Treatment delays in older women with nonmetastatic breast cancer treated at minority-serving hospitals.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 122-122
Author(s):  
Julia Song ◽  
Elizabeth A. Mittendorf ◽  
Tari A. King ◽  
Christina Ahn Minami
Keyword(s):  
Breast Cancer ◽  
Native American ◽  
Metastatic Breast Cancer ◽  
Older Women ◽  
Metastatic Breast ◽  
Treatment Delay ◽  
Treatment Delays ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Hispanic White

122 Background: Almost 60% of breast cancer in the U.S. occur in women aged >65, but these women are less likely to receive guideline-concordant care. Given existing treatment disparities by race/ethnicity, older minority women may be especially prone to potential gaps in breast cancer care. Hospitals serving higher proportions of minority patients are at risk to deliver suboptimal care, but how site of care impacts aging patients with breast cancer is not well defined. We sought to evaluate the association between race/ethnicity and breast cancer treatment delays in older women treated at minority-serving hospitals (MSH) vs non-MSHs. Methods: Women >65 years old with non-metastatic breast cancer diagnosed from 2010-2017 were identified in the National Cancer Database using data from Commission on Cancer (CoC)-accredited hospitals. Treatment delay was defined as >90 days from diagnosis to first treatment (surgery, chemotherapy, endocrine therapy). MSHs were defined as the top decile of hospitals serving predominantly Black or Hispanic patients. Multivariable logistic regression models adjusted for patient, disease, and hospital characteristics were used to determine the odds of treatment delay for women at MSHs vs non-MSHs across racial/ethnic groups. Results: 529,128 women (84.5% non-Hispanic White, 3.3% Hispanic White, 9.6% non-Hispanic Black, 0.1% Hispanic Black, 0.2% Native American, 2.5% Asian/Pacific Islander) were identified among 41 MSHs and 1,146 non-MSHs. Overall, time to treatment was <90 days in >95% of women (mean 33.4 days; standard deviation 26.4 days). Older women regardless of race at MSHs were more likely to suffer treatment delays than those at non-MSHs (odds ratio 1.31; 95% confidence interval 1.22-1.41). Compared to non-Hispanic White women, all minority groups had a higher likelihood of treatment delay regardless of MSH status (Table). Conclusions: Although most older women with non-metastatic breast cancer treated at CoC hospitals received care in a timely fashion, minorities and those treated at MSHs were more likely to experience treatment delays. Effective interventions addressing barriers to timely care at MSHs and among racial/ethnic minorities are needed. [Table: see text]

Trends in breast cancer survival by race-ethnicity in Florida.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18556-e18556
Author(s):  
Robert Brooks Hines ◽  
Asal Johnson ◽  
Eunkyung Lee ◽  
Stephanie Erickson ◽  
Saleh M.M. Rahman
Keyword(s):  
Breast Cancer ◽  
Ethnic Disparities ◽  
Cancer Death ◽  
Cancer Outcomes ◽  
Subdistribution Hazard ◽  
Breast Cancer Death ◽  
Breast Cancer Outcomes ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Hispanic White

e18556 Background: Considerable efforts to improve disparities in breast cancer outcomes for underserved women have occurred over the past 3 decades. This study was conducted to evaluate trends in survival, by race-ethnicity, for women diagnosed with breast cancer in Florida over a 26-year period to assess potential improvement in racial-ethnic disparities. Methods: This was a retrospective cohort study of women diagnosed with invasive breast cancer in Florida between 1990-2015. Data were obtained from the Florida Cancer Data System. Women in the study were categorized according to race (white/black) and Hispanic ethnicity (yes/no) as non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic white (HW), and Hispanic black (HB). Cumulative incidence estimates of 5- and 10-year breast cancer death with 95% confidence intervals (CI) were obtained by race-ethnicity, according to diagnosis year. Subdistribution hazard models were used to obtain subdistribution hazard ratios (sHR) for the relative rate of breast cancer death accounting for competing causes. Results: Compared to NHW women, minority women were more likely to be younger, be uninsured or have Medicaid as health insurance, live in high poverty neighborhoods, have more advanced disease at diagnosis, have high grade tumors, have hormone receptor negative tumors, and receive chemotherapy as treatment. Minority women were less likely to receive surgery. Over the course of the study, breast cancer mortality decreased for all racial-ethnic groups, and racial-ethnic minorities had greater absolute and relative improvement in breast cancer survival for nearly all metrics compared to non-Hispanic white (NHW) women. However, for the most recent time period (2010-2015), black women still experienced significant survival disparities with non-Hispanic black (NHB) women having twice the rate of 5-year (sHR = 2.04: 95% CI; 1.91-2.19) and 10-year (sHR = 2.02: 95% CI; 1.89-2.16) breast cancer death. Conclusions: Despite efforts to improve disparities in breast cancer outcomes for underserved women in Florida, additional targeted approaches are needed to reduce the poorer survival in black (especially NHB) women. Our next step is to conduct a mediation analysis of the most important factors driving racial/ethnic disparities in breast cancer outcomes for women in Florida.

scholarly journals Medical costs associated with metastatic breast cancer in younger, midlife, and older women

2020 ◽  
Vol 181 (3) ◽  
pp. 653-665
Author(s):  
Justin G. Trogdon ◽  
Christopher D. Baggett ◽  
Anagha Gogate ◽  
Katherine E. Reeder-Hayes ◽  
Jason Rotter ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Older Women ◽  
Metastatic Breast ◽  
Medical Costs

Chemotherapy treatment for older women with metastatic breast cancer: What is the evidence?

2011 ◽  
Vol 37 (8) ◽  
pp. 590-598 ◽  
Author(s):  
Marc Debled ◽  
Carine Bellera ◽  
Catherine Donamaria ◽  
Pierre Soubeyran
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Older Women ◽  
Metastatic Breast ◽  
Chemotherapy Treatment

A phase I study of oral metronomic vinorelbine plus capecitabine in patients with metastatic breast cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 1127-1127
Author(s):  
A. Kalykaki ◽  
S. Agelaki ◽  
A. Kotsakis ◽  
L. Vamvakas ◽  
V. Bozionelou ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Febrile Neutropenia ◽  
Phase I ◽  
Dose Level ◽  
Phase I Study ◽  
Metastatic Breast ◽  
Treatment Delay ◽  
Hematological Toxicity ◽  
Oral Vinorelbine

1127 Background: The combination of capecitabine plus intravenous vinorelbine has shown substantial activity in anthracycline and/or taxane pretreated patients with metastatic breast cancer (MBC). The metronomic administration may be associated with reduced toxicity and enhanced efficacy. We conducted a phase I study to determine the maximum tolerated dose (MTD) and dose limiting toxicities (DLT) of capecitabine plus oral vinorelbine administered metronomically in patients with MBC. Methods: Patients were treated with vinorelbine (30–60 mg total dose) p.o three times per week continuously and capecitabine (800–1250 mg/m2 twice a day) from day 1 to 14 in three week cycles. DLT was defined during the first cycle as grade (G) 4 neutropenia or thrombocytopenia, febrile neutropenia, any ≥ G 3 non-hematological toxicity, and any delay of treatment due to toxicity. Results: To date 27 patients have been enrolled on 7 different dose levels. Treatment was first line for 16 and second line for 11 patients. DLTs included G3 febrile neutropenia and treatment delay due to G2 neutropenia occurring in 1 patient each, at dose level 4 and G3 diarrhea and treatment delay due to G2 neutropenia in 1 patient each, at dose level 7. The MTD has not yet been reached. Hematologic and nonhematological toxicities were generally mild to moderate. Most common were myelosuppression, asthenia, nausea, and diarrhea. Nine objective responses were observed with 2 complete and 7 partial. Conclusions: Vinorelbine 60 mg three times a week in combination with capecitabine 1250mg/m2 twice a day, has been well tolerated. Enrollment is ongoing. Updated data will be presented at the meeting. No significant financial relationships to disclose.

Trastuzumab-induced cardiotoxicity and hypertension among racially and ethnically diverse patients with HER2-positive early-stage breast cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24092-e24092
Author(s):  
Monica F. Chen ◽  
Daniel K. Manson ◽  
Ariel Yuan ◽  
Katherine D. Crew
Keyword(s):  
Breast Cancer ◽  
Ethnic Groups ◽  
Ethnic Minorities ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Her2 Positive ◽  
Factors Associated ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Hispanic White

e24092 Background: Trastuzumab improves breast cancer survival but is associated with an increased risk of heart failure. Identifying risk factors associated with trastuzumab induced cardiotoxicity (TIC) would allow for more targeted and intensive screening for at-risk patients. Hypertension is one of the most consistent predictors of TIC. Racial/ethnic minorities are at higher risk of cardiovascular disease but are under-represented in studies of TIC. The objective of this study was to evaluate the relationship between race/ethnicity and risk of TIC among a diverse cohort of patients with HER2-positive early-stage breast cancer. Methods: We conducted a retrospective cohort study of patients treated at Columbia University between 2007 and 2016 for stage I-III breast cancer with adjuvant or neoadjuvant trastuzumab who had at least two echocardiograms. Mild TIC was defined as a ≥10% decline in left ventricular ejection fraction (LVEF); moderate TIC ≥15% decline; severe TIC ≥20% or decline in LVEF to < 50%. Diagnosis of hypertension, average systolic and diastolic blood pressure, and number of hypertension medications was assessed 1- year pre-treatment, during treatment, and 1-year post-treatment. We generated descriptive statistics and used multivariable logistic regression to evaluate demographic and clinical factors associated with TIC. Results: Of 279 patients evaluated, 36.6% were non-Hispanic white, 18.3% non-Hispanic black, 34.8% Hispanic, and 10.4% Asian. The average baseline LVEF was 60% and did not significantly differ between racial/ethnic groups. Mild TIC developed in 33.3% of patients, moderate TIC 18.6%, severe TIC 15.8%, and 14.7% with LVEF decline to < 50%. Patients with hypertension were at increased odds of developing TIC (OR = 2.41, 95% CI = 1.15-3.93; p = 0.02). Prevalence of hypertension was 53% among non-Hispanic white women, 69% non-Hispanic black, 53% Hispanic, and 39% Asian. Incidence of TIC did not differ significantly between racial/ethnic groups. Forty percent of patients with hypertension were not on any medications before initiating trastuzumab. Conclusions: There was no difference in TIC based upon race/ethnicity despite higher rates of hypertension among racial/ethnic minorities compared to non-Hispanic whites. However, a high portion of patients with hypertension were not on any medications before treatment. Increased screening and treatment of hypertension among patients receiving HER2-positive targeted therapy for early-stage breast cancer may be warranted.

Differences in psychosocial factors among diverse women enrolled in a phase III cooperative group metastatic breast cancer trial (CALGB 40502/Alliance).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9581-9581
Author(s):  
Blase N. Polite ◽  
Jacob B Allred ◽  
Hope S. Rugo ◽  
Toni Marie Cipriano ◽  
Constance Cirrincione ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Social Support ◽  
Metastatic Breast Cancer ◽  
Metastatic Breast ◽  
Phase Iii ◽  
Cooperative Group ◽  
Breast Cancer Patients ◽  
Cancer Trial ◽  
Race Ethnicity ◽  
The Impact

9581 Background: Previous metastatic breast cancer trials have shown lower overall survival among African American (AA) women. Studies have also shown links between higher comorbidities and lower levels of social support and survival. Whether these factors differ by race and ethnicity is not known. Methods: Breast cancer patients enrolling in a phase III cooperative group metastatic breast cancer trial completed a self-administered survey measuring psychosocial and socio-demographic factors and comorbidities. Results were analyzed by self-identified race/ethnicity and evaluated by other measured variables. Results: 703 out of 799 patients completed the survey (88%). Questions were answered by greater than 95% of participants. The table shows differences broken down by Race/Ethnicity. AA and Hispanic (H) patients were more likely to have trouble paying for medications and have incomes less than 15K per year. AA were less likely to be married, and had lower levels of social support. Differences in income did not mediate these social support differences. Marital status did not mediate lower social support for AA (p=0.79) but did so for whites (p<0.001) Conclusions: Compliance with the questionnaire was quite high. Differences in social support by race were apparent and were mediated by different factors according to race. Future efforts will analyze the impact of these factors on survival and as mediators for potential racial and ethnic differences in survival. [Table: see text]

scholarly journals Paclitaxel efficacy and toxicity in older women with metastatic breast cancer: combined analysis of CALGB 9342 and 9840

2012 ◽  
Vol 23 (3) ◽  
pp. 632-638 ◽  
Author(s):  
S.M. Lichtman ◽  
A. Hurria ◽  
C.T. Cirrincione ◽  
A.D. Seidman ◽  
E. Winer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Older Women ◽  
Metastatic Breast ◽  
Combined Analysis
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