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 |
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| Affiliation: | 1. Epidemiology Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States;2. 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;3. Biostatistics Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States;4. School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, United States;1. Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio;2. Department of Urology, University Hospitals Case Medical Center, Cleveland, Ohio;3. Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas;4. Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois;1. Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA;2. Dartmouth University School of Medicine, Hanover, New Hampshire, USA;3. Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA;4. University of Texas School of Medicine, Houston, Texas, USA;5. Digestive Health Physicians, Cheektowaga, New York, USA;6. Stanford University School of Medicine, Palo Alto, California, USA;7. Columbia University School of Medicine, New York, New York, USA;8. Atlanta Gastroenterology Associates, Atlanta, Georgia, USA;9. UCLA School of Medicine, Los Angeles, California, USA;10. Gastrointestinal Associates, Knoxville, Tennessee, USA;1. Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ;2. Biometrics Division, Department of Biostatistics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ;3. Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ;1. Eindhoven Cancer Registry, Comprehensive Cancer Centre South, PO Box 231, 5600 AE Eindhoven, The Netherlands;2. Department of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands;3. Department of Surgery, St. Elisabeth Hospital Tilburg, PO Box 90151, 5000 LC Tilburg, The Netherlands;4. Department of Public Health, Erasmus University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands;5. Department of Radiology, Canisius Wilhelmina Hospital, PO Box 9015, 6500 GS Nijmegen, The Netherlands;6. Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, 5000 LE Tilburg, The Netherlands;1. The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland;2. Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland;1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada;2. Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany;3. Department of Urology, Ruhr University Bochum, Marienhospital, Herne, Germany;4. Department of Urology, Medical University of Vienna, Vienna, Austria;5. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;6. Department of Urology, Vita-Salute, San Raffaele University, Milan, Italy;7. Department of Urology, University of Montreal Health Centre, Montreal, Canada |
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| Abstract: | BackgroundThe study aimed to examine racial/ethnic differences in chemotherapy utilization by breast cancer subtype.MethodsData 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.ResultsThe 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.ConclusionsCompared 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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| Keywords: | Racial/ethnic differences Chemotherapy Breast cancer subtype National Program of Cancer Registries |
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