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Racial disparities in treatment and survival among women with early-stage breast cancer.
J Clin Oncol. 2005 Sep 20; 23(27):6639-46.JC

Abstract

PURPOSE

Black women with breast cancer are known to have poorer survival than white women. Suboptimal treatment may compromise the survival benefits of adjuvant chemotherapy. We analyzed the association of race and survival with duration of treatment and number of treatment cycles among women receiving chemotherapy for early-stage breast cancer.

PATIENTS AND METHODS

Patients were women in the Henry Ford Health System tumor registry who were diagnosed with stage I/II breast cancer between January 1, 1996, and December 31, 2001, who received adjuvant chemotherapy. We calculated an observed/expected ratio of treatment duration and of completed chemotherapy cycles for each patient. Using Cox proportional hazards models, we analyzed the association of early treatment termination and treatment duration with all-cause mortality, controlling for age, race, stage, hormone receptor status, grade, comorbidity score, and doxorubicin use.

RESULTS

Of 472 eligible patients, 28% (31% black, 23% white; P = .03) received fewer cycles of treatment than expected. Black race, receipt of < or = 75% of the expected number of cycles, increasing age, hormone receptor negativity, and a comorbidity score of more than 1 were associated with poorer survival. Among the 344 patients receiving the expected number of cycles, 60% experienced delays. These delays did not reduce survival.

CONCLUSION

This study is the first to find that a substantial fraction of women with early-stage breast cancer terminated their chemotherapy prematurely and that early termination was associated with both black race and poorer survival. A better understanding of the determinants of suboptimal treatment may lead to interventions that can reduce racial disparities and improve breast cancer outcomes for all women.

Authors+Show Affiliations

Department of Medicine and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, New York, NY, USA. dlh23@columbia.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

16170171

Citation

Hershman, Dawn, et al. "Racial Disparities in Treatment and Survival Among Women With Early-stage Breast Cancer." Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, vol. 23, no. 27, 2005, pp. 6639-46.
Hershman D, McBride R, Jacobson JS, et al. Racial disparities in treatment and survival among women with early-stage breast cancer. J Clin Oncol. 2005;23(27):6639-46.
Hershman, D., McBride, R., Jacobson, J. S., Lamerato, L., Roberts, K., Grann, V. R., & Neugut, A. I. (2005). Racial disparities in treatment and survival among women with early-stage breast cancer. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 23(27), 6639-46.
Hershman D, et al. Racial Disparities in Treatment and Survival Among Women With Early-stage Breast Cancer. J Clin Oncol. 2005 Sep 20;23(27):6639-46. PubMed PMID: 16170171.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Racial disparities in treatment and survival among women with early-stage breast cancer. AU - Hershman,Dawn, AU - McBride,Russell, AU - Jacobson,Judith S, AU - Lamerato,Lois, AU - Roberts,Kevin, AU - Grann,Victor R, AU - Neugut,Alfred I, PY - 2005/9/20/pubmed PY - 2005/10/28/medline PY - 2005/9/20/entrez SP - 6639 EP - 46 JF - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JO - J Clin Oncol VL - 23 IS - 27 N2 - PURPOSE: Black women with breast cancer are known to have poorer survival than white women. Suboptimal treatment may compromise the survival benefits of adjuvant chemotherapy. We analyzed the association of race and survival with duration of treatment and number of treatment cycles among women receiving chemotherapy for early-stage breast cancer. PATIENTS AND METHODS: Patients were women in the Henry Ford Health System tumor registry who were diagnosed with stage I/II breast cancer between January 1, 1996, and December 31, 2001, who received adjuvant chemotherapy. We calculated an observed/expected ratio of treatment duration and of completed chemotherapy cycles for each patient. Using Cox proportional hazards models, we analyzed the association of early treatment termination and treatment duration with all-cause mortality, controlling for age, race, stage, hormone receptor status, grade, comorbidity score, and doxorubicin use. RESULTS: Of 472 eligible patients, 28% (31% black, 23% white; P = .03) received fewer cycles of treatment than expected. Black race, receipt of < or = 75% of the expected number of cycles, increasing age, hormone receptor negativity, and a comorbidity score of more than 1 were associated with poorer survival. Among the 344 patients receiving the expected number of cycles, 60% experienced delays. These delays did not reduce survival. CONCLUSION: This study is the first to find that a substantial fraction of women with early-stage breast cancer terminated their chemotherapy prematurely and that early termination was associated with both black race and poorer survival. A better understanding of the determinants of suboptimal treatment may lead to interventions that can reduce racial disparities and improve breast cancer outcomes for all women. SN - 0732-183X UR - https://www.unboundmedicine.com/medline/citation/16170171/Racial_disparities_in_treatment_and_survival_among_women_with_early_stage_breast_cancer_ L2 - https://ascopubs.org/doi/10.1200/JCO.2005.12.633?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -