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Forster M, Deal AM, Page A, Vohra S, Wardell AC, Pak J, Lund JL, Nyrop KA, Muss HB. Dose delay, dose reduction, and early treatment discontinuation in Black and White women receiving chemotherapy for nonmetastatic breast cancer. Oncologist 2024:oyae150. [PMID: 38913986 DOI: 10.1093/oncolo/oyae150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/14/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND To describe reasons for deviations from planned chemotherapy treatments in women with nonmetastatic breast cancer that contribute to less-than-planned receipt of chemotherapy. METHODS Electronic medical records for patients receiving chemotherapy were reviewed for adverse events and treatment modifications. Log-binomial regression models were used to estimate relative risks (RRs) with 95% CIs to examine associations between chemotherapy modifications, patient characteristics, and treatment modalities. RESULTS Delays in chemotherapy initiation (7%) were for surgical complications (58%), personal reasons (16%), and other (26%; port malfunction, infections, and obtaining extra imaging). Delays during chemotherapy (38%) were for infections (20%), neutropenia (13%), and personal reasons (13%). Dose reductions (38%) were for neuropathy (36%), unknown causes (9%), anemia (9%), and neutropenia (8%). Early treatment discontinuations (23%) were for neuropathy (29%). Patients receiving paclitaxel/nab-paclitaxel (RR 2.05; 95% CI, 1.47-2.87) and an anthracycline (RR 1.89; 95% CI, 1.39-2.57) reported more dose delays during chemotherapy. Black race (RR 1.46; 95% CI, 1.07-2.00), stage 3 (RR 1.79; 95% CI, 1.09-2.93), and paclitaxel/nab-paclitaxel receipt (RR 1.39; 95% CI, 1.02-1.90) increased the likelihood of dose reduction. Both Black race (RR 2.06; 95% CI, 1.35-3.15) and receipt of paclitaxel/nab-paclitaxel (RR 1.93; 95% CI, 1.19-3.13) increased the likelihood of early discontinuation. Patients receiving anthracyclines had higher rates of hospitalizations during chemotherapy (RR: 1.79; 95% CI, 1.11-2.89). CONCLUSION Toxicities are the most common reason for treatment modifications and need close monitoring in high-risk groups for timely intervention. Dose reductions and early treatment discontinuations occurred more for Black patients and need further study.
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Affiliation(s)
- Moriah Forster
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University, Nashville, TN 37232, United States
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Annie Page
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Sanah Vohra
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, United States
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Alexis C Wardell
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Joyce Pak
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Jennifer L Lund
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, United States
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Kirsten A Nyrop
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, United States
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Hyman B Muss
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, United States
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States
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Nyrop KA, Monaco J, Vohra S, Deal AM, Wood WA, Shachar SS, Dees EC, Kimmick GG, Speca JC, Muss HB. Body mass index and patient-reported function, quality of life and treatment toxicity in women receiving adjuvant chemotherapy for breast cancer. Support Care Cancer 2023; 31:196. [PMID: 36859693 DOI: 10.1007/s00520-023-07637-2] [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: 07/21/2022] [Accepted: 02/08/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND This study investigates whether high body mass index (BMI) in women diagnosed with early breast cancer (BC) is associated with patient-reported symptom severity during chemotherapy. METHODS Women with Stage I-III BC completed toxicity reports for 17 side effects throughout regularly scheduled chemotherapy infusions. Toxicity reports were compared in women with obesity (BMI > = 30) versus no obesity (BMI < 30). Fisher's exact tests and 2-sample t-tests compared baseline patient characteristics. Risk ratios (RR) for women with obesity as compared to no obesity were estimated for individual symptoms that were patient-rated as moderate, severe or very severe (MSVS) severity, adjusting for marital status and race. RESULTS In a sample of 286 patients, Black women comprised 23% of the sample. The obesity rate was 76% among Black patients and 31% among White patients (p < .0001). Women with obesity rated an average of 6.9 side effects (standard deviation, SD 4.2) as MSVS vs 5.5 side effects (SD 3.7) among women with no obesity (p = .003). In adjusted analysis, women with obesity had significantly greater risk for MSVS fatigue (RR 1.18, 95% CI 1.01-1.36), dyspnea (RR 1.71, 95% CI 1.09-2.69), arthralgia (RR 1.47, 95% CI 1.10-1.97), peripheral neuropathy (RR 1.45, 95% CI 1.01-2.08), edema of limbs (RR 1.84, 95% CI 1.18-2.88), and abdominal pain (RR 1.75, 95% CI 1.07-2.87). There were no inter-group differences in BC stage or phenotype, chemotherapy treatment modifications, or hospitalizations. CONCLUSIONS Among women with early BC, patients with obesity reported higher chemotherapy toxicity as compared to patients without obesity; however, this did not result in differences in treatment completion.
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Affiliation(s)
- Kirsten A Nyrop
- School of Medicine, Department of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA.
| | - Jane Monaco
- Gillings School of Global Public Health, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sanah Vohra
- Gillings School of Global Public Health, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA
| | - William A Wood
- School of Medicine, Department of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA
| | | | - E Claire Dees
- School of Medicine, Department of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA
| | | | - JoEllen C Speca
- School of Medicine, Department of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA
| | - Hyman B Muss
- School of Medicine, Department of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA
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Effects of Inositol Hexaphosphate and Myo-Inositol Administration in Breast Cancer Patients during Adjuvant Chemotherapy. J Pers Med 2021; 11:jpm11080756. [PMID: 34442400 PMCID: PMC8400775 DOI: 10.3390/jpm11080756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 01/20/2023] Open
Abstract
Background: Treatment of breast cancer (BC) includes locoregional and systemic therapies depending on tumor and patient’s characteristics. Inositol hexaphosphate (IP6) is known as a strong antioxidant agent, able to improve local (i.e., breast region) side effects, functional status and quality-of-life. We investigated some potential beneficial effects, including hematological and local, of the combined therapy with oral myo-inositol administration and topical IP6 application in patients undergoing surgery for BC and eligible to adjuvant chemotherapy. Methods: We considered BC patients randomly assigned to the Inositol Group (oral myo-inositol + IP6 local application for the entire neoadjuvant treatment period) and to the Control Group (standard of care). The EORTC QLQ-BR23 and QLQ-C30 questionnaires were administered to both groups and blood parameters were assessed as per clinical routine practice at baseline (before starting adjuvant chemotherapy), T1 (after the first two doses of epirubicin-cyclophosphamide regimen), T2 (at the end of epirubicin-cyclophosphamide regimen), T3 (after the first six doses of paclitaxel regimen), and T4 (at the end of the paclitaxel treatment). Results: A total of 36 BC patients were considered, 18 in the Inositol Group and 18 in the Control Group. The Inositol Group showed a lower decrease in red blood cells, hemoglobin levels and white blood cells with respect to controls (p ≤ 0.02), as well as amelioration in scores related to breast and arm local symptoms (p ≤ 0.02), body image (p = 0.04) and quality-of-life related symptoms (p ≤ 0.04). Conclusions: In our cohort of BC patients, a combined treatment with oral myo-inositol + IP6 local application was able to improve local symptoms and quality-of-life related symptoms which represent clinically relevant aspects associated with patient’s prognosis.
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Gebremariam A, Assefa M, Addissie A, Worku A, Dereje N, Abreha A, Tigeneh W, Pace LE, Kantelhardt EJ, Jemal A. Delayed initiation of adjuvant chemotherapy among women with breast cancer in Addis Ababa, Ethiopia. Breast Cancer Res Treat 2021; 187:877-882. [PMID: 33599864 DOI: 10.1007/s10549-021-06131-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Chemotherapy within 90 days following surgery for non-metastatic breast cancer is the standard of care. There are no data, however, on the extent of time to initiation of chemotherapy (TTC) in Africa settings, including Ethiopia. METHODS A total of 223 women with stage I-III breast cancer treated with surgery and adjuvant chemotherapy during 2017-2019 in Addis Ababa, Ethiopia, were included in the analysis. Based on information from medical records, we calculated TTC from date of surgery and completion of planned chemotherapy, with TTC > 90 days considered delayed and receipt of 85% of planned therapy as complete. Multivariable Poisson regression with robust variance was used to assess whether TTC > 90 days was associated with sociodemographic or clinical factors. RESULTS The median TTC was 63 days. Chemotherapy initiation was delayed in 30% (95% CI 24.4-36.6%) of patients, with the risk significantly higher in low-income women. For example, the risk of delay in women with lowest quartile family monthly income group (US$ < 61) was 3.98 (95% CI 1.67-9.46) higher than in those women with highest quartile family income group (US$ > 194). Remarkably, adjuvant chemotherapy was completed in 95% of patients. CONCLUSIONS A staggering one-in-three women with breast cancer in Addis Ababa, Ethiopia, delay to initiation of adjuvant chemotherapy, with the delay more common in low-income women and yet with remarkably high degree of treatment adherence. These findings underscore the need for public policy to expand health care to low-income population to improve breast cancer care and other health outcomes in the country.
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Affiliation(s)
- Alem Gebremariam
- Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Tigray, Adigrat, Ethiopia. .,Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Mathewos Assefa
- Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nebiyu Dereje
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Aynalem Abreha
- Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Lydia E Pace
- Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Eva Johanna Kantelhardt
- Institute for Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle-Wittenberg, Halle, Germany
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
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