Abstract
Purpose
We conducted a systematic review and meta-analysis to measure the extent to which race is associated with delayed initiation or receipt of inadequate chemotherapy among women with early-stage breast cancer.
Methods
We performed a systematic search of all articles published from January 1987 until June 2017 within four databases: PubMed/Medline, EMBASE, CINAHL, and Cochrane CENTRAL. Eligible studies were US-based and examined the influence of race on chemotherapy delays, cessation, or dose reductions among women with stage I, II, or III breast cancer. Data were pooled using a random effects model.
Results
A total of twelve studies were included in the quantitative analysis. Blacks were significantly more likely than whites to have delays to initiation of adjuvant therapy of 90 days or more (OR 1.41, 95% CI 1.06–1.87; X² = 31.05, p < 0.00001; I² = 90%). There was no significant association between race and chemotherapy dosing. Due to overlap between studies assessing the relationship between race and completion of chemotherapy, we conducted two separate analyses. Black patients were significantly more likely to discontinue chemotherapy, however, this was no longer statistically significant when larger numbers of patients with more advanced (stage III) breast cancer were included.
Conclusions
These results suggest that black breast cancer patients experience clinically relevant delays in the initiation of adjuvant chemotherapy more often than white patients, which may in part explain the increased mortality observed among black patients.
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References
Yu KD, Huang S, Zhang JX, Liu GY, Shao ZM (2013) Association between delayed initiation of adjuvant CMF or anthracycline-based chemotherapy and survival in breast cancer: a systematic review and meta-analysis. BMC Cancer 13:240
Biagi JJRM, King WD, Kong W, Booth CM, Mackillop WJ (2011) The effect of delay in time to adjuvant chemotherapy (TTAC) on survival in breast cancer (BC): a systematic review and meta-analysis. J Clin Oncol 29(15):1128–1128
Chavez-MacGregor M, Clarke CA, Lichtensztajn DY, Giordano SH (2016) Delayed initiation of adjuvant chemotherapy among patients with breast cancer. JAMA Oncol 2(3):322–329
Hryniuk W, Bush H (1984) The importance of dose intensity in chemotherapy of metastatic breast cancer. J Clin Oncol 2(11):1281–1288
Wood WC, Budman DR, Korzun AH et al (1994) Dose and dose intensity of adjuvant chemotherapy for stage II, node-positive breast carcinoma. N Engl J Med 330(18):1253–1259
Budman DR, Berry DA, Cirrincione CT et al (1998) Dose and dose intensity as determinants of outcome in the adjuvant treatment of breast cancer. The Cancer and Leukemia Group B. J Natl Cancer Inst 90(16):1205–1211
Pronzato P, Campora E, Amoroso D et al (1989) Impact of administration-related factors on outcome of adjuvant chemotherapy for primary breast cancer. Am J Clin Oncol 12(6):481–485
Hryniuk W, Levine MN (1986) Analysis of dose intensity for adjuvant chemotherapy trials in stage II breast cancer. J Clin Oncol 4(8):1162–1170
Bonadonna G, Valagussa P, Moliterni A, Zambetti M, Brambilla C (1995) Adjuvant cyclophosphamide, methotrexate, and fluorouracil in node-positive breast cancer: the results of 20 years of follow-up. N Engl J Med 332(14):901–906
Wheeler SB, Reeder-Hayes KE, Carey LA (2013) Disparities in breast cancer treatment and outcomes: Biological, social, and health system determinants and opportunities for research. Oncologist 18(9):986–993
Hershman D, Weinberg M, Rosner Z et al (2003) Ethnic neutropenia and treatment delay in African American women undergoing chemotherapy for early-stage breast cancer. J Natl Cancer Inst 95(20):1545–1548
Bain BJ (1996) Ethnic and sex differences in the total and differential white cell count and platelet count. J Clin Pathol 49(8):664–666
Penner LA, Eggly S, Griggs JJ, Underwood W III, Orom H, Albrecht TL (2012) Life-threatening disparities: the treatment of black and white cancer patients. J Soc Issues 68(2):328–357
Green AR, Carney DR, Pallin DJ et al (2007) Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. J Genet Intern Med 22(9):1231–1238
O’Malley AS, Sheppard VB, Schwartz M, Mandelblatt J (2004) The role of trust in use of preventive services among low-income African-American women. Prev Med 38(6):777–785
Griggs JJ, Liu Y, Sorbero ME, Jagielski CH, Maly RC (2014) Adjuvant chemotherapy dosing in low-income women: the impact of Hispanic ethnicity and patient self-efficacy. Br Cancer Res Treat 144(3):665–672
Griggs JJ, Culakova E, Sorbero ME et al (2007) Effect of patient socioeconomic status and body mass index on the quality of breast cancer adjuvant chemotherapy. J Clin Oncol 25(3):277–284
Griggs JJ, Sorbero ME, Stark AT, Heininger SE, Dick AW (2003) Racial disparity in the dose and dose intensity of breast cancer adjuvant chemotherapy. Breast Cancer Res Treat 81(1):21–31
Hershman DL, Unger JM, Barlow WE et al (2009) Treatment quality and outcomes of African American versus white breast cancer patients: retrospective analysis of southwest oncology studies S8814/S8897. J Clin Oncol 27(13):2157–2162
Lyman GH, Dale DC, Crawford J (2003) Incidence and predictors of low dose-intensity in adjuvant breast cancer chemotherapy: a nationwide study of community practices. J Clin Oncol 21(24):4524–4531
Hershman D, McBride R, Jacobson JS et al (2005) Racial disparities in treatment and survival among women with early-stage breast cancer. J Clin Oncol 23(27):6639–6646
Simon MS, Lamerato L, Krajenta R et al (2012) Racial differences in the use of adjuvant chemotherapy for breast cancer in a large urban integrated health system. Int J Br cancer 2012:453985
McLaughlin JM, Anderson RT, Ferketich AK, Seiber EE, Balkrishnan R, Paskett ED (2012) Effect on survival of longer intervals between confirmed diagnosis and treatment initiation among low-income women with breast cancer. J Clin Oncol 30(36):4493–4500
Gwyn K, Bondy ML, Cohen DS et al (2004) Racial differences in diagnosis, treatment, and clinical delays in a population-based study of patients with newly diagnosed breast carcinoma. Cancer 100(8):1595–1604
Gorin SS, Heck JE, Cheng B, Smith SJ (2006) Delays in breast cancer diagnosis and treatment by racial/ethnic group. Arch Intern Med 166(20):2244–2252
Vandergrift JL, Niland JC, Theriault RL et al (2013) Time to adjuvant chemotherapy for breast cancer in National Comprehensive Cancer Network institutions. J Natl Cancer Inst 105(2):104–112
Hershman DL, Wang X, McBride R, Jacobson JS, Grann VR, Neugut AI (2006) Delay of adjuvant chemotherapy initiation following breast cancer surgery among elderly women. Breast Cancer Res Treat 99(3):313–321
Fedewa SA, Ward EM, Stewart AK, Edge SB (2010) Delays in adjuvant chemotherapy treatment among patients with breast cancer are more likely in African American and Hispanic populations: a national cohort study 2004–2006. J Clin Oncol 28(27):4135–4141
Nurgalieva ZZ, Franzini L, Morgan RO, Vernon SW, Liu CC, Du XL (2013) Impact of timing of adjuvant chemotherapy initiation and completion after surgery on racial disparities in survival among women with breast cancer. Med Oncol 30(1):419
de Gagliato M, Gonzalez-Angulo AM, Lei X et al (2014) Clinical impact of delaying initiation of adjuvant chemotherapy in patients with breast cancer. J Clin Oncol 32(8):735–744
Reyes SA, King TA, Fei K, Franco R, Bickell NA (2016) Factors affecting the completion of adjuvant chemotherapy in early-stage breast cancer. Ann Surg Oncol 23(5):1537–1542
Yi M, Mittendorf EA, Cormier JN et al (2011) Novel staging system for predicting disease-specific survival in patients with breast cancer treated with surgery as the first intervention: time to modify the current American Joint Committee on Cancer staging system. J Clin Oncol 29(35):4654–4661
Jemal A, Robbins AS, Lin CC et al (2018) Factors that contributed to black-white disparities in survival among nonelderly women with breast cancer between 2004 and 2013. J Clin Oncol 36(1):14–24
Acknowledgements
Nina A. Bickell MD MPH, Dawn L. Hershman MD MS, and Joseph Unger, PhD MS for provision of data used in the meta-analysis.
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Green, A.K., Aviki, E.M., Matsoukas, K. et al. Racial disparities in chemotherapy administration for early-stage breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat 172, 247–263 (2018). https://doi.org/10.1007/s10549-018-4909-5
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DOI: https://doi.org/10.1007/s10549-018-4909-5