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O’Neil DS, Martei YM, Crew KD, Castillo BS, Costa P, Lim T, Michel A, Rubin E, Goel N, Hurley J, Lopes G, Antoni MH. Time to Cancer Treatment and Chemotherapy Relative Dose Intensity for Patients With Breast Cancer Living With HIV. JAMA Netw Open 2023; 6:e2346223. [PMID: 38051529 PMCID: PMC10698616 DOI: 10.1001/jamanetworkopen.2023.46223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/24/2023] [Indexed: 12/07/2023] Open
Abstract
Importance Patients with breast cancer and comorbid HIV experience higher mortality than other patients with breast cancer. Objective To compare time to cancer treatment initiation and relative dose intensity (RDI) of neoadjuvant and adjuvant chemotherapy among patients with breast cancer with vs without HIV. Design, Setting, and Participants A retrospective, matched cohort study enrolled women who received a diagnosis of breast cancer from January 1, 2000, through December 31, 2018. The electronic medical records of 3 urban, academic cancer centers were searched for women with confirmed HIV infection prior to or simultaneous with diagnosis of stage I to III breast cancer. Tumor registry data were used to identify 2 control patients with breast cancer without HIV for each participant with HIV, matching for study site, stage, and year of cancer diagnosis. Statistical analysis was performed from December 2022 to October 2023. Exposure HIV infection detected before or within 90 days of participants' breast cancer diagnosis. Main Outcomes and Measures The primary outcome was time to breast cancer treatment initiation, defined as the number of days between cancer diagnosis and first treatment. The secondary outcome was overall RDI for patients who received chemotherapy. These outcomes were compared by HIV status using Cox proportional hazards regression and linear regression modeling, respectively, adjusting for confounding demographic and clinical factors. Exploratory outcomes included instances of anemia, neutropenia, thrombocytopenia, and liver function test result abnormalities during chemotherapy, which were compared using Fisher exact tests. Results The study enrolled 66 women with comorbid breast cancer and HIV (median age, 51.1 years [IQR, 45.7-58.2 years]) and 132 with breast cancer alone (median age, 53.9 years [IQR, 47.0-62.5 years]). The median time to first cancer treatment was not significantly higher among patients with HIV than those without (48.5 days [IQR, 32.0-67.0 days] vs 42.5 days [IQR, 25.0-59.0 days]; adjusted hazard ratio, 0.78, 95% CI, 0.55-1.12). Among the 36 women with HIV and 62 women without HIV who received chemotherapy, the median overall RDI was lower for those with HIV vs without HIV (0.87 [IQR, 0.74-0.97] vs 0.96 [IQR, 0.88-1.00]; adjusted P = .01). Grade 3 or higher neutropenia during chemotherapy occurred among more women with HIV than those without HIV (13 of 36 [36.1%] vs 5 of 58 [8.6%]). Conclusions and Relevance This matched cohort study suggests that patients with breast cancer and HIV may have experienced reduced adjuvant chemotherapy RDI, reflecting greater dose reductions, delays, or discontinuation. Strategies for supporting this vulnerable population during chemotherapy treatment are necessary.
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Affiliation(s)
- Daniel S. O’Neil
- Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | - Yehoda M. Martei
- Department of Medicine (Hematology-Oncology), University of Pennsylvania, Philadelphia
- Abramson Cancer Center, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Katherine D. Crew
- Division of Hematology/Oncology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Brenda S. Castillo
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Philippos Costa
- Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Tristan Lim
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Alissa Michel
- Division of Hematology/Oncology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York, New York
| | - Elizabeth Rubin
- Memorial Cancer Institute, Memorial Healthcare System, Hollywood, Florida
| | - Neha Goel
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida
| | - Judith Hurley
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida
- Division of Medical Oncology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Gilberto Lopes
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida
- Division of Medical Oncology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Michael H. Antoni
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
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Development of a key performance indicator for breast cancer in Queensland, Australia. Breast Cancer Res Treat 2023; 197:211-221. [PMID: 36350472 PMCID: PMC9823022 DOI: 10.1007/s10549-022-06796-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/30/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE Using population-based data for women diagnosed with stage I-III breast cancer, our aim was to examine the impact of time to treatment completion on survival and to identify factors associated with treatment delay. METHODS This retrospective study used clinical and treatment data from the Queensland Oncology Repository. Time from diagnosis to completing surgery, chemotherapy and radiation therapy identified a cut-off of 37 weeks as the optimal threshold for completing treatment. Logistic regression was used to identify factors associated with the likelihood of completing treatment > 37 weeks. Overall (OS) and breast cancer-specific survival (BCSS) were examined using Cox proportional hazards models. RESULTS Of 8279 women with stage I-III breast cancer, 31.9% completed treatment > 37 weeks. Apart from several clinical factors, being Indigenous (p = 0.002), living in a disadvantaged area (p = 0.003) and receiving ≥ two treatment modalities within the public sector (p < 0.001) were associated with an increased likelihood of completing treatment > 37 weeks. The risk of death from any cause was about 40% higher for women whose treatment went beyond 37 weeks (HR 1.37, 95%CI 1.16-1.61), a similar result was observed for BCSS. Using the surgery + chemotherapy + radiation pathway, a delay of > 6.9 weeks from surgery to starting chemotherapy was significantly associated with poorer survival (p = 0.001). CONCLUSIONS Several sociodemographic and system-related factors were associated with a greater likelihood of treatment completion > 37 weeks. We are proposing a key performance indicator for the management of early breast cancer where a facility should have > 90% of patients with a time from surgery to adjuvant chemotherapy < 6.9 weeks.
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Appiah D, Mai M, Parmar K. A Prospective Population-Based Study of Cardiovascular Disease Mortality following Treatment for Breast Cancer among Men in the United States, 2000-2019. Curr Oncol 2022; 30:284-297. [PMID: 36661672 PMCID: PMC9857851 DOI: 10.3390/curroncol30010023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
Male breast cancer is rare but its incidence and mortality are increasing in the United States, with racial/ethnic disparities in survival reported. There is limited evidence for cardiotoxicity of cancer treatment among men with breast cancer. We evaluated the relation between breast cancer treatment and cardiovascular disease (CVD) mortality among men and investigated the salient roles that race/ethnicity play on this relation. Data were from 5216 men with breast cancer aged ≥ 40 years from the Surveillance, Epidemiology, and End Results program who were diagnosed from 2000 to 2019 and underwent surgery. Competing risk models were used to estimate hazards ratios (HR) and 95% confidence intervals (CI). During a median follow-up of 5.6 years, 1914 deaths occurred with 25% attributable to CVD. In multivariable-adjusted models, men who received chemotherapy had elevated risk for CVD (HR: 1.55, 95%CI: 1.18-2.04). This risk was higher among Hispanic men (HR: 3.96, 95%CI: 1.31-12.02) than non-Hispanic Black and non-Hispanic White men. There was no significant association between radiotherapy and CVD deaths. In this population-based study, treatment with chemotherapy was associated with elevated risk of CVD mortality in men with breast cancer. Racial/ethnic disparities in the association of chemotherapy and CVD mortality were observed.
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Affiliation(s)
- Duke Appiah
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Megan Mai
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Kanak Parmar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
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Walsh RL, Lofters A, Moineddin R, Krzyzanowska M, Grunfeld E. Primary Care Continuity and Wait Times to Receiving Breast Cancer Chemotherapy: A Population-Based Retrospective Cohort Study Using CanIMPACT Data. Curr Oncol 2021; 28:4786-4804. [PMID: 34898582 PMCID: PMC8628668 DOI: 10.3390/curroncol28060405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/02/2021] [Accepted: 11/07/2021] [Indexed: 12/18/2022] Open
Abstract
(1) Background: Wait times to chemotherapy are associated with morbidity and mortality in breast cancer patients; however, it is unclear how primary care physician (PCP) continuity impacts these wait times, or whether this association is different in immigrants, who experience cancer care inequities. We assessed the association between PCP continuity and the contact-to-chemotherapy interval (wait time from when a patient first presents to healthcare to the first day of receiving breast cancer chemotherapy), with a specific look at the immigrant population. (2) Methods: Population-based, retrospective cohort study of women who were diagnosed with stage I–III breast cancer in Ontario who received surgery and adjuvant chemotherapy. We used quantile regression at the median and 90th percentile to quantify the effect of PCP continuity on the contact-to-chemotherapy interval, performing a separate analysis on the immigrant population. (3) Results: Among 12,781 breast cancer patients, including 1706 immigrants, the median contact-to-chemotherapy interval (126 days) was 3.21 days shorter (95% confidence interval (CI) 0.47–5.96) in symptom-detected patients with low PCP continuity, 10.68 days shorter (95% CI 5.36–16.00) in symptom-detected patients with no baseline PCP visits and 17.43 days longer (95% CI 0.90–34.76) in screen-detected immigrants with low PCP continuity compared to the same groups with high PCP continuity. (4) Conclusions: Higher PCP continuity was not associated with a change in the contact-to-chemotherapy interval for most of our study population, but was associated with a marginally longer interval in our symptom-detected population and a shorter contact-to-chemotherapy interval in screen-detected immigrants. This highlights the importance of PCP continuity among immigrants with positive screening results. Additionally, having no PCP visits at baseline was associated with a shorter contact-to-chemotherapy interval in symptom-detected patients.
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Affiliation(s)
- Rachel Lin Walsh
- Department of Family & Community Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada; (A.L.); (R.M.); (E.G.)
- Correspondence:
| | - Aisha Lofters
- Department of Family & Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada; (A.L.); (R.M.); (E.G.)
- Department of Family & Community Medicine, Women’s College Hospital, Toronto, ON M5S 1B2, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON M4N 3M5, Canada
| | - Rahim Moineddin
- Department of Family & Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada; (A.L.); (R.M.); (E.G.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON M4N 3M5, Canada
| | - Monika Krzyzanowska
- Princess Margaret Cancer Centre, Department of Medical Oncology & Hematology, University Health Network, Toronto, ON M5G 2C1, Canada;
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Eva Grunfeld
- Department of Family & Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada; (A.L.); (R.M.); (E.G.)
- Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada
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Ma X, Chen J, Ma D, Jiang Y, Liu Z, Chen S, Zhang Y, Shen Y, Yu X, Yang Z, Li S, Mo M, Qian Y, Liu G, Wu J, Shao Z, Yu K, Di G. Delayed initiation of radiation therapy is associated with inferior outcomes for breast cancer patients with hormone receptor-negative tumors after breast-conserving surgery. Gland Surg 2021; 10:2631-2643. [PMID: 34733713 DOI: 10.21037/gs-20-717] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 07/30/2021] [Indexed: 11/06/2022]
Abstract
Background To investigate whether the interval between adjuvant chemotherapy (CT) completion and postoperative radiation therapy initiation (ICR) after breast-conserving surgery (BCS) affects ipsilateral breast tumor recurrence (IBTR) or survival. Methods All women who were diagnosed with invasive breast cancer and underwent BCS between 2005 and 2014 were included. In total, 1,472 patients underwent adjuvant CT followed by postoperative radiation therapy (RT) (CT+), whereas 402 patients received postoperative RT alone (CT-). Analyses were stratified by ICR and the interval between surgery and the initiation of postoperative RT (ISR) in these two cohorts. The cutoff points for treatment delay were 47 days in the CT+ cohort and 69 days in the CT- cohort. IBTR, local-regional failure (LRF), disease-free survival (DFS), and overall survival (OS) were assessed through Kaplan-Meier (K-M) analysis. Univariate and multivariate regression analyses were performed to determine the prognostic factors of survival outcomes. Results The median follow-up duration was 56 months. There was an association between a delay in ICR and an increase in IBTR in the CT+ group (P=0.014 for intervals ≤47 vs. >47 days). This association was confirmed by multivariate analyses [hazard ratio (HR) of 2.766; P=0.046] in the hormone receptor-negative subgroup. The 5-year cumulative incidence rates of IBTR were 1.3% and 3.3% (≤47 vs. >47 days, respectively) in the CT+ cohort. For patients in the CT- cohort, a longer delay of initiation of postoperative RT (≤69 vs. >69 days) significantly decreased DFS (HR of 6.430; P=0.002). The 5-year cumulative incidence rates of disease recurrence were 3.0% for RT starting ≤69 days after surgery and 12.6% for RT starting >69 days after surgery. Conclusions A high IBTR rate was related to an ICR beyond 47 days. Delay of RT after CT or surgery among patients who undergo BCS should be avoided, especially among patients in the hormone receptor-negative subgroup.
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Affiliation(s)
- Xiaoyan Ma
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jie Chen
- Department of Thyroid and Breast Surgery, First People's Hospital of Taicang, Taicang, China
| | - Ding Ma
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yizhou Jiang
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhebin Liu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Sheng Chen
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ying Zhang
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yizhou Shen
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaoli Yu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zhaozhi Yang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Shuang Li
- Department of Breast Surgery, Liaoning Province Cancer Hospital, Shenyang, China
| | - Miao Mo
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Cancer Prevention, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yongxiang Qian
- Department of Thyroid and Breast Surgery, First People's Hospital of Taicang, Taicang, China
| | - Guangyu Liu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiong Wu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhiming Shao
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Keda Yu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Genhong Di
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Tang A, Mittal A, Mooney CM, Khoury AL, Chiang A, Lai N, Knopf KB. Factors delaying chemotherapy in patients with breast cancer at a safety-net hospital. J Natl Med Assoc 2021; 113:706-712. [PMID: 34521514 DOI: 10.1016/j.jnma.2021.08.035] [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: 05/09/2021] [Revised: 07/14/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite advances in healthcare and improved chemotherapy, disparities in breast cancer outcomes continue to persist. Our aim was to evaluate socioeconomic factors that may impact timing of treatment for patients receiving chemotherapy in underserved communities. METHODS A review of patients with breast cancer who received neoadjuvant or adjuvant chemotherapy from 2015-2019 was conducted at a safety-net hospital. The primary outcomes were times from diagnosis to chemotherapy and surgery. Clinicodemographic factors including race, age, clinical stage, primary language, comorbidities, and median income by zip code were collected. Multivariable regression analysis was performed to evaluate for factors associated with the primary outcomes. RESULTS One hundred patients were identified. For the neoadjuvant group, median time from diagnosis to chemotherapy and surgery was 52 ± 34 days and 256 ± 59 days, respectively. For the adjuvant group, median time from diagnosis to surgery and chemotherapy was 24.5 ± 18 days and 94.5 ± 53 days, respectively. Non-English language and older age were associated with increased time to chemotherapy in the adjuvant group (p < 0.05). Language and age were not associated with increased time to surgery in both groups. Race, age, comorbidities, and income were not associated with delay in treatment in either groups. CONCLUSIONS Older age and non-English language were associated with prolonged time from surgery to adjuvant chemotherapy. Targeted interventions directed at patient education and decreasing language barriers especially post-operatively may decrease delays in treatment and subsequently reduce disparities seen in the breast cancer population.
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Affiliation(s)
- Annie Tang
- Department of Surgery, University of California San Francisco, East Bay- Highland Hospital: 1411 E 31(st), QIC: 22134, Oakland CA, 94602 USA.
| | - Ananya Mittal
- Department of Surgery, University of California San Francisco, East Bay- Highland Hospital: 1411 E 31(st), QIC: 22134, Oakland CA, 94602 USA.
| | - Colin M Mooney
- Department of Surgery, University of California San Francisco, East Bay- Highland Hospital: 1411 E 31(st), QIC: 22134, Oakland CA, 94602 USA.
| | - Amal L Khoury
- Department of Surgery, University of California San Francisco, East Bay- Highland Hospital: 1411 E 31(st), QIC: 22134, Oakland CA, 94602 USA.
| | - Anna Chiang
- Department of Surgery, University of California San Francisco, East Bay- Highland Hospital: 1411 E 31(st), QIC: 22134, Oakland CA, 94602 USA.
| | - Nicole Lai
- Department of Surgery, University of California San Francisco, East Bay- Highland Hospital: 1411 E 31(st), QIC: 22134, Oakland CA, 94602 USA.
| | - Kevin B Knopf
- Department of Medicine, Alameda Health System- Highland Hospital: 1411 E 31(st), 2(nd) Floor A2, Oakland CA, 94602 USA.
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Blazek A, O'Donoghue C, Terranella S, Ritz E, Alvarado R, Perez C, Madrigrano A. Impact of Inequities on Delay in Breast Cancer Management in Women Undergoing Second Opinions. J Surg Res 2021; 268:445-451. [PMID: 34416417 DOI: 10.1016/j.jss.2021.06.084] [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: 03/01/2021] [Revised: 05/20/2021] [Accepted: 06/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Inequities in breast cancer treatment lead to delay in therapy, decreased survival and lower quality of life. This study aimed to examine demographics and clinical factors impacting time to treatment for second-opinion breast cancer patients. MATERIALS AND METHODS We performed a retrospective chart review to analyze patients presenting to one academic institution for second opinion of breast imaging, diagnosis, or breast-related treatment. Data from women with stage I-III breast cancer who received treatment at this institution were evaluated to determine the impact of patient demographics and clinical characteristics on time to first treatment. RESULTS Of the 1006 charts reviewed, 307 met inclusion criteria. Low-income patients averaged 58 days from diagnosis to surgery compared to 35 days for high-income patients (incidence rate ratio [IRR] 0.64, P<0.01). Black patients averaged 56 days from diagnosis to surgery compared to 42 days for White patients (IRR 1.37, P<0.01). Latina patients averaged 38 days from initial encounter to neoadjuvant chemotherapy compared to 20 days for White patients (IRR 1.69, P<0.05). CONCLUSION Patients with low-income, of Black race and Latina ethnicity experienced increased time to treatment. Additionally, time to mastectomy with and without reconstruction was longer than time to partial mastectomy. Further exploration is needed to determine why certain factors lead to treatment delay and how inequities can be eliminated.
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Affiliation(s)
| | - Cristina O'Donoghue
- Division of Surgical Oncology, Rush University Medical Center, Chicago, Illinois.
| | - Samantha Terranella
- Division of Surgical Oncology, Rush University Medical Center, Chicago, Illinois
| | - Ethan Ritz
- Rush Bioinformatics and Biostatistics Core, Rush University Medical Center, Chicago, Illinois
| | - Rosalinda Alvarado
- Division of Surgical Oncology, Rush University Medical Center, Chicago, Illinois
| | - Claudia Perez
- Division of Surgical Oncology, Rush University Medical Center, Chicago, Illinois
| | - Andrea Madrigrano
- Division of Surgical Oncology, Rush University Medical Center, Chicago, Illinois
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Ashok Kumar P, Paulraj S, Wang D, Huang D, Sivapiragasam A. Associated factors and outcomes of delaying adjuvant chemotherapy in breast cancer by biologic subtypes: a National Cancer Database study. J Cancer Res Clin Oncol 2021; 147:2447-2458. [PMID: 33517468 PMCID: PMC7847714 DOI: 10.1007/s00432-021-03525-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/10/2021] [Indexed: 11/30/2022]
Abstract
Purpose Several studies have evaluated the role of delayed initiation of adjuvant chemotherapy (AC) in breast cancer (BC), but the results have remained controversial and an optimal time has not been defined. Our aim was to determine the effect of time to starting AC from the date of surgery on survival of BC patients, based on estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status, using data from the National Cancer Database (NCDB). Methods A total of 332,927 Stage I–III BC patients who received AC from 2010 to 2016 were analyzed. We included all ER, PR and HER2 statuses and excluded patients with stage 4 and stage 0 (DCIS) disease. The cohort was divided into five groups based on the time of initiating AC from the date of the most definitive surgery i.e., ≤ 30 days, 31–60 days, 61–90 days, 91–120 days and > 120 days. They were further divided into five subgroups based on the receptor status. Results Hazard ratio (HR) estimates and Kaplan–Meier (KM) analysis shows that starting AC by 31–60 days shows the best survival outcome in all the subtypes, except in hormone positive/HER2 negative BC in which 31–60 days and 61–90 days have similar outcomes. Conclusions After surgery for BC, it takes around 4–6 weeks to begin AC and delay in initiating the same leads to poor outcomes. Our results are particularly significant in triple-negative breast cancer (TNBC), similar to prior studies showing a benefit to starting AC as early as possible after surgery.
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Affiliation(s)
- Prashanth Ashok Kumar
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, 13210, USA. .,Department of Internal Medicine, SUNY Upstate Medical University, 750 E Adams Street, Syracuse, NY, 13210, USA.
| | - Shweta Paulraj
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Dongliang Wang
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Danning Huang
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Abirami Sivapiragasam
- Department of Hematology-Oncology, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
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9
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Smith-Graziani D, Lei X, Giordano SH, Zhao H, Karuturi M, Chavez-MacGregor M. Delayed initiation of adjuvant chemotherapy in older women with breast cancer. Cancer Med 2020; 9:6961-6971. [PMID: 32767723 PMCID: PMC7541132 DOI: 10.1002/cam4.3363] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background Adjuvant chemotherapy benefits early‐stage breast cancer (BC) patients. Older women receive guideline‐adherent treatment less frequently and experience treatment delays more frequently. We evaluated factors associated with delaying adjuvant chemotherapy and the delays’ survival impact in a large population–based cohort of elderly BC patients. Methods Patients age >66 years diagnosed 2001‐2015 with localized or regional BC were identified in the SEER‐Medicare and Texas Cancer Registry‐Medicare databases. Time from surgery to chemotherapy (TTC) was categorized into four groups: 0‐30, 31‐60, 61‐90, and >90 days. We identified predictors of delays, estimated overall (OS) and BC‐specific (BCSS) survival, and determined the association between TTC and outcome adjusting for other variables. Results Among 28,968 women (median age 71 years), median TTC was 43 days. 10.7% of patients experienced TTC >90 days. Older age, Black or Hispanic race/ethnicity, unmarried status, more comorbidities, hormone receptor‐positivity, mastectomy, Oncotype DX testing, and full state buy‐in were associated with increased risk of delay. Five‐year OS estimates by TTC group were 0.82, 0.81, 0.80, and 0.74, respectively (p<.001). BCSS demonstrated a similar trend (p<.001). Chemotherapy delay was associated with worse OS (HR=1.33, 95%CI 1.25‐1.40) and BCSS (HR=1.39, 95%CI 1.27‐1.53). In subgroup analysis, delayed chemotherapy was associated with worse OS and BCSS among patients with hormone receptor–positive (HR=1.56, 95%CI 0.97‐2.51), HER2‐positive (HR=1.99, 95%CI 1.04‐3.79), and triple‐negative (HR=2.15, 95%CI 1.38‐3.36) tumors. Conclusion Chemotherapy delays are associated with worse survival in older BC patients. Providers should avoid delays and initiate chemotherapy ≤90 days after surgery regardless of patients’ BC subtype or age.
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Affiliation(s)
- Demetria Smith-Graziani
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xiudong Lei
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hui Zhao
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Meghan Karuturi
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mariana Chavez-MacGregor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Mijwel S, Bolam KA, Gerrevall J, Foukakis T, Wengström Y, Rundqvist H. Effects of Exercise on Chemotherapy Completion and Hospitalization Rates: The OptiTrain Breast Cancer Trial. Oncologist 2020; 25:23-32. [PMID: 31391297 PMCID: PMC6964125 DOI: 10.1634/theoncologist.2019-0262] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/02/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Exercise during chemotherapy is suggested to provide clinical benefits, including improved chemotherapy completion. Despite this, few randomized controlled exercise trials have reported on such clinical endpoints. From the OptiTrain trial we previously showed positive effects on physiological and health-related outcomes after 16 weeks of supervised exercise in patients with breast cancer undergoing chemotherapy. Here, we examined the effects of exercise on rates of chemotherapy completion and hospitalization, as well as on blood cell concentrations during chemotherapy. PATIENTS AND METHODS Two hundred forty women scheduled for chemotherapy were randomized to 16 weeks of resistance and high-intensity interval training (RT-HIIT), moderate-intensity aerobic and high-intensity interval training (AT-HIIT), or usual care (UC). Outcomes included chemotherapy completion, hospitalization, hemoglobin, lymphocyte, thrombocyte, and neutrophil concentrations during chemotherapy. RESULTS No significant between-groups differences were found in the proportion of participants who required dose reductions (RT-HIIT vs. UC: odds ratio [OR], 1.08; AT-HIIT vs. UC: OR, 1.39), or average relative dose intensity of chemotherapy between groups (RT-HIIT vs. UC: effect size [ES], 0.08; AT-HIIT vs. UC: ES, -0.07). A significantly lower proportion of participants in the RT-HIIT group (3%) were hospitalized during chemotherapy compared with UC (15%; OR, 0.20). A significantly lower incidence of thrombocytopenia was found for both RT-HIIT (11%) and AT-HIIT (10%) versus UC (30%; OR, 0.27; OR, 0.27). CONCLUSION No beneficial effects of either RT-HIIT or AT-HIIT on chemotherapy completion rates were found. However, combined resistance training and high-intensity interval training were effective to reduce hospitalization rates, and both exercise groups had a positive effect on thrombocytopenia. These are important findings with potential positive implications for the health of women with breast cancer and costs associated with treatment-related complications. IMPLICATIONS FOR PRACTICE Completing the prescribed chemotherapy regimen is strongly associated with a good prognosis for patients with primary breast cancer. Despite this, treatment-induced side effects make it necessary to reduce or alter the treatment regimen and can also lead to hospitalization. Exercise during chemotherapy is suggested to provide clinical benefits, including improved chemotherapy completion. This study showed that combined resistance and high-intensity interval training during chemotherapy resulted in lower hospitalization rates and a lower incidence of thrombocytopenia in women with breast cancer undergoing chemotherapy. However, no beneficial effects of either exercise program on chemotherapy completion rates were found, which is in contrast to previous findings in this population. The findings reported in the current article have positive implications for the health of women with breast cancer and costs associated with treatment-related complications.
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Affiliation(s)
- Sara Mijwel
- Department of Neurobiology, Care Sciences, and Society, Karolinska InstitutetStockholmSweden
| | - Kate A. Bolam
- Department of Neurobiology, Care Sciences, and Society, Karolinska InstitutetStockholmSweden
| | - Jacob Gerrevall
- Department of Cell and Molecular Biology, Karolinska InstitutetStockholmSweden
| | - Theodoros Foukakis
- Department of Oncology and Pathology, Karolinska InstitutetStockholmSweden
- Cancer Theme, Karolinska University HospitalStockholmSweden
| | - Yvonne Wengström
- Department of Neurobiology, Care Sciences, and Society, Karolinska InstitutetStockholmSweden
- Cancer Theme, Karolinska University HospitalStockholmSweden
| | - Helene Rundqvist
- Department of Cell and Molecular Biology, Karolinska InstitutetStockholmSweden
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11
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Fang CY, Tseng M. Ethnic density and cancer: A review of the evidence. Cancer 2018; 124:1877-1903. [PMID: 29411868 PMCID: PMC5920546 DOI: 10.1002/cncr.31177] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 10/24/2017] [Accepted: 11/13/2017] [Indexed: 01/04/2023]
Abstract
Accumulating data suggest that factors in the social environment may be associated with cancer-related outcomes. Ethnic density, defined as the proportion of racial/ethnic minority individuals residing in a given geographic area, is 1 of the most frequently studied social environment factors, but studies on ethnic density and cancer have yielded inconsistent findings. Thus, the objective of the current review was to summarize the extant data on ethnic density and cancer-related outcomes (cancer risk, stage at diagnosis, and mortality) with the aim of identifying pathways by which ethnic density may contribute to outcomes across populations. In general, the findings indicated an association between ethnic density and increased risk for cancers of infectious origin (eg, liver, cervical) but lower risk for breast and colorectal cancers, particularly among Hispanic and Asian Americans. Hispanic ethnic density was associated with greater odds of late-stage cancer diagnosis, whereas black ethnic density was associated with greater mortality. In addition, this review highlights several methodological and conceptual issues surrounding the measurement of ethnic neighborhoods and their available resources. Clarifying the role of neighborhood ethnic density is critical to developing a greater understanding of the health risks and benefits accompanying these environments and how they may affect racial and ethnic disparities in cancer-related outcomes. Cancer 2018;124:1877-903. © 2018 American Cancer Society.
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Affiliation(s)
- Carolyn Y Fang
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Marilyn Tseng
- Kinesiology Department, California Polytechnic State University, San Luis Obispo, California
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