Effect of race/ethnicity and treatment delay on breast cancer survival

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6063-6063
Author(s):  
S. Sheinfeld Gorin ◽  
J. E. Heck ◽  
B. Cheng ◽  
S. Smith
Keyword(s):  
Breast Cancer ◽  
Propensity Score ◽  
Cancer Treatment ◽  
Propensity Score Analysis ◽  
Large Population ◽  
Treatment Delay ◽  
Breast Cancer Treatment ◽  
Treatment Type ◽  
Increased Risk ◽  
Race Ethnicity

6063 Background: Several papers have examined the relationship between treatment delay and survival among patients who are diagnosed with cancer. None has yet relied on a large, population-based dataset to systematically examine survival among women within different ethnic/racial groups who delay breast cancer treatment. Methods: Subjects were 49,865 female Medicare enrollees age 65 and older who were diagnosed with breast cancer between 1992 and 1999 and identified by the Surveillance, Epidemiology, and End Results (SEER) program. Dates of their health care visits were identified through the linkage of SEER with Medicare claims data. Mortality from breast cancer was assessed through linkage with death certificates. Propensity score analyses that compared patients matched according to their propensity to receive treatment were used to balance patient characteristics between treatment groups, as would occur in a randomized clinical trial. Results: A propensity score analysis and a Cox proportional hazards model of survival (with adjustments for ER/PR status, treatment type, race/ethnicity, stage, age, comorbidities, marital status, poverty status, geographic location, and average number of service contacts) revealed that subjects with 1-month delay in the start of treatment had a reduced likelihood of survival (adjusted HR=1.17, 95% CI, 1.06–1.30) relative to those with less delay. Blacks had significantly lessened survival than women in other races/ethnicities (adjusted HR=1.23, 95% CI, 1.00–1.52). Receipt of radiation (adjusted HR=1.45, 95% CI, 1.24–1.69), chemotherapy (adjusted HR=1.73, 95% CI, 1.51–1.99), stage three diagnosis (adjusted HR=1.35, 95% CI, 1.08–1.70), being age 70 or older (adjusted HR=1.24, 95% CI, 1.09–1.41), or having 2 or more comorbidities (adjusted HR=1.47, 95% CI, 1.12–1.92) also predicted reduced survival from breast cancer. Conclusions: One month delay in accessing breast cancer treatment has a clear relationship to reduced survival, particularly among older, later-stage, comorbid black women who receive chemotherapy or radiation. Mechanisms for rapid access to treatment, using both provider- and system-based strategies, are recommended for these women who are at increased risk for breast cancer-related mortality. No significant financial relationships to disclose.

Killing time: Treatment delay and breast cancer survival

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6589-6589
Author(s):  
S. Sheinfeld Gorin ◽  
J. E. Heck ◽  
B. Cheng
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Propensity Scores ◽  
Cancer Survival ◽  
Treatment Delay ◽  
Breast Cancer Treatment ◽  
Breast Cancer Survival ◽  
Access To Treatment ◽  
Breast Cancer Death ◽  
Increased Risk

6589 Introduction: Treatment delay is commonly associated with reduced breast cancer survival. Inadequate or delayed follow-up for positive findings is the most common reason for breast cancer-related litigation in the U.S. The United Kingdom has made improvements in the delivery of breast cancer services a priority for resources with the aim of reducing delays. Yet, the evidence for the association of delay and breast cancer survival is mixed. Most studies rely on small, non-representative cohorts, treatment approaches have changed over the time since the the most widely-cited review. Studies cite wide variations in delay, and some research is subject to publication or lead time bias. Aims. The purpose of this study is to examine the influence of 3-month breast cancer treatment delay on survival using a large, longitudinal, population-based dataset to provide more definitive findings. Methods: Subjects were 43,359 female Medicare enrollees age 65 and older who were diagnosed with breast cancer between 1992 and 1999 and identified by the Surveillance, Epidemiology, and End Results (SEER) program for whom treatment delay information could be obtained. Billing claims from inpatient, outpatient and provider visits were used. Mortality from breast cancer was assessed through SEER linkage with death certificates. Using propensity scores to balance the comparison groups, the association between treatment delays of three months or more and cancer survival time were analyzed using Cox proportional hazards models with gamma frailty to account for the clustering effect due to census tract. To account for known predictors of breast cancer survival, in addition to the propensity scores, we adjusted for cancer stage, comorbidity, marital status, tumor characteristics, location, detection by screening or diagnostic mammography, and the average number of health provider visits during the study period. Results: Subjects who had over a three month delay in receiving any treatment had a 34% increased risk of breast cancer death by comparison to women with delays less than three months (adjusted Hazard ratio 1.34, 1.01–1.77). Discussion: Three-month delays in accessing breast cancer treatment have a clear relationship to survival. Rapid access to treatment is recommended for all women with breast cancer. No significant financial relationships to disclose.

Seroma indicates increased risk of lymphedema following breast cancer treatment: A retrospective cohort study

The Breast ◽  
2017 ◽  
Vol 32 ◽  
pp. 102-104 ◽  
Author(s):  
Navid Mohamadpour Toyserkani ◽  
Mads Gustaf Jørgensen ◽  
Karen Haugaard ◽  
Jens Ahm Sørensen
Keyword(s):  
Breast Cancer ◽  
Cohort Study ◽  
Cancer Treatment ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Breast Cancer Treatment ◽  
Increased Risk

Risk for SARS-CoV-2 infection in patients with breast cancer treated with chemotherapy, biologic therapy or active surveillance: Patient outcomes from multicenter institution in New York.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1513-1513
Author(s):  
Nibash Budhathoki ◽  
John Kucharczyk ◽  
Nina D'Abreo ◽  
Maryann J. Kwa ◽  
Magdalena Plasilova ◽  
...  
Keyword(s):  
Breast Cancer ◽  
New York ◽  
Cancer Treatment ◽  
Early Stage ◽  
Cancer Center ◽  
Her2 Positive ◽  
Real World Data ◽  
Early Stage Disease ◽  
Treatment Type ◽  
Increased Risk

1513 Background: In high-risk estrogen-receptor positive, HER2 positive, or triple negative breast cancer (BC), chemotherapy can increase cure rates in early-stage disease and prolong survival in setting of advanced disease. Real world data specific to BC is needed to counsel patients (pts) with BC on their risk for SARS-CoV-2 infection and mortality in the context of the SARS-CoV-2 pandemic. Methods: In this retrospective study, we abstracted clinical data including demographics, tumor histology, cancer treatment, and COVID-19 testing results status from the electronic medical record of 3778 BC patients who received cancer care from 02/01/2020 – 05/01/2020 in New York City at our cancer center. The primary endpoint of the study was incidence of SARS-CoV-2 infection by treatment type (cytotoxic chemotherapy (CT) vs non-cytotoxic therapies (endocrine and/or HER2 directed therapy (E/H)) diagnosed by either serology, RT-PCR, or documented clinical diagnosis. Probability of Treatment Weighting (IPTW) and Mann-Whitney Test were used to assess risk of SARS-CoV-2 infection by treatment and assess outcomes based on oncologic and non-oncologic risk factors respectively. Results: 3062 patients met inclusion criteria with 379 pts in CT, 2343 pts in E/H and 340 in NT groups. During study period 641 patients (20.9%) were tested by either PCR or serology with 64 patients (2.1%) diagnosed with COVID-19. All pts who tested positive by PCR and subsequently had serology testing were positive for IgG. The weighted risk of SARS-COV-2 infection was 3.5% in CT vs. 2.7% in E/H (p=0.523). 27 patients (0.9%) expired over follow up, with 10 deaths attributed to SARS-CoV-2 infection. The weighted risk for death was 0.7% with CT vs. 0.1% with E/H, p=0.24 (Table A). Age, BMI,CCI and advanced cancer stage were associated with increased mortality following SARS-CoV-2 infection (Table). Conclusions: CT was not associated with increased risk of infection with SARS-CoV-2 infection or death following infection. BC cancer treatment, including CT, can be safely administered with enhanced infectious precautions and should not be withheld particularly when given for curative intent.[Table: see text]

scholarly journals Determinants of Breast Cancer Treatment Delay Differ for African American and White Women

2013 ◽  
Vol 22 (7) ◽  
pp. 1227-1238 ◽  
Author(s):  
Sasha A. McGee ◽  
Danielle D. Durham ◽  
Chiu-Kit Tse ◽  
Robert C. Millikan
Keyword(s):  
Breast Cancer ◽  
African American ◽  
Cancer Treatment ◽  
White Women ◽  
Treatment Delay ◽  
Breast Cancer Treatment

Aromatase inhibitors and breast cancer

2012 ◽  
Vol 9 (2) ◽  
Author(s):  
Saranya Chumsri ◽  
Angela Brodie
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Aromatase Inhibitors ◽  
Hormone Receptor ◽  
Breast Cancer Treatment ◽  
Cancer Resistance ◽  
Hormone Receptor Positive ◽  
Metastatic Setting ◽  
Increased Risk ◽  
Positive Breast Cancer

AbstractBreast cancer is the most prevalent cancer and the second leading cause of death among women worldwide. The advent of hormonal therapy has revolutionized the treatment for breast cancer for a century. In the 1960s, an important advance was the development of the antiestrogen tamoxifen. While this drug has had a major impact on breast cancer treatment, its partial agonist activity is associated with increased risk of stroke and endometrial cancer as well as drug resistance. One of the breakthroughs in breast cancer treatment is the discovery of aromatase inhibitors (AIs) in the early 1970s. AIs have proven to be effective in treating hormone receptor-positive breast cancer and lack the estrogenic effects of tamoxifen. They are now considered to be the standard treatment for postmenopausal women with hormone receptor-positive breast cancer. While AIs are effective in treating hormone receptor-positive breast cancer, resistance to AIs inevitably occurs in metastatic setting after prolonged suppression of estrogen production. This chapter summarizes the evolution of AIs, clinical efficacy of AIs, mechanisms of AI resistance, and the strategies to overcome resistance.

scholarly journals Factors Affecting Timely Breast Cancer Treatment Among Black Women in a High-risk Urban Community: a Qualitative Study

2021 ◽  
Author(s):  
Johnie Rose ◽  
Yvonne Oliver ◽  
Paulette Sage ◽  
Weichuan Dong ◽  
Siran M. Koroukian ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Black Women ◽  
High Risk ◽  
Cancer Treatment ◽  
Breast Cancer Survivors ◽  
Urban Community ◽  
Treatment Delay ◽  
Breast Cancer Treatment ◽  
Breast Cancer Patients ◽  
Structured Interviews

Abstract Background: Black women diagnosed with breast cancer in the U.S. tend to experience significantly longer waits to begin treatment than do their white counterparts, and such treatment delay has been associated with poorer survival. We sought to identify the factors driving or mitigating treatment delay among Black women in an urban community where treatment delay is common.Methods: Applying the SaTScan method to data from Ohio’s state cancer registry, we identified the community within Cuyahoga County, Ohio (home to Cleveland) with the highest degree of breast cancer treatment delay from 2010 through 2015. We then recruited breast cancer survivors living in the target community, their family caregivers, and professionals serving breast cancer patients in this community. Participants completed semi-structured interviews focused on identifying barriers to and facilitators of timely breast cancer treatment initiation after diagnosis.Results: Factors reported to impact timely treatment fell into three primary themes: informational, intrapersonal, and logistical. Informational barriers included erroneous beliefs and lack of information about processes of care; intrapersonal barriers centered on mistrust, fear, and denial; while logistical barriers involved transportation and financial access, as well as patients’ own caregiving obligations. An informational facilitator was the provision of objective and understandable disease information, and a common intrapersonal facilitator was faith. Logistical facilitators included financial counseling and mechanisms to assist with Medicaid enrollment. Crosscutting these themes, and mentioned frequently, was the centrality of both patient navigators and support networks (formal and, especially, informal) as critical lifelines for overcoming barriers and leveraging facilitating factors.Conclusions: The present study describes the numerous hurdles to timely breast cancer treatment faced by Black women in a high-risk urban community. These hurdles, as well as corresponding facilitators, can be classified as informational, intrapersonal, and logistical. Observing similar results on a larger scale could inform the design of interventions and policies to reduce race-based disparities in processes of cancer care.

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