Disparities in receipt of and time to adjuvant therapy after lumpectomy.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 534-534
Author(s):  
Irene Dankwa-Mullan ◽  
M. Christopher Roebuck ◽  
Joseph Tkacz ◽  
Oluwadamilola Motunrayo Fayanju ◽  
Yi Ren ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Therapy ◽  
Breast Conserving Surgery ◽  
Relative Risk Ratio ◽  
Adjuvant Radiation ◽  
Factors Associated ◽  
Severe Liver Disease ◽  
Insured Patients ◽  
To Receive ◽  
Area Health

534 Background: Adjuvant treatment after breast conserving surgery (BCS) has been shown to improve outcomes, but the degree of uptake varies considerably. We sought to examine factors associated with post-BCS receipt of and time to treatment (TTT) for adjuvant radiation therapy (ART), cytotoxic chemotherapy (ACT) and endocrine therapy (AET) among women with breast cancer. Methods: IBM MarketScan claims data were used to select women diagnosed with non-metastatic invasive breast cancer from 01/01/2012 to 03/31/2018, who received primary BCS without any neoadjuvant therapy, and who had continuous insurance eligibility 60 days post-BCS. Logistic and quantile regressions were used to identify factors associated with receipt of adjuvant therapy (ART, ACT, AET) and median TTT in days for ART (rTTT), ACT (cTTT), and AET (eTTT), respectively, after adjustment for covariates including age, year, region, insurance plan type, comorbidities, and a vector of ZIP3-level measures (e.g., community race/ethnicity-density, education level) from the 2019 Area Health Resource Files. Results: 36,270 patients were identified: 11,996 (33%) received ART only, 4,837 (13%) received ACT only, 3,458 (10 %) received AET only, 5,752 (16%) received both ART and AET, and 9,909 (27%) received no adjuvant therapy within 6 months of BCS. (318) 1% of patients received combinations of either ART, AET or ACT. Relative to having no adjuvant therapy, patients > 80 years were significantly less likely to receive ART only (relative risk ratio [RRR] 0.65), ACT only (RRR 0.05), or combination ART/AET (RRR 0.66) but more likely to receive AET alone (RRR 3.61) (all p < .001). Patients from communities with high proportions of Black (RRR 0.14), Asian (RRR 0.13), or Hispanic (RRR 0.45) residents were significantly less likely to receive combination ART and AET (all p < .001). Having HIV/AIDS (+11 days; p = .01) and residing in highly concentrated Black (+8.5 days; p = .01) and Asian (+12.2 days; p = .04) communities were associated with longer rTTT. Longer cTTT was associated with having comorbidities of cerebrovascular disease (+6.0 days; p < .001), moderate to severe liver disease (+12.3 days; p < .001) and residing in high-density Asian communities (+18.0 days; p < .001). Shorter eTTT (-11.4 days; p = .06) and cTTT (-14.8 days; p < .001) was observed in patients with comorbidities of dementia. Conclusions: Results from this cohort of privately insured patients demonstrate disparities in receipt of post-BCS adjuvant radiation and systemic therapy along multiple demographic dimensions and expose opportunities to promote timely receipt of care.

Receipt of locoregional therapy among young women with breast cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1100-1100
Author(s):  
Rachel A. Freedman ◽  
Katherine S. Virgo ◽  
Julia Labadie ◽  
Ann H. Partridge ◽  
Nancy Lynn Keating
Keyword(s):  
Breast Cancer ◽  
Young Women ◽  
Breast Conserving Surgery ◽  
National Cancer Data Base ◽  
Locoregional Therapy ◽  
Adjuvant Radiation ◽  
Optimal Care ◽  
Younger Women ◽  
Cancer Data ◽  
To Receive

1100 Background: Although younger women with breast cancer have the most to gain from receipt of optimal care, few data are available regarding their receipt of locoregional breast cancer treatments. Methods: We identified 318,083 women aged 18-64 who were diagnosed with invasive breast cancer at hospitals reporting to the National Cancer Data Base, a large national cancer registry, during 2004-2008. We used multivariable logistic regression to assess the association of patient age with mastectomy vs. breast-conserving surgery (BCS), radiation with BCS, and post-mastectomy radiation (PMRT) with varying indications, adjusting for patient and tumor characteristics, area-level socioeconomic status, and insurance. Results: Overall, 4% of women were aged ≤35 and 7% were aged 36-40. Women aged ≤35 were significantly more likely to have mastectomy than BCS compared with women aged 56-60 (57% vs. 35%, adjusted odds ratio [OR] 1.97; 95% Confidence Interval [CI] 1.87-2.07) but were less likely to receive radiation if BCS was performed (69% vs. 80%, OR 0.77; 95% CI 0.73-0.82). For those who underwent mastectomy, although overall rates of PMRT receipt were low, women aged ≤35 were more likely to receive postmastectomy radiation (PMRT) despite the presence or absence of clinical indications for PMRT (OR 1.11; 95% CI 1.01-1.22 for strong indications, OR 1.71; 95% CI 1.53-1.91 for borderline indications, and OR 1.49; 95% CI 1.28-1.73 for no indications [all vs. ages 56-60]). Conclusions: Young women with breast cancer may not be receiving optimal locoregional therapy. We observed lower odds of radiation after BCS but higher odds of PMRT for young women regardless of indications for PMRT. Efforts are needed to further understand and improve the receipt of appropriate adjuvant radiation therapy among young women to improve their disease-free and overall survival.

Trends in the use of breast-conserving surgery and adjuvant radiation therapy in patients with DCIS: A U.S. population-based analysis from 1996 to 2007.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1110-1110
Author(s):  
Jennifer Nishimura ◽  
Audrey Choi ◽  
Sharon Kim ◽  
Julian Kim
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Breast Conserving Surgery ◽  
Adjuvant Radiation ◽  
Adjuvant Radiation Therapy ◽  
Factors Associated ◽  
Breast Cancer Specific Mortality ◽  
Time Period ◽  
Specific Mortality ◽  
Cancer Specific Mortality

1031 Background: The treatment for patients with DCIS remains controversial. Current guidelines based upon best available evidence suggest that breast conserving surgery (BCS) followed by adjuvant radiation therapy (RT) result in acceptable local control and breast cancer specific survival. The purpose of this study was to analyze trends in patterns of care as well as identify factors associated with surgery type and use of adjuvant radiation therapy in a select cohort of patients enrolled into the SEER database. Methods: The study included females 18 years and older with focal DCIS and known tumor size of 5 cm or less diagnosed between 1996 and 2007. The Cochran-Armitage trend test was applied to identify trends in the use of BCS and RT over time. Multivariate logistic regression analyses were used to determine factors associated with receiving BCS vs. mastectomy and BCS plus RT vs. BCS alone. Cox proportional hazard model was used to determine associations with breast cancer-specific mortality. Results: Of the 34,233 women with DCIS, 76.59% were treated with BCS. 66.36% of BCS patients received adjuvant RT over the study period. The proportion of women receiving BCS increased from 71.5% in 1996 to 76.9% in 2007 (p<0.0001). Additionally, the proportion of women who underwent BCS and received adjuvant radiation therapy over the same time period increased from 55.3% to 69.7% (p<0.0001). Multivariate analysis demonstrated that year of diagnosis, race, marital status, geographic region, tumor size, tumor grade and comedo necrosis all were significantly associated with the use of adjuvant radiation therapy, but age was not. Cox proportional hazards models did not associate either surgery type or use of adjuvant radiation in patients undergoing BCS with breast cancer-specific mortality. Conclusions: Based upon reporting within the SEER database, the proportion of DCIS patients undergoing BCS and the BCS patients receiving adjuvant radiation increased over the study time period. Surgery type and use of adjuvant radiation therapy in patients with BCS was not associated with decreased risk of breast-cancer specific death in this cohort.

Factors associated with re-operation for oncological clearance in Breast Conserving Surgery (BCS) for Breast cancer

2021 ◽  
Vol 47 (2) ◽  
pp. e43-e44
Author(s):  
Huma Irshad ◽  
Prakash Sinha ◽  
Abdul Kasem ◽  
Sudeendra Doddi ◽  
Uhercik Michal ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Conserving Surgery ◽  
Factors Associated

scholarly journals Is It Contralateral Axillary Metastasis or Occult Breast Cancer: A Confusing Case Report

2015 ◽  
Vol 8 (3) ◽  
pp. 498-502 ◽  
Author(s):  
Yong Gi Son ◽  
Woon Won Kim ◽  
Ki Hoon Kim ◽  
Jin Soo Kim
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Growth Factor Receptor ◽  
Immunohistochemical Analysis ◽  
Breast Conserving Surgery ◽  
Left Breast ◽  
Lymph Node Biopsy ◽  
Adjuvant Radiation ◽  
Axillary Lymph ◽  
Axillary Metastasis

We report the case of a 43-year-old woman with primary left breast cancer presenting metastatic lymphadenopathy in the contralateral axilla. This patient represents a diagnostic and therapeutic challenge because primary breast cancer, occult contralateral breast cancer, and extra-mammary primary lesion can all be the source of the contralateral axillary metastasis. Left breast-conserving surgery, left sentinel lymph node biopsy, right breast mass excision, and right axillary lymph node dissection were performed. Immunohistochemical analysis revealed that the left breast cancer specimen was positive for estrogen receptor (ER) and progesterone receptor (PR), but negative for human epidermal growth factor receptor 2 (HER2). In contrast, the right axillary lymphadenopathy specimen was negative for ER and PR, but positive for HER2. Further investigation revealed no evidence of occult primary cancers or extra-mammary tumors. After surgical intervention, the patient was treated with adjuvant chemotherapy, adjuvant radiation therapy, and targeted therapy with trastuzumab. Two years after diagnosis, she is free of disease and presently being treated with tamoxifen.

scholarly journals The Role of Para-Aortic Lymphadenectomy in the Surgical Staging of Women with Intermediate and High-Risk Endometrial Adenocarcinomas

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Taymaa May ◽  
Melina Shoni ◽  
Allison F. Vitonis ◽  
Charles M. Quick ◽  
Whitfield B. Growdon ◽  
...  
Keyword(s):  
High Risk ◽  
Adjuvant Therapy ◽  
Endometrial Adenocarcinoma ◽  
Disease Free Survival ◽  
Disease Recurrence ◽  
Pelvic Lymphadenectomy ◽  
Surgical Staging ◽  
Adjuvant Radiation ◽  
Effective Treatment Option ◽  
To Receive

Objectives. To characterize clinical outcomes in patients with intermediate or high-risk endometrial carcinoma who underwent surgical staging with or without para-aortic lymphadenectomy.Methods. This is a retrospective cohort study of patients with intermediate or high-risk endometrial adenocarcinoma who underwent surgical staging with (PPALN group) or without (PLN) para-aortic lymphadenectomy. Data were collected, Kaplan-Meier curves were generated, and univariate and multivariate analyses performed to compare differences in adjuvant therapy, disease recurrence, disease-free survival (DFS), and overall survival (OS).Results.118 patients were included in the PPALN group and 139 in the PLN group. Patients in the PPALN group were more likely to receive adjuvant vaginal brachytherapy (25.4% versus 11.5%,OR=2.5,P=0.03) and less likely to receive adjuvant multimodal combination therapy (17.81% versus 28.8%,OR=0.28,P=0.002). DFS was improved in the PLN group as compared to PPALN (80% versus 62%,P=0.02). OS was equivalent (P=0.93). Patients in the PPALN group who had less than 10 para-aortic nodes removed were twice as likely to recur than patients who had 10 or more para-aortic nodes or patients in the PLN group (HR 2.08, CI 1.20–3.60,P=0.009).Conclusions. Patients in the PLN group were more likely to receive multimodal adjuvant therapy and had better DFS than the PPALN group. Pelvic lymphadenectomy followed by adjuvant radiation and chemotherapy may represent an effective treatment option for patients with intermediate or high-risk disease. If systematic para-aortic lymphadenectomy is performed and less than 10 para-aortic lymph nodes are obtained, multimodality adjuvant therapy should be considered to improve DFS.

scholarly journals Investigating confounders of the association between survival and adjuvant radiation therapy after breast conserving surgery in a sample of elderly breast Cancer patients in Appalachia

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Fabian Camacho ◽  
Roger Anderson ◽  
Gretchen Kimmick
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Structural Model ◽  
Failure Time ◽  
Breast Conserving Surgery ◽  
Adjuvant Radiation ◽  
Percentage Increase ◽  
Adjuvant Radiation Therapy ◽  
Percent Change ◽  
Dual Status

Abstract Background To explain the association between adjuvant radiation therapy after breast conserving surgery (BCS RT) and overall survival (OS) by quantifying bias due to confounding in a sample of elderly breast cancer beneficiaries in a multi-state region of Appalachia. Methods We used Medicare claims linked registry data for fee-for-service beneficiaries with AJCC stage I-III, treated with BCS, and diagnosed from 2006 to 2008 in Appalachian counties of Kentucky, Ohio, North Carolina, and Pennsylvania. Confounders of BCS RT included age, rurality, regional SES, access to radiation facilities, marital status, Charlson comorbidity, Medicaid dual status, institutionalization, tumor characteristics, and surgical facility characteristics. Adjusted percent change in expected survival by BCS RT was examined using Accelerated Failure Time (AFT) models. Confounding bias was assessed by comparing effects between adjusted and partially adjusted associations using a fully specified structural model. Results The final sample had 2675 beneficiaries with mean age of 75, with 81% 5-year survival from diagnosis. Unadjusted percentage increase in expected survival was 2.75 times greater in the RT group vs. non-RT group, with 5-year survival of 85% vs 60%; fully adjusted percentage increase was 1.70 times greater, with 5-year rates of 83% vs 71%. Quantification of incremental confounding showed age accounted for 71% of the effect reduction, followed by tumor features (12%), comorbidity (10%), dual status(10%), and institutionalization (8%). Adjusting for age and tumor features only resulted in only 4% bias from fully adjusted percent change (70% change vs 66%). Conclusion Quantification of confounding aids in determining covariates to adjust for and in interpreting raw associations. Substantial confounding was present (60% of total association), with age accounting for the largest share (71%); adjusting for age plus tumor features corrected for most of the confounding (4% bias). The direct effect of BCS RT on OS accounted for 40% of the total association.

HSR20-085: Real-World Study of Factors Associated With Breast Conserving Surgery for Females Diagnosed With Early Stage Breast Cancer

2020 ◽  
Vol 18 (3.5) ◽  
pp. HSR20-085
Author(s):  
Judy George ◽  
Joseph Tkacz ◽  
M. Christopher Roebuck ◽  
Fredy Reyes ◽  
Yull E. Arriaga ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Real World ◽  
Early Stage ◽  
Breast Conserving Surgery ◽  
Early Stage Breast Cancer ◽  
Factors Associated

Management and outcomes of clinical stage II a/b seminoma: Results from the National Cancer Database.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 378-378
Author(s):  
Jonathan J. Paly ◽  
Phillip John Gray ◽  
Chun Chieh Lin ◽  
Helmneh Sineshaw ◽  
Ahmedin Jemal ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Clinical Stage ◽  
National Cancer Data Base ◽  
Treatment Center ◽  
Adjuvant Radiation ◽  
Testicular Seminoma ◽  
Cancer Data ◽  
Factors Associated ◽  
Significant Difference

378 Background: Testicular seminoma is the most common solid tumor seen in patients aged 15-35 and disease specific survival approaches 100% in controlled studies, even for those with node-positive disease. We sought to describe modern practice patterns as well as survival outcomes and factors associated with receipt of adjuvant therapy for patients presenting with initial clinical stage (CS) IIA/B disease. Methods: Data on patients diagnosed with CS IIA/B testicular seminoma from 1998-2011 were extracted from the National Cancer Data Base. Demographic, clinical, treatment, payer characteristics were evaluated using multivariate logistic regression to identify factors associated with receipt of chemotherapy or adjuvant radiation therapy (ART) within 6 months of orchiectomy. Five-year Kaplan-Meier overall survival (OS) by CS and treatment was calculated. Results: In total, 2,185 patients with CS II A/B were included. Management included orchiectomy alone (11.35%), adjuvant chemotherapy (27.46%), or ART (52.72%). In multivariate analysis, receipt of orchiectomy plus ART rather than adjuvant chemotherapy was more likely with CS IIA status (OR 2.4, p < 0.01), treatment outside of teaching or NCI network institution (OR 1.9-2.8, p < 0.02), or tumor size ≥4cm (OR 1.6, p < 0.01). Receipt of ART was less likely in Hispanic patients (OR 0.6, p=0.03) or in those diagnosed from 2006-2011 (OR 0.5, p < 0.01). Five-year OS for all patients was 97.2% for orchiectomy + ART, and 93.9% for orchiectomy + chemotherapy (log-rank p = 0.01). For CS IIA patients, 5-year OS was 98.3% for orchiectomy + ART versus 93.6% for orchiectomy + chemotherapy (log-rank p < 0.01). Differences in OS for CS IIB treated with chemotherapy or ART were not statistically significant. Conclusions: Consistent with national guideline recommendations, our analysis suggest that compared to chemotherapy, ART is associated with a survival advantage for CS IIA patients. Chemotherapy or ART showed no significant difference in effectiveness in patients with CS IIB. Disease bulk, race, treatment center type, and time period are associated with choice of adjuvant therapy. Longer follow-up and validation of these results is needed to account for late effects of treatment.

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