 95% CI, 0.38–0.89) was less likely to have a delay in initiation. No significant impact from year of publication or sample size on the heterogeneity across studies was found, and no potential publication bias existed among the included studies. Conclusions Risk factors associated with DAC included black race, rural residents, receiving mastectomy and single status. Identifying of these risk factors could further help decisions making in clinical practice.
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Affiliation(s)
- Xiaofang He
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Fen Ye
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Bingcheng Zhao
- Department of Anesthesiology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Hailin Tang
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Jin Wang
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Xiangsheng Xiao
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Xiaoming Xie
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
- * E-mail:
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Xuan Q, Gao K, Song Y, Zhao S, Dong L, Zhang Z, Zhang Q, Wang J. Adherence to Needed Adjuvant Therapy Could Decrease Recurrence Rates for Rural Patients With Early Breast Cancer. Clin Breast Cancer 2016; 16:e165-e173. [DOI: 10.1016/j.clbc.2016.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 07/18/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
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Wieder R, Shafiq B, Adam N. African American Race is an Independent Risk Factor in Survival from Initially Diagnosed Localized Breast Cancer. J Cancer 2016; 7:1587-1598. [PMID: 27698895 PMCID: PMC5039379 DOI: 10.7150/jca.16012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/04/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND: African American race negatively impacts survival from localized breast cancer but co-variable factors confound the impact. METHODS: Data sets were analyzed from the Surveillance, Epidemiology and End Results (SEER) directories from 1973 to 2011 consisting of patients with designated diagnosis of breast adenocarcinoma, race as White or Caucasian, Black or African American, Asian, American Indian or Alaskan Native, Native Hawaiian or Pacific Islander, age, stage I, II or III, grade 1, 2 or 3, estrogen receptor or progesterone receptor positive or negative, marital status as single, married, separated, divorced or widowed and laterality as right or left. The Cox Proportional Hazards Regression model was used to determine hazard ratios for survival. Chi square test was applied to determine the interdependence of variables found significant in the multivariable Cox Proportional Hazards Regression analysis. Cells with stratified data of patients with identical characteristics except African American or Caucasian race were compared. RESULTS: Age, stage, grade, ER and PR status and marital status significantly co-varied with race and with each other. Stratifications by single co-variables demonstrated worse hazard ratios for survival for African Americans. Stratification by three and four co-variables demonstrated worse hazard ratios for survival for African Americans in most subgroupings with sufficient numbers of values. Differences in some subgroupings containing poor prognostic co-variables did not reach significance, suggesting that race effects may be partly overcome by additional poor prognostic indicators. CONCLUSIONS: African American race is a poor prognostic indicator for survival from breast cancer independent of 6 associated co-variables with prognostic significance.
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Affiliation(s)
- Robert Wieder
- 1. Department of Medicine, Rutgers New Jersey Medical School and the New Jersey Medical School Cancer Center, Rutgers Biomedical and Health Sciences
| | - Basit Shafiq
- 2. Rutgers Institute for Data Science, Learning, and Applications and the Center for Information Management, Integration, and Connectivity, Rutgers Newark
| | - Nabil Adam
- 2. Rutgers Institute for Data Science, Learning, and Applications and the Center for Information Management, Integration, and Connectivity, Rutgers Newark
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Reyes SA, King TA, Fei K, Franco R, Bickell NA. Factors Affecting the Completion of Adjuvant Chemotherapy in Early-Stage Breast Cancer. Ann Surg Oncol 2015; 23:1537-42. [PMID: 26714953 DOI: 10.1245/s10434-015-5039-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Despite the survival benefit associated with adjuvant chemotherapy in early-stage breast cancer, many do not complete treatment. This study identified factors associated with noncompletion of adjuvant chemotherapy among a select population of women with early-stage breast cancer. METHODS The study sample was obtained from a multicenter study designed to evaluate patient-assistance program usage among early-stage breast cancer patients requiring adjuvant therapy. In this study, 333 patients with stages I and II breast cancer undergoing surgery from October 2006 to September 2009 completed 6-month follow-up surveys assessing their experiences with care, health status, social support, self-efficacy, and treatment beliefs. In- and outpatient medical records were abstracted to assess treatment completion. Of the 333 patients, 198 initiated adjuvant chemotherapy and formed our study cohort. The study compared patients who did and did not complete adjuvant chemotherapy. RESULTS The median patient age was 53 years (range 28-86 years). According to self-identification, 41 % of the patients were non-Hispanic white and 21 % were black. A total of 13 patients (7 %) did not complete adjuvant chemotherapy. In the bivariate analysis, the patients not completing chemotherapy were more likely to be black and unmarried women with low emotional social support and a poor body image after treatment. In the multivariate analysis, black race [odds ratio (OR) 5.62; 95 % confidence interval (CI) 1.63-20.36] and poor body image (OR 9.75; 95 % CI 2.12-95.95) were independently associated with noncompletion of chemotherapy. CONCLUSIONS Overall chemotherapy noncompletion rates were low among women exposed to patient-assistance programs. However, poor body image and black race were independent predictors of uncompleted chemotherapy. The true impact of race in this group may result from social factors that occur more often among black women, including poor social support.
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Affiliation(s)
- Sylvia A Reyes
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tari A King
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kezhen Fei
- Department of Population Health Science & Policy, Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rebeca Franco
- Department of Population Health Science & Policy, Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nina A Bickell
- Department of Population Health Science & Policy, Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Zhu Z, Huo Q, Wang S, Yang Q. Occupational type affects the receipt of breast cancer adjuvant chemotherapy in China. Oncol Lett 2015; 10:2547-2552. [PMID: 26622887 DOI: 10.3892/ol.2015.3571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/07/2015] [Indexed: 01/10/2023] Open
Abstract
Adjuvant chemotherapy has been demonstrated to improve the prognosis of patients with early-stage breast cancer; however, the high cost and side effects associated with this treatment may discourage patients from receiving it. The present study assessed the candidate factors that may influence decisions regarding postoperative adjuvant chemotherapy in females with early-stage breast cancer. Patients diagnosed with invasive breast cancer between January 2000 and December 2007 were enrolled in the study. Information about the patients, including socio-demographic factors, clinicopathological characteristics and receipt of adjuvant chemotherapy, was obtained from their medical records. Overall, 434 out of 1,296 (33.5%) patients with breast cancer decided against receiving adjuvant chemotherapy. Receipt of chemotherapy was significantly associated with the age of the patient at the time of diagnosis (P=0.029), occupational type (P=0.023), and lymph node status (P<0.001). Moderate associations were also observed between receipt of adjuvant chemotherapy and the patients family history of cancer (P=0.055) and hormone-receptor status (P=0.075). The results of the present study suggest that the occupational type of the patient is associated with receipt of adjuvant chemotherapy in China. This observation may provide a novel strategy for physicians to improve patients compliance regarding adjuvant chemotherapy. Further studies in additional developing countries are required in order to validate these observations.
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Affiliation(s)
- Zhengzhi Zhu
- Department of Breast Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China ; Department of Oncology Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, P.R. China
| | - Qiang Huo
- Department of Breast Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Shengying Wang
- Medical Center of Breast Disease, Anhui Tumor Hospital, Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Qifeng Yang
- Department of Breast Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
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de Camargo Cancela M, Comber H, Sharp L. Which women with breast cancer do, and do not, undergo receptor status testing? A population-based study. Cancer Epidemiol 2015; 39:778-82. [PMID: 26318110 DOI: 10.1016/j.canep.2015.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 08/12/2015] [Accepted: 08/14/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Receptor status determines of breast cancer treatment and prognosis. In a population-based study, we investigated predictors of receptor test receipt. MATERIALS AND METHODS Invasive breast cancers diagnosed 2006-2008 were abstracted from the National Cancer Registry Ireland. Modified Poisson regression with robust error variance was used to identify socio-demographic, health service and clinical predictors of not undergoing ER, PR or HER2 testing. RESULTS 7619 breast cancers were included. 7% were not tested for any receptor. 92%, 80% and 86% had oestrogen (ER), progesterone (PR) and human epidermal growth factor 2 (HER2) tests, respectively; 73% were tested for all three. For all three tests, unmarried women were significantly less likely to be tested than married women. Current smokers significantly more often had ER and PR tests. Women treated in a high-volume hospital significantly more often had ER and HER2 tests. CONCLUSION After adjusting for clinical factors, socio-demographic and service-related factors significantly predicted receptor test receipt. Some factors deserve further investigation, especially marital status. In the interests of equity, the reasons underlying these associations should be further investigated.
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Affiliation(s)
| | | | - Linda Sharp
- National Cancer Registry Ireland, Cork, Ireland; Institute of Health & Society, Newcastle University, England
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Khan-Gates JA, Ersek JL, Eberth JM, Adams SA, Pruitt SL. Geographic Access to Mammography and Its Relationship to Breast Cancer Screening and Stage at Diagnosis: A Systematic Review. Womens Health Issues 2015; 25:482-93. [PMID: 26219677 PMCID: PMC4933961 DOI: 10.1016/j.whi.2015.05.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 05/24/2015] [Accepted: 05/26/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A review was conducted to summarize the current evidence and gaps in the literature on geographic access to mammography and its relationship to breast cancer-related outcomes. METHODS Ovid, Medline, and PubMed were searched for articles published between January 1, 2000, and April 1, 2013, using Medical Subject Headings and key terms representing geographic accessibility and breast cancer-related outcomes. Owing to a paucity of breast cancer treatment and mortality outcomes meeting the criteria (N = 6), outcomes were restricted to breast cancer screening and stage at diagnosis. Studies included one or more of the following types of geographic accessibility measures: capacity, density, distance, and travel time. Study findings were grouped by outcome and type of geographic measure. RESULTS Twenty-one articles met the inclusion criteria. Fourteen articles included stage at diagnosis as an outcome, five included mammography use, and two included both. Geographic measures of mammography accessibility varied widely across studies. Findings also varied, but most articles found either increased geographic access to mammography associated with increased use and decreased late-stage at diagnosis or no association. CONCLUSION The gaps and methodologic heterogeneity in the literature to date limit definitive conclusions about an underlying association between geographic mammography access and breast cancer-related outcomes. Future studies should focus on the development and application of more precise and consistent measures of geographic access to mammography.
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Affiliation(s)
- Jenna A Khan-Gates
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois.
| | - Jennifer L Ersek
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Swann A Adams
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Sandi L Pruitt
- Department of Clinical Science, Southwestern University, Dallas, Texas
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Non-small cell lung cancer treatment receipt and survival among African-Americans and whites in a rural area. J Community Health 2015; 39:696-705. [PMID: 24346819 DOI: 10.1007/s10900-013-9813-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Data on racial disparities among lung cancer patients in rural areas are scarce. We examined differences in treatment receipt and survival among African-American (AA) and Non-Hispanic White (NHW) non-small cell lung cancer (NSCLC) patients residing in Southwest Georgia (SWGA)-a primarily rural 33-county area; population 700,000. Medical records for 934 SWGA NSCLC patients diagnosed in 2001-2003 were used to extract information on age, race, marital status, insurance coverage, comorbidities, and treatment. Information pertaining to socioeconomic status, urban/rural residence, and survival was obtained from the cancer registry. Multivariable logistic regression analyses examined the relation of various patient and disease characteristics to receipt of tumor-directed therapy. Cox regression models were used to assess determinants of survival. Treatment receipt was associated with age, marital status, comorbidities, and disease stage in most analyses. No associations were observed between race and either surgery [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.49-1.39] or radiation (OR 0.72; 95% CI 0.52-1.00). NHW patients were more likely to receive no treatment at all (OR 1.50, 95% CI 1.01-2.23). There was no racial difference in survival (hazard ratio = 1.07, 95% CI 0.90-1.26). Effects of insurance and treatment on survival were most pronounced within 6 months post-diagnosis, but were attenuated over time. We found no evidence of racial disparities in survival and, in some analyses, a decreased likelihood of treatment receipt among NHW NSCLC patients compared to AA. The results from SWGA stand in contrast to studies that applied different methodologies and were conducted elsewhere.
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Wells JS, Strickland OL, Dalton JA, Freeman S. Adherence to intravenous chemotherapy in African American and white women with early-stage breast cancer. Cancer Nurs 2015; 38:89-98. [PMID: 24831041 PMCID: PMC4232488 DOI: 10.1097/ncc.0000000000000139] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Adherence to intravenous chemotherapy offers survival and recurrence-free benefits for women diagnosed with early-stage breast cancer. However, previous studies have found that African American women are more likely to discontinue intravenous chemotherapy early, thus shortening their survival. Yet the existence of racial differences and predictors of adherence to chemotherapy treatment between African American and white women are largely understudied or inconsistent. OBJECTIVE The purposes of this study were to examine factors that influence the decision to adhere to chemotherapy in African American and white women diagnosed with early-stage breast cancer and to test for racial differences that may exist in this sample. INTERVENTIONS/METHODS The study recruited a convenience sample of 99 African American and white women. Factors examined were sociodemographic variables (age, race, access to healthcare), social support, religious coping, chemotherapy adverse effects, depression, breast cancer knowledge, health beliefs, cancer fatalism, and days from diagnosis to treatment. Data analyses included logistic regression modeling. RESULTS No racial differences in adherence to intravenous chemotherapy between African American and white women were found (χ = 2.627, P = .10). Days to treatment (odds ratio [OR], 0.982, P = .058), health insurance (OR, 0.121; P = .016), change in depression (OR, 0.935; P = .118), and symptom severity (OR, 0.950; P = .038) were independently associated with nonadherence to chemotherapy. CONCLUSIONS This study provides emerging evidence of factors that may be potentially modified with interventions at the clinical setting. IMPLICATIONS FOR PRACTICE The findings can be used to spearhead future intervention studies that improve treatment decision making to chemotherapy adherence.
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Affiliation(s)
- Jessica S Wells
- Author Affiliations: Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia (Drs Wells, Dalton, and Freeman); and Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami (Dr Strickland)
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Guy GP, Lipscomb J, Gillespie TW, Goodman M, Richardson LC, Ward KC. Variations in Guideline-Concordant Breast Cancer Adjuvant Therapy in Rural Georgia. Health Serv Res 2014; 50:1088-108. [PMID: 25491350 DOI: 10.1111/1475-6773.12269] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine factors associated with guideline-concordant adjuvant therapy among breast cancer patients in a rural region of the United States and to present an advancement in quality-of-care assessment in the context of multiple treatments. DATA SOURCES Chart abstraction on initial therapy received by 868 women diagnosed with primary, invasive, early-stage breast cancer in a largely rural region of southwest Georgia. STUDY DESIGN Using multivariable logistic regression, we examined predictors of adjuvant chemo-, radiation, and hormonal therapy regimens defined as guideline-concordant according to the 2000 National Institutes of Health Consensus Development Conference Statement. PRINCIPAL FINDINGS Overall, 35.2 percent of women received guideline-concordant care for all three adjuvant therapies. Higher socioeconomic status was associated with receiving guideline-concordant care for all three adjuvant therapies jointly, and for chemotherapy. Compared with private insurance, having Medicaid was associated with guideline-concordant chemotherapy. Unmarried women were more likely to be nonconcordant for chemotherapy and radiation therapy. Increased age predicted nonconcordance for adjuvant therapies jointly, for chemotherapy, and for hormonal therapy. CONCLUSIONS A number of factors were independently associated with receiving guideline-concordant adjuvant therapy. Identifying and addressing factors that lead to nonconcordance may reduce disparities in treatment and survival.
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Affiliation(s)
- Gery P Guy
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Chamblee, GA
| | - Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Theresa W Gillespie
- Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | - Michael Goodman
- Department of Health Policy and Management, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Lisa C Richardson
- Division of Blood Disorders, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kevin C Ward
- Department of Health Policy and Management, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, GA
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Ademuyiwa FO, Gao F, Hao L, Morgensztern D, Aft RL, Ma CX, Ellis MJ. US breast cancer mortality trends in young women according to race. Cancer 2014; 121:1469-76. [PMID: 25483625 DOI: 10.1002/cncr.29178] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 11/06/2014] [Accepted: 11/10/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Young age at diagnosis has a negative prognostic impact on outcome in patients with breast cancer (BC). In the current study, the authors sought to determine whether there is a differential effect of race and examined mortality trends according to race and age. METHODS The Surveillance, Epidemiology, and End Results program was used to identify women aged <50 years with invasive BC diagnosed between 1990 and 2009. Multivariate regression analyses were performed to determine the risk-adjusted likelihood of survival for white and black patients. Annual hazards of BC death according to race and calendar period and adjusted relative hazards of death for white and black women stratified by age were computed. RESULTS A total of 162,976 women were identified, 126,573 of whom were white, 20,405 of whom were black, and 15,998 of whom were of other races. At a median follow-up of 85 months, the 5-year disease specific survival rates were 90.1% for white patients and 79.3% for black patients. Annual hazards of death in white patients decreased by 26% at 5 years after diagnosis in contrast to the hazards in black patients, which decreased by only 19%. With 1990 as the referent year, the adjusted relative hazards of death in women aged <40 years in 2005 were 0.55 (95% confidence interval [95% CI], 0.46-0.66) and 0.68 (95% CI, 0.49-0.93), respectively, for white and black women. In women aged 40 to 49 years, adjusted hazards of death were 0.53 (95% CI, 0.47-0.60) and 0.78 (95% CI, 0.61-0.99), respectively, for white and black women. CONCLUSIONS Among young women diagnosed with BC, black patients have a worse outcome compared with white patients. Mortality declines have been observed over time in both groups, although more rapid gains have been reported to occur in white women. Emphasis should be placed on improving outcomes for young patients with BC.
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Affiliation(s)
- Foluso O Ademuyiwa
- Division of Oncology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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Gillespie TW, Lipscomb J. Improving outcomes in breast cancer: where should we target our efforts? Expert Rev Pharmacoecon Outcomes Res 2014; 14:469-71. [PMID: 24849759 DOI: 10.1586/14737167.2014.919858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Rural-urban differences in health outcomes, including breast cancer, in the US have been studied for decades, but often with inconsistent findings. Possible reasons include methodological differences, lack of prospective investigations, small number of studies overall, and the tendency to measure rurality as a simple patient-level predictor variable. Studies have tended to assume that the same racial/ethnic cancer disparities found in the general population exist in rural regions, but this conclusion may not always be warranted. Needed are better definitions of rurality; the capability to define important predictor variables such as race, ethnicity, education, and income with greater precision than at present; and data revealing the patient's own perspective regarding care decisions. Future studies should examine whether the impact of rurality status on outcomes varies with geographic location by including the appropriate interaction terms in the outcome prediction models, as well as patient-reported reasons that might explain the outcomes observed.
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Affiliation(s)
- Theresa Wicklin Gillespie
- Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322, USA
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White A, Richardson LC, Krontiras H, Pisu M. Socioeconomic disparities in breast cancer treatment among older women. J Womens Health (Larchmt) 2014; 23:335-41. [PMID: 24350590 PMCID: PMC3991993 DOI: 10.1089/jwh.2013.4460] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Racial disparities in breast cancer treatment among Medicare beneficiaries have been documented. This study aimed to determine whether racial disparities exist among white and black female Medicare beneficiaries in Alabama, an economically disadvantaged U.S. state. METHODS From a linked dataset of breast cancer cases from the Alabama Statewide Cancer Registry and fee-for-service claims from Medicare, we identified 2,097 white and black females, aged 66 years and older, who were diagnosed with stages 1-3 breast cancer from January 1, 2000, to December 31, 2002. Generalized estimating equation (GEE) models were used to determine whether there were racial differences in initiating and completing National Comprehensive Cancer Network Clinical Practice guideline-specific treatment. RESULTS Sixty-two percent of whites and 64.7% of blacks had mastectomy (p=0.27); 34.6% of whites and 30.2% of blacks had breast conserving surgery (BCS) (p=0.12). Among those who had BCS, 76.8% of whites and 83.3% of blacks started adjuvant radiation therapy (p=0.33) and they equally completed adjuvant radiation therapy (p=0.29). For women with tumors over 1 centimeter, whites and blacks were equally likely to start (16.1% of whites and 18.3% of black; p=0.34) and complete (50.6% of whites and 46.3% of black; p=0.87) adjuvant chemotherapy. There were still no differences after adjusting for confounders using GEE. However, differences were observed by area-level socioeconomic status (SES), with lower SES residents more likely to receive a mastectomy (odds ratio [OR]=1.26; 95% confidence interval [CI]: 1.01-1.57) and initiate radiation after BCS (OR=2.24; 95% CI: 1.28-3.93). CONCLUSIONS No racial differences were found in guideline-specific breast cancer treatment or treatment completion, but there were differences by SES. Future studies should explore reasons for SES differences and whether similar results hold in other economically disadvantaged U.S. states.
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Affiliation(s)
- Arica White
- Division of Cancer Prevention and Control, National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa C. Richardson
- Division of Cancer Prevention and Control, National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Helen Krontiras
- School of Medicine, University of Alabama, Birmingham, Alabama
| | - Maria Pisu
- Division of Preventive Medicine, University of Alabama, Birmingham, Alabama
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Zhang Y, Gao H, Bu Y, Fan X, Jia J. Factors associated with receipt of adjuvant chemotherapy among married women with breast cancer. World J Surg Oncol 2013; 11:286. [PMID: 24175997 PMCID: PMC3816536 DOI: 10.1186/1477-7819-11-286] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 10/18/2013] [Indexed: 11/10/2022] Open
Abstract
Background Adjuvant chemotherapies are recommended for most women after breast cancer surgery, and can greatly affect the patients’ survival. We describe and evaluate possible factors influencing receipt of postoperative adjuvant chemotherapy among breast cancer patients in China. Methods A total of 1,431 women diagnosed with breast cancer from 1997 to 2005 were enrolled. We reviewed medical records and abstracted information about these patients. Details on social-demographic factors and clinical-pathological characteristics of participants were collected and analyzed. To meet our objectives, the patient’s age at diagnosis, comorbidities, menstrual status, rural/urban status, tumor size, lymph node status, distant metastasis, tumor stage and hormone receptor status were estimated. Results Overall, 936 of these 1,431 patients (65.41%) received adjuvant chemotherapy. Receipt of chemotherapy was significantly associated with age at diagnosis, rural–urban disparities, and lymph node status of patients, though no significant difference was found between the age <50 and age 50 to 64 groups. Moderate association was also observed between hormone receptor status and receipt of adjuvant chemotherapy, though it was still not statistically significant. Conclusions Our study suggests that age at diagnosis, rural–urban disparities and lymph node status of breast cancer patients are independent predictors for receipt of adjuvant chemotherapy among married Chinese women. Further investigations are warranted, and related public health education needs to be expanded in China.
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Affiliation(s)
| | | | | | - Xiuzhen Fan
- Department of Nursing, Qilu Hospital and School of Nursing, Shandong University, West Wenhua Road, Ji'nan, Shandong 250012, P,R China.
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Camacho-Rivera M, Ragin C, Roach V, Kalwar T, Taioli E. Breast Cancer Clinical Characteristics and Outcomes in Trinidad and Tobago. J Immigr Minor Health 2013; 17:765-72. [DOI: 10.1007/s10903-013-9930-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Sheppard VB, Isaacs C, Luta G, Willey SC, Boisvert M, Harper FWK, Smith K, Horton S, Liu MC, Jennings Y, Hirpa F, Snead F, Mandelblatt JS. Narrowing racial gaps in breast cancer chemotherapy initiation: the role of the patient-provider relationship. Breast Cancer Res Treat 2013; 139:207-16. [PMID: 23588954 PMCID: PMC3662254 DOI: 10.1007/s10549-013-2520-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 04/01/2013] [Indexed: 10/27/2022]
Abstract
Chemotherapy improves breast cancer survival but is underused more often in black than in white women. We examined associations between patient-physician relationships and chemotherapy initiation and timeliness of initiation among black and white patients. Women with primary invasive, non-metastatic breast cancer were recruited via hospitals (in Washington, DC and Detroit) and community outreach between July 2006 and April 2011. Data were collected via telephone interviews and medical records. Logistic regression models evaluated associations between chemotherapy initiation and independent variables. Since there were race interactions, analyses were race-stratified. Factors associated with time from surgery to chemotherapy initiation and delay of ≥90 days were evaluated with linear and logistic regressions, respectively. Among eligible women, 82.8 % were interviewed and 359 (90.9 %) of those had complete data. The odds of initiating chemotherapy were 3.26 times (95 % CI: 1.51, 7.06) higher among black women reporting greater communication with physicians (vs. lesser), after considering covariates. In contrast, the odds of starting chemotherapy were lower for white women reporting greater communication (vs. lesser) (adjusted OR 0.22, 95 % CI: 0.07, 0.73). The opposing direction of associations was also seen among the sub-set of black and white women with definitive clinical indications for chemotherapy. Among those initiating treatment, black women had longer mean time to the start of chemotherapy than whites (71.8 vs. 55.0 days, p = 0.005), but race was not significant after considering trust in oncologists, where initiation time decreased as trust increased, controlling for covariates. Black women were also more likely to delay ≥90 days than whites (27 vs. 8.3 %; p = 0.024), but this was not significant after considering religiosity. The patient-physician dyad and sociocultural factors may represent leverage points to improve chemotherapy patterns in black women.
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Affiliation(s)
- Vanessa B Sheppard
- Breast Cancer Program, Lombardi Comprehensive Cancer Center and Department of Oncology, Georgetown University, 3300 Whitehaven St. NW, Suite 4100, Washington, DC 20007, USA.
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Adjuvant endocrine therapy initiation and persistence in a diverse sample of patients with breast cancer. Breast Cancer Res Treat 2013; 138:931-9. [PMID: 23542957 DOI: 10.1007/s10549-013-2499-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 03/21/2013] [Indexed: 01/08/2023]
Abstract
Adjuvant endocrine therapy for breast cancer reduces recurrence and improves survival rates. Many patients never start treatment or discontinue prematurely. A better understanding of factors associated with endocrine therapy initiation and persistence could inform practitioners how to support patients. We analyzed data from a longitudinal study of 2,268 women diagnosed with breast cancer and reported to the Metropolitan Detroit and Los Angeles SEER cancer registries in 2005-2007. Patients were surveyed approximately both 9 months and 4 years after diagnosis. At the 4-year mark, patients were asked if they had initiated endocrine therapy, terminated therapy, or were currently taking therapy (defined as persistence). Multivariable logistic regression models examined factors associated with initiation and persistence. Of the 743 patients eligible for endocrine therapy, 80 (10.8 %) never initiated therapy, 112 (15.1 %) started therapy but discontinued prematurely, and 551 (74.2 %) continued use at the second time point. Compared with whites, Latinas (OR 2.80, 95 % CI 1.08-7.23) and black women (OR 3.63, 95 % CI 1.22-10.78) were more likely to initiate therapy. Other factors associated with initiation included worry about recurrence (OR 3.54, 95 % CI 1.31-9.56) and inadequate information about side effects (OR 0.24, 95 % CI 0.10-0.55). Factors associated with persistence included two or more medications taken weekly (OR 4.19, 95 % CI 2.28-7.68) and increased age (OR 0.98, 95 % CI 0.95-0.99). Enhanced patient education about potential side effects and the effectiveness of adjuvant endocrine therapy in improving outcomes may improve initiation and persistence rates and optimize breast cancer survival.
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Wray CJ, Phatak UR, Robinson EK, Wiatek RL, Rieber AG, Gonzalez A, Ko TC, Kao LS. The effect of age on race-related breast cancer survival disparities. Ann Surg Oncol 2013; 20:2541-7. [PMID: 23435633 DOI: 10.1245/s10434-013-2913-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Indexed: 12/24/2022]
Abstract
BACKGROUND Breast cancer survival disparities by race are likely multifactorial. In a small pilot cohort, we demonstrated a statistical interaction between age and race. The purpose of this study was to validate earlier findings in a larger, more diverse cohort and to test the hypothesis that breast cancer survival is influenced by the dependent relationship of age and race. METHODS We conducted a retrospective analysis of a multi-institutional breast cancer database for patients treated between 1999 and 2009. Study variables included age and disease stage at diagnosis, race, treatment (surgery, chemotherapy, radiotherapy, hormone therapy) and overall survival. Statistical analysis and regression models were performed by Stata software. RESULTS A total of 9,249 patients were included in this study. African American, Hispanic, and Asian patients were more likely to present at a younger age with metastases. African American and Hispanic race were associated with increased mortality after adjusting for stage, age, and treatment. A 2-way interaction between age and race was identified in the Cox regression model (p < 0.001). To further define this interaction, a postestimation analysis was performed to determine the predicted relative hazard for each race with age fixed at 40, 50, 60, 70, and 80 years. At younger ages, the predicted relative hazard was significantly higher for both African American and Hispanic race. CONCLUSIONS Despite adjusting for stage and treatment differences, African American and Hispanic race predicted poor survival. The effect of age and treatment on breast cancer survival differs across races. Additional research is needed to accurately determine the reasons for worsened survival.
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Affiliation(s)
- Curtis J Wray
- Department of Surgery, University of Texas Medical School at Houston, Houston, TX, USA.
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Kurian AW, Lichtensztajn DY, Keegan THM, Leung RW, Shema SJ, Hershman DL, Kushi LH, Habel LA, Kolevska T, Caan BJ, Gomez SL. Patterns and predictors of breast cancer chemotherapy use in Kaiser Permanente Northern California, 2004-2007. Breast Cancer Res Treat 2013; 137:247-60. [PMID: 23139057 PMCID: PMC3769522 DOI: 10.1007/s10549-012-2329-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 10/30/2012] [Indexed: 01/07/2023]
Abstract
Chemotherapy regimens for early stage breast cancer have been tested by randomized clinical trials, and specified by evidence-based practice guidelines. However, little is known about the translation of trial results and guidelines to clinical practice. We extracted individual-level data on chemotherapy administration from the electronic medical records of Kaiser Permanente Northern California (KPNC), a pre-paid integrated healthcare system serving 29 % of the local population. We linked data to the California Cancer Registry, incorporating socio-demographic and tumor factors, and performed multivariable logistic regression analyses on the receipt of specific chemotherapy regimens. We identified 6,004 women diagnosed with Stage I-III breast cancer at KPNC during 2004-2007; 2,669 (44.5 %) received at least one chemotherapy infusion at KPNC within 12 months of diagnosis. Factors associated with receiving chemotherapy included <50 years of age [odds ratio (OR) 2.27, 95 % confidence interval (CI) 1.81-2.86], tumor >2 cm (OR 2.14, 95 % CI 1.75-2.61), involved lymph nodes (OR 11.3, 95 % CI 9.29-13.6), hormone receptor-negative (OR 6.94, 95 % CI 4.89-9.86), Her2/neu-positive (OR 2.71, 95 % CI 2.10-3.51), or high grade (OR 3.53, 95 % CI 2.77-4.49) tumors; comorbidities associated inversely with chemotherapy use [heart disease for anthracyclines (OR 0.24, 95 % CI 0.14-0.41), neuropathy for taxanes (OR 0.45, 95 % CI 0.22-0.89)]. Relative to high-socioeconomic status (SES) non-Hispanic Whites, we observed less anthracycline and taxane use by SES non-Hispanic Whites (OR 0.63, 95 % CI 0.49-0.82) and American Indians (OR 0.23, 95 % CI 0.06-0.93), and more anthracycline use by high-SES Asians/Pacific Islanders (OR 1.72, 95 % CI 1.02-2.90). In this equal-access healthcare system, chemotherapy use followed practice guidelines, but varied by race and socio-demographic factors. These findings may inform efforts to optimize quality in breast cancer care.
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MESH Headings
- Adult
- Aged
- Anthracyclines/therapeutic use
- Antineoplastic Agents/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/epidemiology
- Breast Neoplasms/pathology
- California/epidemiology
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/epidemiology
- Carcinoma, Lobular/secondary
- Chemotherapy, Adjuvant/statistics & numerical data
- Electronic Health Records
- Female
- Health Personnel
- Humans
- Logistic Models
- Lymphatic Metastasis
- Middle Aged
- Multivariate Analysis
- Practice Guidelines as Topic
- Taxoids/therapeutic use
- Tumor Burden
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Affiliation(s)
- Allison W. Kurian
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Daphne Y. Lichtensztajn
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538, USA
| | - Theresa H. M. Keegan
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA; Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538, USA
| | - Rita W. Leung
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538, USA
| | - Sarah J. Shema
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538, USA
| | | | | | | | | | - Bette J. Caan
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | - Scarlett L. Gomez
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA; Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538, USA
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