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Record SM, Thomas SM, Tian WM, van den Bruele AB, Chiba A, DiLalla G, DiNome ML, Kimmick G, Rosenberger LH, Woriax HE, Hwang ES, Plichta JK. Anatomy Versus Biology: What Guides Chemotherapy Decisions in Older Patients With Breast Cancer? J Surg Res 2024; 296:654-664. [PMID: 38359680 PMCID: PMC10947834 DOI: 10.1016/j.jss.2024.01.037] [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: 09/15/2023] [Revised: 01/08/2024] [Accepted: 01/18/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION With the increasing utilization of genomic assays, such as the Oncotype DX recurrence score (RS), the relevance of anatomic staging has been questioned for select older patients with breast cancer. We sought to evaluate differences in chemotherapy receipt and/or survival among older patients based on RS and sentinel lymph node biopsy (SLNB) receipt/result. METHODS Patients aged ≥ 65 diagnosed with pT1-2/cN0/M0 hormone-receptor-positive (HR+)/HER2-breast cancer (2010-2019) were selected from the National Cancer Database. Logistic regression was used to identify factors associated with chemotherapy receipt. Cox proportional hazards models were used to estimate the association of RS/SLNB group with overall survival. A cost-benefit study was also performed. RESULTS Of the 75,428 patients included, the majority had an intermediate RS (58.2% versus 27.9% low, 13.8% high) and were SLNB- (85.1% versus 11.6% SLNB+, 3.3% none). Chemotherapy was recommended for 13,442 patients (17.8%). After adjustment, chemotherapy receipt was more likely with higher RS and SLNB+. After adjustment, SLNB receipt/result was only associated with overall survival among those with an intermediate RS. However, returning to the OR for SLNB is not cost-effective. CONCLUSIONS SLNB receipt/result was associated with survival for those with an intermediate RS, but not a low or high RS, suggesting that an SLNB may indeed be unnecessary for select older patients with breast cancer.
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Affiliation(s)
- Sydney M Record
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, North Carolina; Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - William M Tian
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Astrid Botty van den Bruele
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Akiko Chiba
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Gayle DiLalla
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Maggie L DiNome
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Gretchen Kimmick
- Duke Cancer Institute, Duke University, Durham, North Carolina; Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Laura H Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Hannah E Woriax
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Duke University, Durham, North Carolina
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Duke University, Durham, North Carolina; Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina.
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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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Carbajal-Ochoa W, Bravo-Solarte DC, Bernal AM, Anampa JD. Benefit of adjuvant chemotherapy in lymph node-negative, T1b and T1c triple-negative breast cancer. Breast Cancer Res Treat 2024; 203:257-269. [PMID: 37833449 DOI: 10.1007/s10549-023-07132-6] [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: 06/08/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION Current guidelines recommendations regarding chemotherapy in small (T1b and T1c), node-negative triple-negative breast cancer (TNBC) differ due to lack of high-quality data. Our study aimed to assess the benefit of adjuvant chemotherapy in patients with T1bN0M0 and T1cN0M0 TNBC. METHODS We obtained data from the Surveillance, Epidemiology, and End Results database for patients with node-negative, T1b/T1c TNBC diagnosed between 2010 and 2020. Logistic regresion models assessed variables associated with chemotherapy administration. We evaluated the effect of chemotherapy on overall survival (OS) and breast cancer specific survival (BCSS) with Kaplan-Meier methods and Cox proportional hazards methods. RESULTS We included 11,510 patients: 3,388 with T1b and 8,122 with T1c TNBC. During a median follow-up of 66 months, 305 patients with T1b and 995 with T1c died. After adjusting for clinicopathological, demographic and treatment factors, adjuvant chemotherapy improved OS in T1b TNBC (HR, 0.52; 95% CI, 0.41-0.68 p < 0.001) but did not improve BCSS (HR, 0.70; 95% CI, 0.45-1.07; p = 0.10); the association between chemotherapy and BCSS was not statistically significant in any subgroup. In T1c TNBC, adjuvant chemotherapy improved OS (HR, 0.54; 95% CI, 0.47-0.62; p < 0.001) and BCSS (HR, 0.79; 95% CI, 0.63-0.99; p = 0.043); the benefit of chemotherapy in OS varied by age (Pinteraction=0.024); moreover, the benefit in BCSS was similar in all subgroups. CONCLUSIONS Our study results support the use of adjuvant chemotherapy in patients with node-negative, T1c TNBC. Patients with node-negative, T1b TNBC had excellent long-term outcomes; furthermore, chemotherapy was not associated with improved BCSS in these patients.
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Affiliation(s)
- Walter Carbajal-Ochoa
- Department of Medical Oncology, Catalan Institute of Oncology/Josep Trueta Hospital, Girona, Spain
| | | | - Ana M Bernal
- Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, 1695 Eastchester Rd, Bronx, NY, 10461, USA
| | - Jesus D Anampa
- Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, 1695 Eastchester Rd, Bronx, NY, 10461, USA.
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Sykes DAW, Waguia R, Abu-Bonsrah N, Price M, Dalton T, Sperber J, Owolo E, Hockenberry H, Bishop B, Kruchko C, Barnholtz-Sloan JS, Erickson M, Ostrom QT, Goodwin CR. Associations between urbanicity and spinal cord astrocytoma management and outcomes. Cancer Epidemiol 2023; 86:102431. [PMID: 37478632 DOI: 10.1016/j.canep.2023.102431] [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: 04/20/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND The management of spinal cord astrocytomas (SCAs) remains controversial and may include any combination of surgery, radiation, and chemotherapy. Factors such as urbanicity (metropolitan versus non-metropolitan residence) are shown to be associated with patterns of treatment and clinical outcomes in a variety of cancers, but the role urbanicity plays in SCA treatment remains unknown. METHODS The Central Brain Tumor Registry of the United States (CBTRUS) analytic dataset, which combines data from CDC's National Program of Cancer Registries (NPCR) and NCI's Surveillance, Epidemiology, and End Results Programs, was used to identify individuals with SCAs between 2004 and 2019. Individuals' county of residence was classified as metropolitan or non-metropolitan. Multivariable logistic regression models were used to evaluate associations between urbanicity and SCA. Cox proportional hazard models were constructed to assess the effect of urbanicity on survival using the NPCR survival dataset (2004-2018). RESULTS 1697 metropolitan and 268 non-metropolitan SCA cases were identified. The cohorts did not differ in age or gender composition. The populations had different racial/ethnic compositions, with a higher White non-Hispanic population in the non-metropolitan cohort (86 % vs 66 %, p < 0.001) and a greater Black non-Hispanic population in the metropolitan cohort (14 % vs 9.9 %, p < 0.001). There were no significant differences in likelihood of receiving comprehensive treatment (OR=0.99, 95 % CI [0.56, 1.65], p = >0.9), or survival (hazard ratio [HR]=0.92, p = 0.4) when non-metropolitan and metropolitan cases were compared. In the metropolitan cohort, there were statistically significant differences in SCA treatment patterns when stratified by race/ethnicity (p = 0.002). CONCLUSIONS Urbanicity does not significantly impact SCA management or survival. Race/ethnicity may be associated with likelihood of receiving certain SCA treatments in metropolitan communities.
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Affiliation(s)
- David A W Sykes
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | - Romaric Waguia
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | - Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mackenzie Price
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA; Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
| | - Tara Dalton
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | - Jacob Sperber
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | - Edwin Owolo
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | | | - Brandon Bishop
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
| | - Jill S Barnholtz-Sloan
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA; Trans-Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, MD, USA; Center for Biomedical Informatics & Information Technology (CBIIT), National Cancer Institute, Bethesda, MD, USA
| | - Melissa Erickson
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Quinn T Ostrom
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA; Central Brain Tumor Registry of the United States, Hinsdale, IL, USA; The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA; Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA.
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Nash AL, Ren Y, Plichta JK, Rosenberger LH, van den Bruele AMB, DiNome ML, Westbrook K, Hwang ES. Survival Benefit of Chemotherapy According to 21-Gene Recurrence Score in Young Women with Breast Cancer. Ann Surg Oncol 2023; 30:2130-2139. [PMID: 36611067 DOI: 10.1245/s10434-022-12699-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/05/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Initial trials evaluating Oncotype DX, reported as a recurrence score (RS) from 0 to 100, were not powered to evaluate overall survival, and premenopausal women were underrepresented. The purpose of this study was to explore the benefit of chemotherapy according to RS among younger women eligible for oncotype testing. METHODS Women aged 40-50, diagnosed with HR-positive, HER2-negative breast cancer between 2010 and 2017 were selected from the National Cancer Database (NCBD). Patients were grouped by age, RS, nodal status, and chemotherapy receipt. Kaplan-Meier curves were used to compare unadjusted overall survival (OS) between the groups, and log-rank tests were used to test for a difference between groups. Cox proportional hazards models were used to examine the association between select factors and OS. RESULTS A total of 15,422 patients met inclusion criteria, 45.3% of whom received chemotherapy. Median follow-up time was 66.4 (50.6-86.6) months. Patients who received chemotherapy were more likely to have higher-stage and higher-grade tumors, tumors that were PR-negative, and have higher RS (p < 0.001 for all). RS was prognostic for OS regardless of nodal status. After adjustment, chemotherapy was associated with a significant improvement in OS only in the pN1 RS 31-50 subgroup (p = 0.02). CONCLUSIONS RS retains its prognostic value in younger patients with early stage HR-positive, HER2-negative breast cancer. Chemotherapy survival benefit was limited to patients aged 40-50 with pN1 disease and RS of 31-50. Therefore, chemotherapy decision-making should be especially preference-sensitive in women aged 40-50 with intermediate RS, where it may not provide a survival benefit for many women.
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Affiliation(s)
- A L Nash
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Y Ren
- Duke Cancer Institute Biostatistics Shared Resources, Durham, NC, USA
| | - J K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - L H Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - A M B van den Bruele
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - M L DiNome
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - K Westbrook
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University, Durham, NC, USA.
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Subramanian S, Jones M, Tangka FKL, Edwards P, Flanigan T, Kaganova J, Smith K, Fairley T, Hawkins NA, Rodriguez JL, Guy GP, Thomas CC. Utility of linking survey and registry data to evaluate interventions and policies to address disparities in breast cancer survivorship among young women. EVALUATION AND PROGRAM PLANNING 2021; 88:101967. [PMID: 34091395 PMCID: PMC8533048 DOI: 10.1016/j.evalprogplan.2021.101967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 04/27/2021] [Accepted: 05/18/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE There is limited research linking data sources to evaluate the multifactorial impacts on the quality of treatment received and financial burden among young women with breast cancer. To address this gap and support future evaluation efforts, we examined the utility of combining patient survey and cancer registry data. PATIENT AND METHODS We administered a survey to women, aged 18-39 years, with breast cancer from four U.S. states. We conducted a systematic response-rate analysis and evaluated differences between racial groups. Survey responses were linked with cancer registry data to assess whether surveys could reliably supplement registry data. RESULTS A total of 830 women completed the survey for a response rate of 28.4 %. Blacks and Asian/Pacific Islanders were half as likely to respond as white women. Concordance between survey and registry data was high for demographic variables (Cohen's kappa [k]: 0.879 to 0.949), moderate to high for treatments received (k: 0.467 to 0.854), and low for hormone receptor status (k: 0.167 to 0.553). Survey items related to insurance status, employment, and symptoms revealed racial differences. CONCLUSION Cancer registry data, supplemented by patient surveys, can provide a broader understanding of the quality of care and financial impacts of breast cancer among young women.
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Affiliation(s)
| | - Madeleine Jones
- RTI International, 307 Waverly Oaks Road, Waltham, MA, 0245, USA
| | - Florence K L Tangka
- Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USA
| | - Patrick Edwards
- RTI International, 307 Waverly Oaks Road, Waltham, MA, 0245, USA
| | - Tim Flanigan
- RTI International, 307 Waverly Oaks Road, Waltham, MA, 0245, USA
| | - Jenya Kaganova
- RTI International, 307 Waverly Oaks Road, Waltham, MA, 0245, USA
| | - Kevin Smith
- RTI International, 307 Waverly Oaks Road, Waltham, MA, 0245, USA
| | - Temeika Fairley
- Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USA
| | - Nikki A Hawkins
- Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USA
| | - Juan L Rodriguez
- Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USA
| | - Gery P Guy
- Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USA
| | - Cheryll C Thomas
- Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USA
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McDougall JA, Cook LS, Tang MTC, Linden HM, Thompson B, Li CI. Determinants of Guideline-Discordant Breast Cancer Care. Cancer Epidemiol Biomarkers Prev 2020; 30:61-70. [PMID: 33093159 DOI: 10.1158/1055-9965.epi-20-0985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/21/2020] [Accepted: 10/14/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Evidence-based breast cancer treatment guidelines recommend the most appropriate course of therapy based on tumor characteristics and extent of disease. Evaluating the multilevel factors associated with guideline discordance is critical to identifying strategies to eliminate breast cancer survival disparities. METHODS We identified females diagnosed with a first primary, stage I-III breast cancer between the ages of 20-69 years of age from the population-based Seattle-Puget Sound Surveillance, Epidemiology, and End Results registry. Participants completed a survey about social support, utilization of patient support services, hypothesized barriers to care, and initiation of breast cancer treatment. We used logistic regression to estimate odds ratios and 95% confidence intervals (CI). RESULTS Among 1,390 participants, 10% reported guideline-discordant care. In analyses adjusted for patient-level sociodemographic factors, individuals who did not have someone to go with them to appointments or drive them home (OR 1.96; 95% CI, 1.09-3.59) and those who had problems talking to their doctors or their staff (OR 2.03; 95% CI, 1.13-3.64) were more likely to be guideline discordant than those with social support or without such problems, respectively. Use of patient support services was associated with a 43% lower odds of guideline discordance (OR 0.57; 95% CI, 0.36-0.88). CONCLUSIONS Although guideline discordance in this cohort of early-stage breast cancer survivors diagnosed <70 years of age was low, instrumental social support, patient support services, and communication with doctors and their staff emerged as potential multilevel intervention targets for improving breast cancer care delivery. IMPACT This study supports extending the reach of interventions designed to improve guideline concordance.
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Affiliation(s)
- Jean A McDougall
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico. .,Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Linda S Cook
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico.,Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Mei-Tzu C Tang
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Hannah M Linden
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Department of Medicine, University of Washington, Seattle, Washington
| | - Beti Thompson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Department of Health Services, University of Washington, Seattle, Washington
| | - Christopher I Li
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Department of Epidemiology, University of Washington, Seattle, Washington
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McCall MK, Connolly M, Nugent B, Conley YP, Bender CM, Rosenzweig MQ. Symptom Experience, Management, and Outcomes According to Race and Social Determinants Including Genomics, Epigenomics, and Metabolomics (SEMOARS + GEM): an Explanatory Model for Breast Cancer Treatment Disparity. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:428-440. [PMID: 31392599 PMCID: PMC7245588 DOI: 10.1007/s13187-019-01571-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Even after controlling for stage, comorbidity, age, and insurance status, black women with breast cancer (BC) in the USA have the lowest 5-year survival as compared with all other races for stage-matched disease. One potential cause of this survival difference is the disparity in cancer treatment, evident in many population clinical trials. Specifically, during BC chemotherapy, black women receive less relative dose intensity with more dose reductions and early chemotherapy cessation compared with white women. Symptom incidence, cancer-related distress, and ineffective communication, including the disparity in patient-centeredness of care surrounding patient symptom reporting and clinician assessment, are important factors contributing to racial disparity in dose reduction and early therapy termination. We present an evidence-based overview and an explanatory model for racial disparity in the symptom experience during BC chemotherapy that may lead to a reduction in dose intensity and a subsequent disparity in outcomes. This explanatory model, the Symptom Experience, Management, Outcomes and Adherence according to Race and Social determinants + Genomics Epigenomics and Metabolomics (SEMOARS + GEM), considers essential factors such as social determinants of health, clinician communication, symptoms and symptom management, genomics, epigenomics, and pharmacologic metabolism as contributory factors.
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Affiliation(s)
- Maura K. McCall
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| | - Mary Connolly
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| | - Bethany Nugent
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| | - Yvette P. Conley
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| | - Catherine M. Bender
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| | - Margaret Q. Rosenzweig
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
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9
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Wang X, Feng Z, Huang Y, Li H, Cui P, Wang D, Dai H, Song F, Zheng H, Wang P, Cao X, Gu L, Zhang J, Song F, Chen K. A Nomogram To Predict The Overall Survival Of Breast Cancer Patients And Guide The Postoperative Adjuvant Chemotherapy In China. Cancer Manag Res 2019; 11:10029-10039. [PMID: 31819635 PMCID: PMC6886546 DOI: 10.2147/cmar.s215000] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/12/2019] [Indexed: 01/02/2023] Open
Abstract
Purpose We aim to construct a nomogram to predict breast cancer survival and guide postoperative adjuvant chemotherapy in China. Patients and methods A total of 5,504 breast cancer patients from the Tianjin Breast Cancer Cases Cohort were included. Multivariable Cox regression was used to investigate the factors associated with overall survival (OS) and a nomogram was constructed based on these prognostic factors. The nomogram was internal and external validated and the performance was evaluated by area under the curve (AUC) and calibration curve. The partial score was also constructed and stratified them into low, moderate and high-risk subgroups for death according to the tripartite grouping method. Multivariate Cox regression analysis and the propensity score matching method were respectively used to test the association between adjuvant chemotherapy and OS in different risk subgroups. Results Age, diameter, histological differentiation, lymph node metastasis, estrogen, and progesterone receptor were incorporated into the nomogram and validation results showed this nomogram was well-calibrated to predict the 3-year [AUC =74.1%; 95% confidence interval (CI): 70.1–78.0%] and 5-year overall survival [AUC =72.3%; 95% CI: 69.6–75.1%]. Adjuvant chemotherapy was negatively associated with death in high risk subgroup [Hazard Ratio (HR) = 0.54; 95% CI: 0.37–0.77; P<0.001]. However, no significant association were found in groups with low (HR=1.47; 95% CI: 0.52–4.19; P=0.47) and moderate risk (HR=0.78; 95% CI: 0.42–1.48; P=0.45). The 1:1 PSM generated 822 pairs of well-matched patients and Kaplan-Meier showed the high-risk patients could benefit from chemotherapy, whereas low risk and moderate risk subjects did not appear to benefit from chemotherapy. Conclusion Not all of the breast cancer patients benefit equally from chemotherapy. The nomogram could be used to evaluate the overall survival of breast cancer patients and predict the magnitude of benefit and guide adjuvant chemotherapy for breast cancer patients after surgery.
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Affiliation(s)
- Xin Wang
- Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, People's Republic of China
| | - Ziwei Feng
- Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, People's Republic of China
| | - Yubei Huang
- Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, People's Republic of China
| | - Haixin Li
- Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, People's Republic of China.,Department of Cancer Biobank, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, People's Republic of China
| | - Ping Cui
- Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, People's Republic of China
| | - Dezheng Wang
- Center for Non-Communicable Disease Control and Prevention, Tianjin Centers for Disease Control and Prevention, Tianjin 300011, People's Republic of China
| | - Hongji Dai
- Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, People's Republic of China
| | - Fangfang Song
- Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, People's Republic of China
| | - Hong Zheng
- Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, People's Republic of China
| | - Peishan Wang
- Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, People's Republic of China
| | - Xuchen Cao
- The First Department of Breast Cancer, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, People's Republic of China
| | - Lin Gu
- The Second Department of Breast Cancer, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, People's Republic of China
| | - Jin Zhang
- The Third Department of Breast Cancer, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, People's Republic of China
| | - Fengju Song
- Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, People's Republic of China
| | - Kexin Chen
- Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, People's Republic of China
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10
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Powis M, Groome P, Biswanger N, Kendell C, Decker KM, Grunfeld E, McBride ML, Urquhart R, Winget M, Porter GA, Krzyzanowska MK. Cross-Canada differences in early-stage breast cancer treatment and acute-care use. Curr Oncol 2019; 26:e624-e639. [PMID: 31708656 PMCID: PMC6821122 DOI: 10.3747/co.26.5003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Chemotherapy has improved outcomes in early-stage breast cancer, but treatment practices vary, and use of acute care is common. We conducted a pan-Canadian study to describe treatment differences and the incidence of emergency department visits (edvs), edvs leading to hospitalization (edvhs), and direct hospitalizations (hs) during adjuvant chemotherapy. Methods The cohort consisted of women diagnosed with early-stage breast cancer (stages i-iii) during 2007-2012 in British Columbia, Manitoba, Ontario, or Nova Scotia who underwent curative surgery. Parallel provincial analyses were undertaken using linked clinical, registry, and administrative databases. The incidences of edvs, edvhs, and hs in the 6 months after treatment initiation were examined for patients treated with adjuvant chemotherapy. Results The cohort consisted of 50,224 patients. The proportion of patients who received chemotherapy varied by province, with Ontario having the highest proportion (46.4%), and Nova Scotia, the lowest proportion (38.0%). Age, stage, receptor status, comorbidities, and geographic location were associated with receipt of chemotherapy in all provinces. Ontario had the highest proportion of patients experiencing an edv (36.1%), but the lowest proportion experiencing h (6.4%). Conversely, British Columbia had the lowest proportion of patients experiencing an edv (16.0%), but the highest proportion experiencing h (26.7%). The proportion of patients having an edvh was similar across provinces (13.9%-16.8%). Geographic location was associated with edvs, edvhs, and hs in all provinces. Conclusions Intra- and inter-provincial differences in the use of chemotherapy and acute care were observed. Understanding variations in care can help to identify gaps and opportunities for improvement and shared learnings.
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Affiliation(s)
- M Powis
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - P Groome
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON
| | - N Biswanger
- Epidemiology and Cancer Registry Department, CancerCare Manitoba, Winnipeg, MB
| | - C Kendell
- Cancer Outcomes Research Program, Department of Surgery, Dalhousie University and Nova Scotia Health Authority, Halifax, NS
| | - K M Decker
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB
- Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB
| | - E Grunfeld
- Department of Family and Community Medicine, University of Toronto, Toronto, ON
| | - M L McBride
- Cancer Control Research, BC Cancer, Vancouver, BC
| | | | - M Winget
- Stanford University School of Medicine, Stanford, CA, U.S.A
| | - G A Porter
- Department of Surgery, Queen Elizabeth ii Health Sciences Centre, Halifax, NS
| | - M K Krzyzanowska
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON
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11
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Thomas PS, Class CA, Gandhi TR, Bambhroliya A, Do KA, Brewster AM. Demographic, clinical, and geographical factors associated with lack of receipt of physician recommended chemotherapy in women with breast cancer in Texas. Cancer Causes Control 2019; 30:409-415. [PMID: 30868330 PMCID: PMC7239038 DOI: 10.1007/s10552-019-01151-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 02/22/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE Identifying demographic, clinical, and geographical factors that contribute to disparities in the receipt of physician recommended chemotherapy in breast cancer patients. METHODS The Texas Cancer Registry was used to identify women aged ≥ 18 years with invasive breast cancer diagnosed from 2007 to 2011 who received a recommendation for chemotherapy. Multivariable logistic regression was performed to determine associations between demographic and clinical factors and the receipt of chemotherapy. Cox proportional regression was used to estimate the hazard ratio (HR) for overall survival. Spatial analysis was conducted using Poisson models for breast cancer mortality and receipt of chemotherapy. RESULTS Age ≥ 65 years, residence in areas with > 20% poverty index, and early disease stage were associated with lack of receipt of chemotherapy (all p < 0.001). Lack of receipt of chemotherapy was associated with decreased overall survival (HR 1.33, 95% CI 1.12-1.59, p = 0.001). A 38-county cluster in West Texas had lower receipt of chemotherapy (relative risk 0.88, p = 0.02) and increased breast cancer mortality (p = 0.03) compared to the rest of Texas. CONCLUSION Older age, increased poverty and rural geographical location are barriers to the receipt of chemotherapy. Interventions that target these barriers may reduce health disparities and improve breast cancer survival.
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Affiliation(s)
- Parijatham S Thomas
- Department of Clinical Cancer Prevention, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA.
| | - Caleb A Class
- Department of Biostatistics, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
| | - Tanmay R Gandhi
- Department of Biostatistics, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
| | - Arvind Bambhroliya
- Department of Neurology, The University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Kim-Anh Do
- Department of Biostatistics, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
| | - Abenaa M Brewster
- Department of Clinical Cancer Prevention, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
- Department of Epidemiology, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
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12
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He X, Chen W, Tang D, Wen F, Zhang P, Li Q. Factors related to the receipt of adjuvant therapy among patients with gastric cancer in Western China. Eur J Cancer Care (Engl) 2019; 28:e13012. [PMID: 30748055 DOI: 10.1111/ecc.13012] [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: 11/27/2017] [Revised: 10/23/2018] [Accepted: 01/17/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Adjuvant therapy following curative resection has been shown to be associated with significant survival benefits in patients with gastric cancer (GC); however, this treatment is not available to some patients. The aim was to investigate factors associated with the receipt of adjuvant therapy among GC patients. METHODS This is a retrospective study including patients with stage IB-IIIC gastric adenocarcinoma who underwent curative resection between November 2010 and July 2014. Patients were identified using a database from West China Hospital, Sichuan University. Univariate and multivariable analyses examined factors associated with adjuvant therapy receipt. RESULTS A total of 1,476 patients were included. Among these, 852 patients were eligible, with 157 patients not receiving adjuvant therapy. Age, education, income, residence, medical insurance, employment status and visiting an oncologist were independently associated with adjuvant therapy receipt by univariate analysis. After adjustment for other factors, medical insurance (p = 0.005), employment status (p = 0.008) and visiting an oncologist (p < 0.001) remained significantly correlated, and income was near the threshold of a significant difference (p = 0.050). CONCLUSION Our study indicates that disparities do exist in determining the receipt of adjuvant therapy in GC patients according to income, insurance and employment status, and highlight the importance of visiting an oncologist postoperatively.
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Affiliation(s)
- Xiaofeng He
- Department of Medical Oncology, Division of Abdominal Cancer, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Department of Medical Oncology, The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Wenwen Chen
- Department of Medical Oncology, The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Dan Tang
- Department of Medical Oncology, The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Feng Wen
- Department of Medical Oncology, Division of Abdominal Cancer, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Pengfei Zhang
- Department of Medical Oncology, Division of Abdominal Cancer, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiu Li
- Department of Medical Oncology, Division of Abdominal Cancer, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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13
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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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14
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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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15
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Siow ZR, De Boer RH, Lindeman GJ, Mann GB. Spotlight on the utility of the Oncotype DX ® breast cancer assay. Int J Womens Health 2018; 10:89-100. [PMID: 29503586 PMCID: PMC5827461 DOI: 10.2147/ijwh.s124520] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The Oncotype DX® assay was developed to address the need for optimizing the selection of adjuvant systemic therapy for patients with estrogen receptor (ER)-positive, lymph node-negative breast cancer. It has ushered in the era of genomic-based personalized cancer care for ER-positive primary breast cancer and is now widely utilized in various parts of the world. Together with several other genomic assays, Oncotype DX has been incorporated into clinical practice guidelines on biomarker use to guide treatment decisions. The Oncotype DX result is presented as the recurrence score which is a continuous score that predicts the risk of distant disease recurrence. The assay, which provides information on clinicopathological factors, has been validated for use in the prognostication and prediction of degree of adjuvant chemotherapy benefit in both lymph node-positive and lymph node-negative early breast cancers. Clinical studies have consistently shown that the Oncotype DX has a significant impact on decision making in adjuvant therapy recommendations and appears to be cost-effective in diverse health care settings. In this article, we provide an overview of the validation and clinical impact studies for the Oncotype DX assay. We also discuss its potential use in the neoadjuvant setting, as well as the more recent prospective validation trials, and the economic and utility implications of studies that use a lower cutoff score to define low-risk disease.
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Affiliation(s)
- Zhen Rong Siow
- ACRF Stem Cells and Cancer Division, Walter and Eliza Hall Institute of Medical Research.,Department of Medical Oncology, Peter MacCallum Cancer Centre.,Familial Cancer Centre, The Royal Melbourne Hospital
| | - Richard H De Boer
- Department of Medical Oncology, Peter MacCallum Cancer Centre.,Familial Cancer Centre, The Royal Melbourne Hospital
| | - Geoffrey J Lindeman
- ACRF Stem Cells and Cancer Division, Walter and Eliza Hall Institute of Medical Research.,Department of Medical Oncology, Peter MacCallum Cancer Centre.,Familial Cancer Centre, The Royal Melbourne Hospital.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - G Bruce Mann
- Department of Medical Oncology, Peter MacCallum Cancer Centre.,Familial Cancer Centre, The Royal Melbourne Hospital.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
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16
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Reeder-Hayes KE, Wheeler SB, Baggett CD, Zhou X, Meng K, Roberts MC, Carey LA, Meyer AM. Influence of provider factors and race on uptake of breast cancer gene expression profiling. Cancer 2018; 124:1743-1751. [PMID: 29338090 DOI: 10.1002/cncr.31222] [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: 09/28/2017] [Revised: 11/07/2017] [Accepted: 11/10/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Gene expression profiling (GEP) has been rapidly adopted for early breast cancer and can aid in chemotherapy decision making. Study results regarding racial disparities in testing are conflicting, and may reflect different care settings. To the authors' knowledge, data regarding the influence of provider factors on testing are scarce. METHODS The authors used a statewide, multipayer, insurance claims database linked to cancer registry records to examine the impact of race and provider characteristics on GEP uptake in a cohort of patients newly diagnosed with breast cancer between 2005 and 2012. Incidence proportion models were used to examine the adjusted likelihood of testing. Models were stratified by lymph node status (N0 vs N1). RESULTS Among 11,958 eligible patients, 23% of black and 26% of non-Hispanic white patients received GEP. Among patients with N0 disease, black individuals were 16% less likely to receive testing after adjustment for clinical factors and the provider's specialty and volume of patients with breast cancer (95% confidence interval, 0.77-0.93). Adjustment for provider characteristics did not attenuate the effect of race on testing. Patients of middle-volume providers were more likely to be tested compared with those with either high-volume or low-volume providers, whereas patients seeing a medical oncologist were more likely to be tested compared with those whose only providers were from surgical specialties. CONCLUSIONS Provider volume and specialty were found to be significant predictors of GEP use, but did not explain racial disparities in testing. Further research concerning the key contributors to lagging test use among black women is needed to optimize the equitable use of GEPs and support personalized treatment decision making for all patients. Cancer 2018;124:1743-51. © 2018 American Cancer Society.
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Affiliation(s)
- Katherine E Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stephanie B Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Christopher D Baggett
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Xi Zhou
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ke Meng
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Megan C Roberts
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Lisa A Carey
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anne-Marie Meyer
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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17
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Pasculli B, Barbano R, Parrella P. Epigenetics of breast cancer: Biology and clinical implication in the era of precision medicine. Semin Cancer Biol 2018; 51:22-35. [PMID: 29339244 DOI: 10.1016/j.semcancer.2018.01.007] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 12/15/2017] [Accepted: 01/11/2018] [Indexed: 02/09/2023]
Abstract
In the last years, mortality from breast cancer has declined in western countries as a consequence of a more widespread screening resulting in earlier detection, as well as an improved molecular classification and advances in adjuvant treatment. Nevertheless, approximately one third of breast cancer patients will develop distant metastases and eventually die for the disease. There is now a compelling body of evidence suggesting that epigenetic modifications comprising DNA methylation and chromatin remodeling play a pivotal role since the early stages of breast cancerogenesis. In addition, recently, increasing emphasis is being placed on the property of ncRNAs to finely control gene expression at multiple levels by interacting with a wide array of molecules such that they might be designated as epigenetic modifiers. In this review, we summarize the current knowledge about the involvement of epigenetic modifications in breast cancer, and provide an overview of the significant association of epigenetic traits with the breast cancer clinicopathological features, emphasizing the potentiality of epigenetic marks to become biomarkers in the context of precision medicine.
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Affiliation(s)
- Barbara Pasculli
- Laboratory of Oncology, IRCCS "Casa Sollievo della Sofferenza", 71013, San Giovanni Rotondo, FG, Italy.
| | - Raffaela Barbano
- Laboratory of Oncology, IRCCS "Casa Sollievo della Sofferenza", 71013, San Giovanni Rotondo, FG, Italy.
| | - Paola Parrella
- Laboratory of Oncology, IRCCS "Casa Sollievo della Sofferenza", 71013, San Giovanni Rotondo, FG, Italy.
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18
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Katz SJ, Wallner LP, Abrahamse PH, Janz NK, Martinez KA, Shumway DA, Hamilton AS, Ward KC, Resnicow KA, Hawley ST. Treatment experiences of Latinas after diagnosis of breast cancer. Cancer 2017; 123:3022-3030. [PMID: 28398629 PMCID: PMC5544545 DOI: 10.1002/cncr.30702] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/07/2017] [Accepted: 03/09/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND The authors examined racial/ethnic differences in patient perspectives regarding their breast cancer treatment experiences. METHODS A weighted random sample of women newly diagnosed with breast cancer between 2013 and 2015 in Los Angeles County and Georgia were sent surveys 2 months after undergoing surgery (5080 women; 70% response rate). The analytic sample was limited to patients residing in Los Angeles County (2397 women). RESULTS The pattern of visits with different specialists before surgery was found to be similar across racial/ethnic groups. Low acculturated Latinas (Latinas-LA) were less likely to report high clinician communication quality for both surgeons and medical oncologists (<69% vs >72% for all other groups; P<.05). The percentage of patients who reported high satisfaction regarding how physicians worked together was similar across racial/ethnic groups. Latinas-LA were more likely to have a low autonomy decision style (48% vs 24%-50% for all other groups; P<.001) and were more likely to report receiving too much information versus other ethnic groups (20% vs <16% for other groups; P<.001). Patients who reported a low autonomy decision style were more likely to rate the amount of information they received for the surgery decision as "too much" (16% vs 9%; P<.001). CONCLUSIONS There appears to be moderate disparity in breast cancer treatment communication and decision-making experiences reported by Latinas-LA versus other groups. The approach to treatment decision making by Latinas-LA represents an important challenge to health care providers. Initiatives are needed to improve patient engagement in decision making and increase clinician awareness of these challenges in this patient population. Cancer 2017;123:3022-30. © 2017 American Cancer Society.
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Affiliation(s)
- Steven J. Katz
- Department of Internal Medicine, School of Medicine, University of Michigan
- Department of Health Management and Policy, School of Public Health, University of Michigan
| | - Lauren P. Wallner
- Department of Internal Medicine, School of Medicine, University of Michigan
- Department of Epidemiology, School of Public Health, University of Michigan
| | - Paul H. Abrahamse
- Department of Epidemiology, School of Public Health, University of Michigan
| | - Nancy K. Janz
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan
| | | | - Dean A. Shumway
- Department of Radiation Oncology, School of Medicine, University of Michigan
| | | | - Kevin C. Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Kenneth A. Resnicow
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan
| | - Sarah T. Hawley
- Department of Internal Medicine, School of Medicine, University of Michigan
- Department of Health Management and Policy, School of Public Health, University of Michigan
- Veterans Administration Center for Clinical Management Research, Ann Arbor VA Health Care System
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19
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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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20
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Jemal A, Ward EM, Johnson CJ, Cronin KA, Ma J, Ryerson B, Mariotto A, Lake AJ, Wilson R, Sherman RL, Anderson RN, Henley SJ, Kohler BA, Penberthy L, Feuer EJ, Weir HK. Annual Report to the Nation on the Status of Cancer, 1975-2014, Featuring Survival. J Natl Cancer Inst 2017; 109:3092246. [PMID: 28376154 PMCID: PMC5409140 DOI: 10.1093/jnci/djx030] [Citation(s) in RCA: 1004] [Impact Index Per Article: 143.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/07/2017] [Indexed: 12/13/2022] Open
Abstract
Background: The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate to provide annual updates on cancer occurrence and trends in the United States. This Annual Report highlights survival rates. Methods: Data were from the CDC- and NCI-funded population-based cancer registry programs and compiled by NAACCR. Trends in age-standardized incidence and death rates for all cancers combined and for the leading cancer types by sex were estimated by joinpoint analysis and expressed as annual percent change. We used relative survival ratios and adjusted relative risk of death after a diagnosis of cancer (hazard ratios [HRs]) using Cox regression model to examine changes or differences in survival over time and by sociodemographic factors. Results: Overall cancer death rates from 2010 to 2014 decreased by 1.8% (95% confidence interval [CI] = –1.8 to –1.8) per year in men, by 1.4% (95% CI = –1.4 to –1.3) per year in women, and by 1.6% (95% CI = –2.0 to –1.3) per year in children. Death rates decreased for 11 of the 16 most common cancer types in men and for 13 of the 18 most common cancer types in women, including lung, colorectal, female breast, and prostate, whereas death rates increased for liver (men and women), pancreas (men), brain (men), and uterine cancers. In contrast, overall incidence rates from 2009 to 2013 decreased by 2.3% (95% CI = –3.1 to –1.4) per year in men but stabilized in women. For several but not all cancer types, survival statistically significantly improved over time for both early and late-stage diseases. Between 1975 and 1977, and 2006 and 2012, for example, five-year relative survival for distant-stage disease statistically significantly increased from 18.7% (95% CI = 16.9% to 20.6%) to 33.6% (95% CI = 32.2% to 35.0%) for female breast cancer but not for liver cancer (from 1.1%, 95% CI = 0.3% to 2.9%, to 2.3%, 95% CI = 1.6% to 3.2%). Survival varied by race/ethnicity and state. For example, the adjusted relative risk of death for all cancers combined was 33% (HR = 1.33, 95% CI = 1.32 to 1.34) higher in non-Hispanic blacks and 51% (HR = 1.51, 95% CI = 1.46 to 1.56) higher in non-Hispanic American Indian/Alaska Native compared with non-Hispanic whites. Conclusions: Cancer death rates continue to decrease in the United States. However, progress in reducing death rates and improving survival is limited for several cancer types, underscoring the need for intensified efforts to discover new strategies for prevention, early detection, and treatment and to apply proven preventive measures broadly and equitably.
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Affiliation(s)
- Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | | | | | - Kathleen A Cronin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Jiemin Ma
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Blythe Ryerson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Angela Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Andrew J Lake
- Information Management Services, Inc., Rockville, MD, USA
| | - Reda Wilson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Recinda L Sherman
- North American Association of Central Cancer Registries, Springfield, IL, USA
| | - Robert N Anderson
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA
| | - S Jane Henley
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Betsy A Kohler
- North American Association of Central Cancer Registries, Springfield, IL, USA
| | - Lynne Penberthy
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Eric J Feuer
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Hannah K Weir
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Marcinkowski EF, Ottesen R, Niland J, Vito C. Acceptance of adjuvant chemotherapy recommendations in early-stage hormone-positive breast cancer. J Surg Res 2017. [DOI: 10.1016/j.jss.2017.02.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Bhoo-Pathy NT, Inaida S, Tanaka S, Taib NA, Yip CH, Saad M, Kawakami K, Bhoo-Pathy N. Impact of adjuvant chemotherapy on survival of women with T1N0M0, hormone receptor negative breast cancer. Cancer Epidemiol 2017; 48:56-61. [DOI: 10.1016/j.canep.2017.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/02/2017] [Accepted: 03/19/2017] [Indexed: 10/19/2022]
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Reeder-Hayes KE, Anderson BO. Breast Cancer Disparities at Home and Abroad: A Review of the Challenges and Opportunities for System-Level Change. Clin Cancer Res 2017; 23:2655-2664. [PMID: 28572260 PMCID: PMC5499686 DOI: 10.1158/1078-0432.ccr-16-2630] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/03/2017] [Accepted: 04/06/2017] [Indexed: 01/06/2023]
Abstract
Sizeable disparities exist in breast cancer outcomes, both between Black and White patients in the United States, and between patients in the United States and other high-income countries compared with low- and middle-income countries (LMIC). In both settings, health system factors are key drivers of disparities. In the United States, Black women are more likely to die of breast cancer than Whites and have poorer outcomes, even among patients with similar stage and tumor subtype. Over-representation of higher risk "triple-negative" breast cancers contributes to breast cancer mortality in Black women; however, the greatest survival disparities occur within the good-prognosis hormone receptor-positive (HR+) subtypes. Disparities in access to treatment within the complex U.S. health system may be responsible for a substantial portion of these differences in survival. In LMICs, breast cancer mortality rates are substantially higher than in the United States, whereas incidence continues to rise. This mortality burden is largely attributable to health system factors, including late-stage presentation at diagnosis and lack of availability of systemic therapy. This article will review the existing evidence for how health system factors in the United States contribute to breast cancer disparities, discuss methods for studying the relationship of health system factors to racial disparities, and provide examples of health system interventions that show promise for mitigating breast cancer disparities. We will then review evidence of global breast cancer disparities in LMICs, the treatment factors that contribute to these disparities, and actions being taken to combat breast cancer disparities around the world. Clin Cancer Res; 23(11); 2655-64. ©2017 AACRSee all articles in this CCR Focus section, "Breast Cancer Research: From Base Pairs to Populations."
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Affiliation(s)
- Katherine E Reeder-Hayes
- Division of Hematology and Oncology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
- The University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Benjamin O Anderson
- Departments of Surgery and Global Health Medicine, School of Medicine, University of Washington, Seattle, Washington
- Program in Epidemiology, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Chow LWC, Biganzoli L, Leo AD, Kuroi K, Han HS, Patel J, Huang CS, Lu YS, Zhu L, Chow CYC, Loo WTY, Glück S, Toi M. Toxicity profile differences of adjuvant docetaxel/cyclophosphamide (TC) between Asian and Caucasian breast cancer patients. Asia Pac J Clin Oncol 2017; 13:372-378. [PMID: 28371190 DOI: 10.1111/ajco.12682] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/30/2017] [Indexed: 12/01/2022]
Abstract
AIM For early-stage breast cancer, four cycles of docetaxel and cyclophosphamide (TC) was proven superior to doxorubicin plus cyclophosphamide in the US Oncology 9375 trial. Given primary prophylactic antibiotics, 5% febrile neutropenia was recorded in a population comprising 75.5% Caucasians. Smaller trials and retrospective studies reviewing TC use in Asian patients did not produce similar incidence rates. This study aims to discover the variable hematological toxicities with TC use in Caucasian and Asian patients. METHODS Breast cancer data was retrospectively reviewed for patients receiving adjuvant docetaxel 60-75 mg/m2 plus cyclophosphamide 600 mg/m2 from six countries (China, Hong Kong, Japan, Taiwan, Italy, and United States). Similar number of patients with relatively balanced baseline characteristics were chosen for analysis of hematological and nonhematological toxicities and survival data. RESULTS From March 2004 to July 2013, data of 227 patients (127 Asians and 100 Caucasian) patients were analyzed for treatment-related toxicities. During the four cycles of TC, Asians had a significantly higher rate of grade ≥2 neutropenia than Caucasians (45.7% vs 6.0%; P <0.001) and significantly more grade ≥3 neutropenia events were documented (respectively 30.7% vs 4.0%, P <0.001). The prophylactic use of G-CSF was similar; 26.0% in Asians and 28.0% in Caucasian (P = 0.764). There were no differences in nonhematological toxicities. No significant difference in disease-free survival was observed between Asians and Caucasians (log-rank P = 0.910). CONCLUSIONS Ethnic differences in toxicity profile exist between Asian and Caucasian patients given adjuvant TC. Over 30% Asians but less than 5% Caucasians experienced grade ≥3 neutropenia.
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Affiliation(s)
- L W C Chow
- State Key Laboratory of Quality Research in Chinese Medicine, Macau Institute of Applied Medicine and Health, Macau University of Science and Technology, Macau.,Organisation for Oncology and Translational Research, Hong Kong.,UNIMED Medical Institute, Hong Kong
| | - L Biganzoli
- Sandro Pitigliani Medical Oncology Unit, Hospital of Prato, Italy
| | - A D Leo
- Sandro Pitigliani Medical Oncology Unit, Hospital of Prato, Italy
| | - K Kuroi
- Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - H S Han
- Department of Women's Oncology, H. Lee Moffitt Cancer Center and Research Institute, USA
| | - J Patel
- Department of Women's Oncology, H. Lee Moffitt Cancer Center and Research Institute, USA
| | - C S Huang
- Department of Surgery, National Taiwan University Hospital, Taiwan
| | - Y S Lu
- Department of Oncology, National Taiwan University Hospital, Taiwan
| | - L Zhu
- Department of Surgery, Shanghai Jiao Tong University, Shanghai, China
| | | | - W T Y Loo
- Organisation for Oncology and Translational Research, Hong Kong.,UNIMED Medical Institute, Hong Kong
| | - S Glück
- Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami, USA
| | - M Toi
- Organisation for Oncology and Translational Research, Hong Kong.,Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Yee MK, Sereika SM, Bender CM, Brufsky AM, Connolly MC, Rosenzweig MQ. Symptom incidence, distress, cancer-related distress, and adherence to chemotherapy among African American women with breast cancer. Cancer 2017; 123:2061-2069. [PMID: 28199006 DOI: 10.1002/cncr.30575] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/20/2016] [Accepted: 01/03/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND There is a persistent racial survival disparity between African American (AA) and white women with breast cancer. There is evidence that symptom incidence, associated distress, and overall cancer-related distress may be unexplored, important contributing factors. The purpose of the current study was to: 1) describe and compare the number of chemotherapy-related symptoms and associated distress among AA women with breast cancer over the course of chemotherapy at 3 time points (at baseline before initiating chemotherapy, midpoint, and at the completion of chemotherapy); and 2) to describe the relationship between the number of chemotherapy-related symptoms and overall cancer distress compared with the ability to receive at least 85% of the prescribed chemotherapy within the prescribed timeframe. METHODS Descriptive, comparative, and correlational analyses of symptom incidence, symptom distress, cancer-related distress, and prescribed chemotherapy dose received among a cohort of AA women receiving chemotherapy for breast cancer were performed. RESULTS AA women (121 women) experienced worsening symptoms from baseline to midpoint in chemotherapy and then stabilized for the duration of therapy. The inability to receive 85% of the prescribed chemotherapy within a prescribed time point was found to be significantly correlated with midpoint symptom distress. CONCLUSIONS The main findings of the current study were that AA women experience a deterioration in symptom distress over the course of chemotherapy from baseline (before chemotherapy) to the midpoint, which was found to be associated with less adherence to chemotherapy overall. Thus, the incidence and management of physical and emotional symptoms, as measured through a multidimensional symptom measurement tool, may be contributing to breast cancer dose disparity and should be explored further. Cancer 2017;123:2061-2069. © 2017 American Cancer Society.
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Affiliation(s)
- Melissa K Yee
- Department of Medical Oncology at Dana-Farber/Brigham and Women's Cancer Center in clinical affiliation with South Shore Hospital, Harvard University, Cambridge, Massachusetts
| | - Susan M Sereika
- Department of Epidemiology, School of Nursing and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Adam M Brufsky
- Department of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mary C Connolly
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Margaret Q Rosenzweig
- Acute and Tertiary Care Department, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
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Freedman RA, Foster JC, Seisler DK, Lafky JM, Muss HB, Cohen HJ, Mandelblatt J, Winer EP, Hudis CA, Partridge AH, Carey LA, Cirrincione C, Moreno-Aspitia A, Kimmick G, Jatoi A, Hurria A. Accrual of Older Patients With Breast Cancer to Alliance Systemic Therapy Trials Over Time: Protocol A151527. J Clin Oncol 2017; 35:421-431. [PMID: 27992272 PMCID: PMC5455700 DOI: 10.1200/jco.2016.69.4182] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose Despite increasing awareness of accrual challenges, it is unknown if accrual of older patients to breast cancer treatment trials is improving. Methods We examined accrual of older patients to Alliance for Clinical Trials in Oncology systemic therapy breast cancer trials during 1985-2012 and compared disease characteristics and reasons for therapy cessation for older (age ≥ 65 years and ≥ 70 years) versus younger (age < 65 years and < 70 years) participants. To examine accrual trends, we modeled age as a function of time, using logistic regression. Results Overall, 17% of study participants were ≥ 65 years of age. Approximately 15%, 24%, and 24% of participants in adjuvant, neoadjuvant, and metastatic trials were age ≥ 65 years, and 7%, 15%, and 13% were age ≥ 70 years, respectively. The odds of a patient age ≥ 65 years enrolling significantly increased over time for adjuvant trials (odds ratio [OR] per year, 1.04; 95% CI, 1.04 to 1.05) but decreased significantly for neoadjuvant and metastatic trials (OR, 0.62; 95% CI, 0.58 to 0.67 and OR, 0.98, 95% CI, 0.97 to 1.00). Similar trends were seen for those age ≥ 70 years but these were statistically significant for adjuvant and neoadjuvant trials only (OR, 1.05, 95% CI, 1.04 to 1.07; and OR, 0.57, 95% CI, 0.52 to 0.62). In general, those age ≥ 65 years ( v those < 65 years) in adjuvant studies had a higher mean number of lymph nodes involved and more hormone receptor-negative tumors, although tumor sizes were similar. Early protocol treatment cessation was also more frequent in those age ≥ 65 years (50%) versus < 65 years (35.9%) across trials. Conclusion Older patients with breast cancer remain largely underrepresented in cooperative group therapeutic trials. We observed some improvement in accrual to adjuvant trials but worsening of accrual for neoadjuvant/metastatic trials. Novel strategies to increase accrual of older patients are critical to meaningfully change the evidence base for this growing patient population.
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Affiliation(s)
- Rachel A. Freedman
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Jared C. Foster
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Drew K. Seisler
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Jacqueline M. Lafky
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Hyman B. Muss
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Harvey J. Cohen
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Jeanne Mandelblatt
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Eric P. Winer
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Clifford A. Hudis
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Ann H. Partridge
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Lisa A. Carey
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Constance Cirrincione
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Alvaro Moreno-Aspitia
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Gretchen Kimmick
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Aminah Jatoi
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
| | - Arti Hurria
- Rachel A. Freedman, Eric P. Winer, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Jared C. Foster, Drew K. Seisler, Jacqueline M. Lafky, and Aminah Jatoi, Mayo Clinic; Jared C. Foster and Drew K. Seisler, Mayo Cancer Center, Rochester, MN; Hyman B. Muss and Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Harvey J. Cohen, Constance Cirrincione, and Gretchen Kimmick, Duke University, Durham, NC; Jeanne Mandelblatt, Georgetown University, Washington, DC; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; Alvaro Moreno-Aspitia, Mayo Clinic, Jacksonville, FL; and Arti Hurria, City of Hope, Duarte, CA
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Griggs JJ, Hamilton AS, Schwartz KL, Zhao W, Abrahamse PH, Thomas DG, Jorns JM, Jewell R, Saber MES, Haque R, Katz SJ. Discordance between original and central laboratories in ER and HER2 results in a diverse, population-based sample. Breast Cancer Res Treat 2017; 161:375-384. [PMID: 27900490 PMCID: PMC5902386 DOI: 10.1007/s10549-016-4061-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 11/19/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the discordance between original and central laboratories in estrogen receptor (ER) status, in tumors originally deemed to be ER-negative, and in HER2 status in a diverse population-based sample. METHODS In a follow-up study of 1785 women with Stage I-III breast cancer diagnosed between 2005 and 2007 in the Detroit and Los Angeles County SEER registry catchment areas, participants were asked to consent to reassessment of ER (in tumors originally deemed to be ER-negative) and HER2 status on archival tumor samples approximately four years after diagnosis. Blocks were centrally prepared and analyzed for ER and HER2 using standardized methods and the guidelines of the American Society of Clinical Oncology and the College of American Pathologists. Analyses determined the discordance between original and central laboratories. RESULTS 132 (31%) of those eligible for ER reassessment and 367 (21%) eligible for HER2 reassessment had archival blocks reassessed centrally. ER discordance was only 6%. HER2 discordance by immunohistochemistry (IHC) was 26%, but final HER2 results-employing FISH in tumors that were IHC 2+ at the central laboratory-were discordant in only 6%. Half of the original laboratories did not perform their own assays. CONCLUSIONS Discordance between original and central laboratories in two large metropolitan areas was low in this population-based sample compared to previously reported patient samples. Centralization of testing for key pathology variables appears to be occurring in many hospitals. In addition, quality improvement efforts may have preceded the publication and dissemination of specialty society guidelines.
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Affiliation(s)
- Jennifer J Griggs
- University of Michigan, 2800 Plymouth Rd., Building 16, 116W, Ann Arbor, MI, 48109, USA.
| | - Ann S Hamilton
- Keck School of Medicine, University of Southern California, 2001 N. Soto St 318E, Los Angeles, CA, 90089, USA
| | - Kendra L Schwartz
- Wayne State University School of Medicine, 320 E. Canfield, Detroit, MI, 48201, USA
| | - Weiqiang Zhao
- The Ohio State University, 2001 Polaris Parkway, Columbus, OH, 43240, USA
| | - Paul H Abrahamse
- University of Michigan, 2800 Plymouth Rd., Building 16, 116W, Ann Arbor, MI, 48109, USA
| | - Dafydd G Thomas
- University of Michigan, 2800 Plymouth Rd., Building 16, 116W, Ann Arbor, MI, 48109, USA
| | - Julie M Jorns
- University of Michigan, 2800 Plymouth Rd., Building 16, 116W, Ann Arbor, MI, 48109, USA
| | - Rachel Jewell
- The Ohio State University, 2001 Polaris Parkway, Columbus, OH, 43240, USA
| | - Maria E Sibug Saber
- Keck School of Medicine, University of Southern California, 2001 N. Soto St 318E, Los Angeles, CA, 90089, USA
| | - Reina Haque
- Kaiser Permanente Southern California, Research & Evaluation, 100 S Los Robles, Pasadena, CA, 91101, USA
| | - Steven J Katz
- University of Michigan, 2800 Plymouth Rd., Building 16, 116W, Ann Arbor, MI, 48109, USA
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Bernhardt SM, Dasari P, Walsh D, Townsend AR, Price TJ, Ingman WV. Hormonal Modulation of Breast Cancer Gene Expression: Implications for Intrinsic Subtyping in Premenopausal Women. Front Oncol 2016; 6:241. [PMID: 27896218 PMCID: PMC5107819 DOI: 10.3389/fonc.2016.00241] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/27/2016] [Indexed: 12/12/2022] Open
Abstract
Clinics are increasingly adopting gene-expression profiling to diagnose breast cancer subtype, providing an intrinsic, molecular portrait of the tumor. For example, the PAM50-based Prosigna test quantifies expression of 50 key genes to classify breast cancer subtype, and this method of classification has been demonstrated to be superior over traditional immunohistochemical methods that detect proteins, to predict risk of disease recurrence. However, these tests were largely developed and validated using breast cancer samples from postmenopausal women. Thus, the accuracy of such tests has not been explored in the context of the hormonal fluctuations in estrogen and progesterone that occur during the menstrual cycle in premenopausal women. Concordance between traditional methods of subtyping and the new tests in premenopausal women is likely to depend on the stage of the menstrual cycle at which the tissue sample is taken and the relative effect of hormones on expression of genes versus proteins. The lack of knowledge around the effect of fluctuating estrogen and progesterone on gene expression in breast cancer patients raises serious concerns for intrinsic subtyping in premenopausal women, which comprise about 25% of breast cancer diagnoses. Further research on the impact of the menstrual cycle on intrinsic breast cancer profiling is required if premenopausal women are to benefit from the new technology of intrinsic subtyping.
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Affiliation(s)
- Sarah M Bernhardt
- Discipline of Surgery, School of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Woodville, SA, Australia; The Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Pallave Dasari
- Discipline of Surgery, School of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Woodville, SA, Australia; The Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - David Walsh
- Discipline of Surgery, School of Medicine, The Queen Elizabeth Hospital, University of Adelaide , Woodville, SA , Australia
| | - Amanda R Townsend
- Discipline of Surgery, School of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Woodville, SA, Australia; Department of Medical Oncology, The Queen Elizabeth Hospital, Woodville, SA, Australia
| | - Timothy J Price
- Discipline of Surgery, School of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Woodville, SA, Australia; Department of Medical Oncology, The Queen Elizabeth Hospital, Woodville, SA, Australia
| | - Wendy V Ingman
- Discipline of Surgery, School of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Woodville, SA, Australia; The Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
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Popescu I, Schrag D, Ang A, Wong M. Racial/Ethnic and Socioeconomic Differences in Colorectal and Breast Cancer Treatment Quality: The Role of Physician-level Variations in Care. Med Care 2016; 54:780-8. [PMID: 27326547 PMCID: PMC6173517 DOI: 10.1097/mlr.0000000000000561] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite a large body of research showing racial/ethnic and socioeconomic disparities in cancer treatment quality, the relative role of physician-level variations in care is unclear. OBJECTIVE To examine the effect of physicians on disparities in breast and colorectal cancer care. SUBJECTS Linked SEER Medicare data were used to identify Medicare beneficiaries diagnosed with colorectal and breast cancer during 1995-2007 and their treating physicians. RESEARCH DESIGN We identified treating physicians from Medicare claims data. We measured the use of NIH guideline-recommended therapies from SEER and Medicare claims data, and used logistic models to examine the relationship between race/ethnicity, socioeconomic status, and cancer quality of care. We used physician fixed effects to account for between-physician variations in treatment. RESULTS Minority and low socioeconomic status beneficiaries with breast and colorectal cancer were less likely to receive any recommended treatments as compared with whites. Overall, between-physician variation explained <20% of the total variation in quality of care. After accounting for between-physician differences, median household income explained 14.3%, 18.4%, and 13.2% of the variation in use of breast-conserving surgery, chemotherapy, and radiation for breast cancer, and 13.7%, 12.9%, and 12.6% of the within-physician variation in use of colorectal surgery, chemotherapy, and radiation for colorectal cancer, whereas race and ethnicity explained <2% of the within-physician variation in cancer care. CONCLUSIONS Between-physician variations partially explain racial disparities in cancer care. Residual within-physician disparities may be due to differences in patient-provider communication, patient preferences and treatment adherence, or unmeasured clinical severity.
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Affiliation(s)
- Ioana Popescu
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Los Angeles, CA
| | - Deborah Schrag
- Division of Population Sciences, Dana Farber Cancer Institute and the Harvard Medical School, Boston, MA
| | - Alfonso Ang
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Los Angeles, CA
| | - Mitchell Wong
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Los Angeles, CA
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Cress RD, Chen YS, Morris CR, Chew H, Kizer KW. Underutilization of gene expression profiling for early-stage breast cancer in California. Cancer Causes Control 2016; 27:721-7. [PMID: 27097910 DOI: 10.1007/s10552-016-0743-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/29/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the utilization of gene expression profiling (GEP) among California breast cancer patients, identify predictors of use of GEP, and evaluate how utilization of GEP influenced treatment of early-stage breast cancer. METHODS All women diagnosed with hormone-receptor-positive, node-negative breast cancer reported to the California Cancer Registry between January 2008 and December 2010 were linked to Oncotype DX (ODX) assay results. RESULTS Overall, 26.7 % of 23,789 eligible patients underwent the assay during the study period. Women age 65 or older were much less likely than women under age 50 to be tested (15.1 vs. 41.4 %, p < 0.001). Black women were slightly less likely and Asian women were slightly more likely than non-Hispanic white women to undergo GEP with the ODX assay (22.2 and 28.9 vs. 26.9 %, respectively, p < 0.001). Patients residing in low SES census tracts had the lowest use of the test (8.9 %), with the proportion increasing with higher SES category. Women with Medicaid health insurance were less likely than other women to be tested (17.7 vs. 27.5 %, p < 0.001). Receipt of adjuvant chemotherapy (ACT) was associated with the ODX recurrence score, although only 63 % of patients whose recurrence scores indicated a high benefit received ACT. Of patients not tested, 15 % received ACT. CONCLUSIONS Nearly three-fourths of eligible breast cancer patients in California during the 3-year period 2008 through 2010 did not undergo GEP. As a result, it is likely that many women unnecessarily received ACT and suffered associated morbidity. In addition, some high-risk women who would have benefited most from ACT were not identified.
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Affiliation(s)
- Rosemary D Cress
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, CA, USA.
- Cancer Registry of Greater California, Public Health Institute, 1825 Bell Street, Suite 102, Sacramento, CA, 95825, USA.
| | - Yingjia S Chen
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, CA, USA
| | - Cyllene R Morris
- California Cancer Reporting and Epidemiologic Surveillance Program, Institute for Population Health Improvement, University of California Davis Health System, Sacramento, CA, USA
| | - Helen Chew
- Division of Hematology/Oncology, UC Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Kenneth W Kizer
- California Cancer Reporting and Epidemiologic Surveillance Program, Institute for Population Health Improvement, University of California Davis Health System, Sacramento, CA, USA
- School of Medicine, University of California, Davis, Sacramento, CA, USA
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, USA
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Quantitative changes in skin composition parameters due to chemotherapy in breast cancer patients: a cohort study. Breast Cancer Res Treat 2015. [DOI: 10.1007/s10549-015-3502-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Reeder-Hayes KE, Wheeler SB, Mayer DK. Health disparities across the breast cancer continuum. Semin Oncol Nurs 2015; 31:170-7. [PMID: 25951746 DOI: 10.1016/j.soncn.2015.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To provide a brief overview of disparities across the spectrum of breast cancer incidence, treatment, and long-term care during the survivorship period. DATA SOURCES Review of the literature including research reports, review articles, and clinically based articles available through PubMed and CINAHL. CONCLUSION Minority women generally experience worse breast cancer outcomes despite a lower incidence of breast cancer than whites. A variety of factors contribute to this disparity, including advanced stage at diagnosis, higher rates of aggressive breast cancer subtypes, and lower receipt of appropriate therapies including surgery, chemotherapy, and radiation. Disparities in breast cancer care also extend into the survivorship trajectory, including lower rates of endocrine therapy use among some minority groups, as well as differences in follow-up and survivorship care. IMPLICATIONS FOR NURSING PRACTICE Breast cancer research should include improved minority representation and analyses by race, ethnicity, and socioeconomic status. While we cannot yet change the biology of this disease, we can encourage adherence to screening and treatment and help address the many physical, psychological, spiritual, and social issues minority women face in a culturally sensitive manner.
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Martinez KA, Li Y, Resnicow K, Graff JJ, Hamilton AS, Hawley ST. Decision Regret following Treatment for Localized Breast Cancer: Is Regret Stable Over Time? Med Decis Making 2014; 35:446-57. [PMID: 25532824 DOI: 10.1177/0272989x14564432] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 11/21/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND While studies suggest most women have little regret regarding their breast cancer treatment decisions immediately following treatment, no studies to date have evaluated how regret may change over time. OBJECTIVE To measure the stability of posttreatment decision regret over time among women with breast cancer. METHODS Women diagnosed with breast cancer between August 2005 and May 2007 reported to the Detroit, Michigan, or Los Angeles County Surveillance, Epidemiology, and End Results (SEER) registry and completed surveys at 9 months following diagnosis (time 1) and again approximately 4 years later (time 2). A decision regret scale consisting of 5 items was summed to create 2 decision regret scores at both time 1 and time 2 (range, 0-20). Multivariable linear regression was used to examine change in regret from 9 months to 4 years. Independent variables included surgery type, receipt of reconstruction, and recurrence status at follow-up. The model controlled for demographic and clinical factors. RESULTS The analytic sample included 1536 women. Mean regret in the overall sample was 4.9 at time 1 and 5.4 at time 2 (P < 0.001). In the multivariable linear model, we found no difference in change in decision regret over time by surgery type. Reporting a new diagnosis of breast cancer at time 2 was associated with a 2.6-point increase in regret over time compared with women without an additional diagnosis (P = 0.003). Receipt of reconstruction was not associated with change in decision regret over time. CONCLUSIONS Decision regret following treatment was low and relatively stable over time for most women. Those facing an additional diagnosis of breast cancer following treatment may be at risk for elevated regret-related distress.
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Affiliation(s)
- Kathryn A Martinez
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan (KAM, STH)
| | - Yun Li
- University of Michigan School of Public Health, Department of Biostatistics, Ann Arbor, Michigan (YL)
| | - Ken Resnicow
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, Ann Arbor, Michigan (KR)
| | - John J Graff
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey (JJG)
| | - Ann S Hamilton
- Keck School of Medicine, University of Southern California, Los Angeles, California (ASH)
| | - Sarah T Hawley
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan (KAM, STH),University of Michigan, Division of General Medicine, Ann Arbor, Michigan (STH)
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Polite BN, Griggs JJ, Moy B, Lathan C, duPont NC, Villani G, Wong SL, Halpern MT. American Society of Clinical Oncology policy statement on medicaid reform. J Clin Oncol 2014; 32:4162-7. [PMID: 25403206 PMCID: PMC4879717 DOI: 10.1200/jco.2014.56.3452] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Blase N Polite
- Blase N. Polite, University of Chicago, Chicago, IL; Jennifer J. Griggs and Sandra L. Wong, University of Michigan, Ann Arbor, MI; Beverly Moy, Massachusetts General Hospital; Christopher Lathan, Dana-Farber Cancer Institute, Boston, MA; Nefertiti C. duPont, Roswell Park Cancer Institute, Buffalo; Gina Villani, Ralph Lauren Center for Cancer Care and Prevention, New York, NY; and Michael T. Halpern, RTI International, Washington, DC.
| | - Jennifer J Griggs
- Blase N. Polite, University of Chicago, Chicago, IL; Jennifer J. Griggs and Sandra L. Wong, University of Michigan, Ann Arbor, MI; Beverly Moy, Massachusetts General Hospital; Christopher Lathan, Dana-Farber Cancer Institute, Boston, MA; Nefertiti C. duPont, Roswell Park Cancer Institute, Buffalo; Gina Villani, Ralph Lauren Center for Cancer Care and Prevention, New York, NY; and Michael T. Halpern, RTI International, Washington, DC
| | - Beverly Moy
- Blase N. Polite, University of Chicago, Chicago, IL; Jennifer J. Griggs and Sandra L. Wong, University of Michigan, Ann Arbor, MI; Beverly Moy, Massachusetts General Hospital; Christopher Lathan, Dana-Farber Cancer Institute, Boston, MA; Nefertiti C. duPont, Roswell Park Cancer Institute, Buffalo; Gina Villani, Ralph Lauren Center for Cancer Care and Prevention, New York, NY; and Michael T. Halpern, RTI International, Washington, DC
| | - Christopher Lathan
- Blase N. Polite, University of Chicago, Chicago, IL; Jennifer J. Griggs and Sandra L. Wong, University of Michigan, Ann Arbor, MI; Beverly Moy, Massachusetts General Hospital; Christopher Lathan, Dana-Farber Cancer Institute, Boston, MA; Nefertiti C. duPont, Roswell Park Cancer Institute, Buffalo; Gina Villani, Ralph Lauren Center for Cancer Care and Prevention, New York, NY; and Michael T. Halpern, RTI International, Washington, DC
| | - Nefertiti C duPont
- Blase N. Polite, University of Chicago, Chicago, IL; Jennifer J. Griggs and Sandra L. Wong, University of Michigan, Ann Arbor, MI; Beverly Moy, Massachusetts General Hospital; Christopher Lathan, Dana-Farber Cancer Institute, Boston, MA; Nefertiti C. duPont, Roswell Park Cancer Institute, Buffalo; Gina Villani, Ralph Lauren Center for Cancer Care and Prevention, New York, NY; and Michael T. Halpern, RTI International, Washington, DC
| | - Gina Villani
- Blase N. Polite, University of Chicago, Chicago, IL; Jennifer J. Griggs and Sandra L. Wong, University of Michigan, Ann Arbor, MI; Beverly Moy, Massachusetts General Hospital; Christopher Lathan, Dana-Farber Cancer Institute, Boston, MA; Nefertiti C. duPont, Roswell Park Cancer Institute, Buffalo; Gina Villani, Ralph Lauren Center for Cancer Care and Prevention, New York, NY; and Michael T. Halpern, RTI International, Washington, DC
| | - Sandra L Wong
- Blase N. Polite, University of Chicago, Chicago, IL; Jennifer J. Griggs and Sandra L. Wong, University of Michigan, Ann Arbor, MI; Beverly Moy, Massachusetts General Hospital; Christopher Lathan, Dana-Farber Cancer Institute, Boston, MA; Nefertiti C. duPont, Roswell Park Cancer Institute, Buffalo; Gina Villani, Ralph Lauren Center for Cancer Care and Prevention, New York, NY; and Michael T. Halpern, RTI International, Washington, DC
| | - Michael T Halpern
- Blase N. Polite, University of Chicago, Chicago, IL; Jennifer J. Griggs and Sandra L. Wong, University of Michigan, Ann Arbor, MI; Beverly Moy, Massachusetts General Hospital; Christopher Lathan, Dana-Farber Cancer Institute, Boston, MA; Nefertiti C. duPont, Roswell Park Cancer Institute, Buffalo; Gina Villani, Ralph Lauren Center for Cancer Care and Prevention, New York, NY; and Michael T. Halpern, RTI International, Washington, DC
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Wittayanukorn S, Qian J, Westrick SC, Billor N, Johnson B, Hansen RA. Treatment patterns among breast cancer patients in the United States using two national surveys on visits to physicians' offices and hospital outpatient departments. Res Social Adm Pharm 2014; 11:708-20. [PMID: 25582892 DOI: 10.1016/j.sapharm.2014.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/11/2014] [Accepted: 12/12/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Despite the availability of previous studies, little research has examined how types of anti-neoplastic agents prescribed differ among various populations and health care characteristics in ambulatory settings, which is a primary method of providing care in the U.S. Understanding treatment patterns can help identify possible disparities and guide practice or policy change. OBJECTIVES To characterize patterns of anti-neoplastic agents prescribed to breast cancer patients in ambulatory settings and identify factors associated with receipt of treatment. METHODS A cross-sectional analysis using the National Ambulatory Medical Care Survey data in 2006-2010 was conducted. Breast cancer treatments were categorized by class and further grouped as chemotherapy, hormone, and targeted therapy. A visit-level descriptive analysis using visit sampling weights estimated national prescribing trends (n = 2746 breast cancer visits, weighted n = 28,920,657). Multiple logistic regression analyses identified factors associated with anti-neoplastic agent used. RESULTS The proportion of visits in which anti-neoplastic agent(s) was/were documented remained stable from 2006 to 2010 (20.47% vs. 24.56%; P > 0.05). Hormones were commonly prescribed (29.69%) followed by mitotic inhibitors (9.86%) and human epidermal growth factor receptor2 inhibitors (5.34%). Patients with distant stage were more likely than patients with in-situ stage to receive treatment (Adjusted Odds Ratio [OR] = 2.79; 95% CI, 1.04-7.77), particularly chemotherapy and targeted therapy. Patients with older age, being ethnic minorities, having comorbid depression, and having U.S. Medicaid insurance were less likely to receive targeted therapy (P < 0.05). Patients with older age, having comorbid obesity and osteoporosis were less likely to receive chemotherapy, while patients seen in hospital-based settings and settings located in metropolitan areas were more likely to receive chemotherapy (P < 0.05). CONCLUSIONS Anti-neoplastic treatment patterns differ among breast cancer patients treated in ambulatory settings. Factors predicting treatment include certain socio-demographics, cancer stages, comorbidities, metropolitan areas, and setting.
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Affiliation(s)
- Saranrat Wittayanukorn
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, 020 James E Foy Hall, Auburn, AL 36849-5506, USA.
| | | | | | - Nedret Billor
- Auburn University, College of Sciences and Mathematics, USA
| | - Brandon Johnson
- East Alabama Medical Center, USA; Department of Internal Medicine, Edward via College of Osteopathic Medicine, AL, USA
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Smaldone MC, Handorf E, Kim SP, Thompson RH, Costello BA, Corcoran AT, Wong YN, Uzzo RG, Leibovich BC, Kutikov A, Boorjian SA. Temporal trends and factors associated with systemic therapy after cytoreductive nephrectomy: an analysis of the National Cancer Database. J Urol 2014; 193:1108-13. [PMID: 25444991 DOI: 10.1016/j.juro.2014.10.095] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE We evaluated temporal trends in systemic therapy use in patients undergoing cytoreductive nephrectomy for metastatic renal cell carcinoma. We used data from a large national cancer registry and assessed characteristics associated with the receipt of systemic treatment. MATERIALS AND METHODS We reviewed the NCDB to identify patients with stage IV renal cell carcinoma who underwent cytoreductive nephrectomy between 1998 and 2010. Systemic therapy was defined as immunotherapy and/or chemotherapy, including targeted agents. We evaluated associations between clinicopathological features and receipt of systemic therapy using multivariable logistic regression with generalized estimating equations. RESULTS Of 22,409 patients with metastatic renal cell carcinoma treated with cytoreductive nephrectomy 8,830 (39%) received systemic therapy. Use of systemic therapy increased from 32% of cases in 1998 to 49% in 2010 (p < 0.001). After adjustment older patient age (71 years or greater OR 0.36, CI 0.31-0.43), increasing comorbidity count (Charlson comorbidity index 2 or greater OR 0.79, 95% CI 0.68-0.92), papillary histology (OR 0.81, 95% CI 0.71-0.93), sarcomatoid histology (OR 0.88, 95% CI 0.80-0.98), Medicaid (OR 0.61, 95% CI 0.5-0.74), Medicare (OR 0.70, 95% CI 0.62-0.79) and no insurance (OR 0.75, 95% CI 0.63-0.91) were associated with significantly decreased systemic therapy use. Male gender (OR 1.05, 95% CI 1.02-1.08) predicted an increased likelihood of systemic therapy. CONCLUSIONS Systemic therapy in patients undergoing cytoreductive nephrectomy has increased with time, coinciding with the introduction of targeted therapies. Nevertheless, still less than half of such patients receive systemic treatment. While the etiology of the lack of treatment is likely multifactorial, the potential health policy implications of disparities in care warrant further investigation.
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Affiliation(s)
- Marc C Smaldone
- Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, Pennsylvania
| | - Elizabeth Handorf
- Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center-Temple University Health System, Philadelphia, Pennsylvania
| | - Simon P Kim
- Department of Urology, Yale University, New Haven, Connecticut
| | | | | | - Anthony T Corcoran
- Division of Urology, State University of New York at Stony Brook, Stony Brook, New York
| | - Yu-Ning Wong
- Division of Medical Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, Pennsylvania
| | - Robert G Uzzo
- Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, Pennsylvania
| | | | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, Pennsylvania
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Keegan THM, Press DJ, Tao L, DeRouen MC, Kurian AW, Clarke CA, Gomez SL. Impact of breast cancer subtypes on 3-year survival among adolescent and young adult women. Breast Cancer Res 2014; 15:R95. [PMID: 24131591 PMCID: PMC3978627 DOI: 10.1186/bcr3556] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 10/04/2013] [Indexed: 12/24/2022] Open
Abstract
Introduction Young women have poorer survival after breast cancer than do older women. It is unclear whether this survival difference relates to the unique distribution of hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2)-defined molecular breast cancer subtypes among adolescent and young adult (AYA) women aged 15 to 39 years. The purpose of our study was to examine associations between breast cancer subtypes and short-term survival in AYA women, as well as to determine whether the distinct molecular subtype distribution among AYA women explains the unfavorable overall breast cancer survival statistics reported for AYA women compared with older women. Methods Data for 5,331 AYA breast cancers diagnosed between 2005 and 2009 were obtained from the California Cancer Registry. Survival by subtype (triple-negative; HR+/HER2-; HR+/HER2+; HR-/HER2+) and age-group (AYA versus 40- to 64-year-olds) was analyzed with Cox proportional hazards regression with follow-up through 2010. Results With up to 6 years of follow-up and a mean survival time of 3.1 years (SD = 1.5 years), AYA women diagnosed with HR-/HER + and triple-negative breast cancer experienced a 1.6-fold and 2.7-fold increased risk of death, respectively, from all causes (HR-/HER + hazard ratio: 1.55; 95% confidence interval (CI): 1.10 to 2.18; triple-negative HR: 2.75; 95% CI, 2.06 to 3.66) and breast cancer (HR-/HER + hazard ratio: 1.63; 95% CI, 1.12 to 2.36; triple-negative hazard ratio: 2.71; 95% CI, 1.98 to 3.71) than AYA women with HR+/HER2- breast cancer. AYA women who resided in lower socioeconomic status neighborhoods, had public health insurance, and were of Black, compared with White, race/ethnicity experienced worse survival. This race/ethnicity association was attenuated somewhat after adjusting for breast cancer subtypes (hazard ratio, 1.33; 95% CI, 0.98 to 1.82). AYA women had similar all-cause and breast cancer-specific short-term survival as older women for all breast cancer subtypes and across all stages of disease. Conclusions Among AYA women with breast cancer, short-term survival varied by breast cancer subtypes, with the distribution of breast cancer subtypes explaining some of the poorer survival observed among Black, compared with White, AYA women. Future studies should consider whether distribution of breast cancer subtypes and other factors, including differential receipt of treatment regimens, influences long-term survival in young compared with older women.
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Loibl S, Reinisch M. Present status of adjuvant chemotherapy for elderly breast cancer patients. ACTA ACUST UNITED AC 2014; 7:439-44. [PMID: 24715824 DOI: 10.1159/000345867] [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] [Indexed: 01/24/2023]
Abstract
Elderly breast cancer patients are underrepresented in clinical trials, leading to a lack of knowledge regarding their tolerance of modern chemotherapy regimens. In addition, physicians are often reluctant to treat older patients with chemotherapy due to potential side effects. This article summarizes the up-to-date literature on chemotherapy in elderly patients with breast cancer, evaluates the impact of the patients' comorbidities and treatment alterations and aims to encourage treating patients adequately according to their disease in combination with the biological age rather than the chronological age alone. Finally, a short overview is given of the recruiting studies in Europe evaluating chemotherapy in elderly patients.
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Affiliation(s)
- Sibylle Loibl
- German Breast Group, Neu-Isenburg, Germany ; Städtische Kliniken Offenbach, Germany
| | - Mattea Reinisch
- German Breast Group, Neu-Isenburg, Germany ; Frauenklinik, Bürgerhospital Frankfurt/M., Germany
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The State of Cancer Care in America, 2014: A Report by the American Society of Clinical Oncology. J Oncol Pract 2014; 10:119-42. [DOI: 10.1200/jop.2014.001386] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This publication is ASCO's inaugural report on the state of cancer care in America. Going forward, these annual reports will track progress against cancer and examine the most important trends that affect the oncology community's ability to provide high-quality, high-value cancer care.
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Friese CR, Martinez KA, Abrahamse P, Hamilton AS, Graff JJ, Jagsi R, Griggs JJ, Hawley ST, Katz SJ. Providers of follow-up care in a population-based sample of breast cancer survivors. Breast Cancer Res Treat 2014; 144:179-84. [PMID: 24481682 DOI: 10.1007/s10549-014-2851-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 01/20/2014] [Indexed: 10/25/2022]
Abstract
To describe which providers provide breast cancer survivorship care, we conducted a longitudinal survey of nonmetastatic breast cancer patients identified by the SEER registries of Los Angeles and Detroit. Multinomial logistic regression examined the adjusted odds of surgeon compared with a medical oncologist follow-up or primary care provider compared with medical oncologist follow-up, adjusting for age, race/ethnicity, insurance, tumor stage, receipt of chemotherapy, endocrine therapy use, and visit to a medical oncologist at the time of diagnosis. Results were weighted to account for sample selection and nonresponse. 844 women had invasive disease and received chemotherapy or endocrine therapy. 65.2 % reported medical oncologists as their main care provider at 4 years, followed by PCP/other physicians (24.3 %) and surgeons (10.5 %). Black women were more likely to receive their follow-up care from surgeons (OR 2.47, 95 % CI 1.16-5.27) or PCP/other physicians (OR 2.62, 95 % CI 1.47-4.65) than medical oncologists. Latinas were more likely to report PCP/other physician follow-up than medical oncologists (OR 2.33, 95 % CI 1.15-4.73). Compared with privately insured women, Medicaid recipients were more likely to report PCP/other physician follow-up (OR 2.52, 95 % CI 1.24-5.15). Women taking endocrine therapy 4 years after diagnosis were less likely to report surgeons or PCP/other physicians as their primary provider of breast cancer follow-up care. Different survivorship care patterns emerge on race/ethnicity and insurance status. Interventions are needed to inform patients and providers on the recommended sources of breast cancer follow-up.
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Affiliation(s)
- Christopher R Friese
- School of Nursing, University of Michigan, 400 North Ingalls Building, Ann Arbor, MI, 48109-5482, USA,
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Silva A, Rauscher GH, Hoskins K, Rao R, Ferrans CE. Assessing racial/ethnic disparities in chemotherapy treatment among breast cancer patients in context of changing treatment guidelines. Breast Cancer Res Treat 2013; 142:667-72. [PMID: 24265033 DOI: 10.1007/s10549-013-2759-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 10/30/2013] [Indexed: 10/26/2022]
Abstract
Conflicting study results with regards to racial/ethnic disparities in chemotherapy use among breast cancer patients may be due to the different sample populations, treatment data sources, and treatment eligibility definitions used. This study examined chemotherapy disparity in the context of changing treatment guidelines and explored factors that may help explain treatment differences observed. The data come from a population-based study that included interview and medical record data (including state cancer registry) from non-Hispanic (nH) White, nH Black, and Hispanic breast cancer patients diagnosed in 2005-2008. Logistic regression using model-based standardization was used to estimate age-adjusted risk differences and multivariate analysis was conducted to identify explanatory factors of the differences. Per the 2005/2006 National Comprehensive Cancer Network (NCCN) guidelines, minority patients appeared more likely than nH White patients to receive a chemotherapy recommendation (0.87 vs 0.75, p = 0.003). When eligibility was determined per the 2007 guidelines, there was no disparity because under these guidelines, nH White patients were more likely than minority patients to have tumors that no longer required chemotherapy. There was evidence that chemotherapy advances for breast cancer patients are implemented in the clinical setting well ahead of NCCN guidelines. Finally, among eligible patients, chemotherapy recommendation was very high and virtually always accepted and received, with no disparities found at these points of clinical care. The findings suggest that an evaluation of guideline-adherent chemotherapy treatment patterns must carefully consider the definition of treatment eligibility, given ongoing changes in treatment guidelines and early uptake of new diagnostic tools and treatments.
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Affiliation(s)
- Abigail Silva
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, USA,
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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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The impact of the Oncotype Dx breast cancer assay in clinical practice: a systematic review and meta-analysis. Breast Cancer Res Treat 2013; 141:13-22. [PMID: 23974828 DOI: 10.1007/s10549-013-2666-z] [Citation(s) in RCA: 158] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 08/09/2013] [Indexed: 12/20/2022]
Abstract
The impact of the Oncotype Dx (ODX) breast cancer assay on adjuvant chemotherapy (ACT) treatment decisions has been evaluated in many previous studies. However, it can be difficult to interpret the collective findings, which were conducted in diverse settings with limited sample sizes. We conducted a systematic review and meta-analysis to synthesize the results and provide insights about ODX utility. Studies, identified from PubMed, Embase, ASCO, and SABCS, were included if patients had ER+, node -, early-stage breast cancer, reported use of ODX to inform actual ACT decisions. Information was summarized and pooled according to: (1) distribution of ODX recurrence scores (RS), (2) impact of ODX on ACT recommendations, (3) impact of ODX on ACT use, and (4) proportion of patients following the treatment suggested by the ODX RS. A total of 23 studies met inclusion criteria. The distribution of RS categories was 48.8 % low, 39.0 % intermediate, and 12.2 % high (21 studies, 4,156 patients). ODX changed the clinical-pathological ACT recommendation in 33.4 % of patients (8 studies, 1,437 patients). In patients receiving ODX, receipt of ACT were: 28.2 % overall, 5.8 % low, 37.4 % intermediate, and 83.4 % high. Low RS patients were significantly more likely to follow the treatment suggested by ODX versus high RS patients RR: 1.07 (1.01–1.14) [corrected].The pooled results are consistent with most individual studies to date. The increased proportion of intermediate scores relative to original estimates may have implications for the clinical utility and cost impacts of testing. In addition, low versus high RS patients were significantly more likely to follow the ODX results, suggesting a tendency toward less aggressive treatment, despite a high ODX RS. Finally, there was a lack of studies on the impact of ODX on ACT use versus standard approaches, suggesting that additional studies are warranted.
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Harder H, Ballinger R, Langridge C, Ring A, Fallowfield LJ. Adjuvant chemotherapy in elderly women with breast cancer: patients' perspectives on information giving and decision making. Psychooncology 2013; 22:2729-35. [DOI: 10.1002/pon.3338] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 05/21/2013] [Accepted: 05/21/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Helena Harder
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton and Sussex Medical School; University of Sussex; Falmer UK
| | - Rachel Ballinger
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton and Sussex Medical School; University of Sussex; Falmer UK
| | - Carolyn Langridge
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton and Sussex Medical School; University of Sussex; Falmer UK
| | - Alistair Ring
- Brighton and Sussex Medical School and Sussex Cancer Centre; Royal Sussex County Hospital; Brighton UK
| | - Lesley J. Fallowfield
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton and Sussex Medical School; University of Sussex; Falmer UK
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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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Blinder VS. Disparities in breast cancer outcomes: receipt of chemotherapy is only part of the story. J Clin Oncol 2012; 30:3041-3. [PMID: 22869880 DOI: 10.1200/jco.2012.44.3416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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