Association of Adjuvant Hormone Therapy Timing With Overall Survival Among Patients With Hormone Receptor–Positive Human Epidermal Growth Factor Receptor-2–Negative Early Breast Cancer Without Chemotherapy

Fu, Fangmeng; Yu, Liuwen; Zeng, Bangwei; Chen, Minyan; Guo, Wenhui; Chen, Lili; Lin, Yuxiang; Hou, Jialin; Li, Jing; Yan, Li; Li, Shengmei; Chen, Xiaobin; Zhang, Wenzhe; Jin, Xuan; Cai, Weifeng; Zhang, Kun; Chen, Hanxi; Qiu, Yongqiang; Nie, Qian; Jacobs, Lisa K.

doi:10.1001/jamanetworkopen.2021.45934

Cited by 5 publications

(3 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition to disparities in use of and response to ODX results, women with HR+/HER2breast cancer are eligible for endocrine therapy as part of their treatment regimens. Delays in the initiation of endocrine therapy have been associated with decreased survival: in a study of 144,103 women, Fu et al found that time to adjuvant hormone therapy of >150 days was associated with decreased survival (HR 1.31, 95% CI 1.26-1.35) [59]. Within this study, Black women were at increased risk for initiating endocrine therapy >150 days (OR 1.66, 95% CI 1.55-1.77).…”

Section: Endocrine Therapymentioning

confidence: 99%

Survival Disparities in US Black Compared to White Women with Hormone Receptor Positive-HER2 Negative Breast Cancer

Lovejoy

Shriver

Haricharan

et al. 2023

IJERPH

View full text Add to dashboard Cite

Black women in the US have significantly higher breast cancer mortality than White women. Within biomarker-defined tumor subtypes, disparate outcomes seem to be limited to women with hormone receptor positive and HER2 negative (HR+/HER2−) breast cancer, a subtype usually associated with favorable prognosis. In this review, we present data from an array of studies that demonstrate significantly higher mortality in Black compared to White women with HR+/HER2-breast cancer and contrast these data to studies from integrated healthcare systems that failed to find survival differences. Then, we describe factors, both biological and non-biological, that may contribute to disparate survival in Black women.

show abstract

Section: Endocrine Therapymentioning

confidence: 99%

Survival Disparities in US Black Compared to White Women with Hormone Receptor Positive-HER2 Negative Breast Cancer

Lovejoy

Shriver

Haricharan

et al. 2023

IJERPH

View full text Add to dashboard Cite

show abstract

“… 12 , 13 Of the nearly 300 000 women diagnosed with breast cancer annually, about 83% have hormone receptor–positive tumors, which makes them eligible for adjuvant hormone therapy that is associated with increased survival and decreased risk of recurrence. 33 Yet prior studies associated Medicaid insurance with lower use of both radiation and hormone therapy compared with other insurance. 12 , 13 , 18 Using registry data alone, our findings confirmed these reported disparities.…”

Section: Discussionmentioning

confidence: 99%

Treatment Disparities in Radiation and Hormone Therapy Among Women Covered by Medicaid vs Private Insurance in Cancer Registry and Claims Data

et al. 2023

View full text Add to dashboard Cite

ImportancePrior research has reported undertreatment among patients with cancer who are insured by Medicaid, but this finding may be due, in part, to incomplete data in cancer registries.ObjectiveTo compare disparities in radiation and hormone therapy between women with breast cancer covered by Medicaid and those with private insurance using the Colorado Central Cancer Registry (CCCR) and CCCR data supplemented with All Payer Claims Data (APCD).Design, Setting, and ParticipantsThis observational cohort study included women aged 21 to 63 years who received breast cancer surgery. We linked the CCCR and Colorado APCD to identify Medicaid and privately insured women who were newly diagnosed with invasive, nonmetastatic breast cancer between January 1, 2012, and December 31, 2017. In the radiation treatment analysis, we narrowed the sample to women who received breast-conserving surgery (Medicaid, n = 1408; private, n = 1984) and in the hormone therapy analysis, we selected women who were hormone-receptor positive (Medicaid, n = 1156; private, n = 1667).Main Outcomes and MeasuresWe used logistic regression to estimate the likelihood of treatment within 12 months to assess whether the results varied between data sources.ResultsThere were 3392 and 2823 participants in the radiation and hormone therapy cohorts, respectively. The mean (SD) age was 51.71 (8.30) years in the radiation therapy cohort, and 52.00 (8.16) years in the hormone therapy cohort. Among the participants, there were 140 (4%) and 105 (4%) who were Black non-Hispanic, 499 (15%) and 406 (14%) who were Hispanic, 2602 (77%) and 2190 (78%) were White, and 151 (4%) and 122 (4%) were other/unknown in the radiation and hormone therapy cohorts, respectively. A higher percentage of women were aged 50 years or younger in the Medicaid samples (40% vs 34% in the privately insured sample) and identified as non-Hispanic Black (about 7%) or Hispanic (approximately 24%). Treatment was underreported in both sources, but to a lesser extent in the APCD (2.5% and 2.0% for Medicaid and private insurance, respectively) compared with CCCR (19.5% and 13.3% for Medicaid and private insurance, respectively). Using CCCR data, Women with Medicaid insurance were 4 (95% CI, −8 to −1; P = .02) and 10 (95% CI, −14 to −6; P &lt; .001) percentage points less likely to have a record of radiation and hormone therapy compared with privately insured women, respectively. Using combined CCCR and APCD, no statistically significant disparity was observed in radiation or hormone therapy between Medicaid-insured and privately insured women.Conclusions and RelevanceAmong women with breast cancer covered by Medicaid vs private insurance, cancer treatment disparities may be overestimated if based solely on cancer registry data.

show abstract

“…Delay in breast cancer surgery is a topic receiving national attention in the US, given that some prior studies have observed worse survival outcomes with longer times from breast cancer diagnosis to surgical treatment . However, the specific time point after which it is disadvantageous to have surgery is unknown.…”

Section: Introductionmentioning

confidence: 99%

Reexamining Time From Breast Cancer Diagnosis to Primary Breast Surgery

et al. 2023

View full text Add to dashboard Cite

ImportanceAlthough longer times from breast cancer diagnosis to primary surgery have been associated with worse survival outcomes, the specific time point after which it is disadvantageous to have surgery is unknown. Identifying an acceptable time to surgery would help inform patients, clinicians, and the health care system.ObjectiveTo examine the association between time from breast cancer diagnosis to surgery (in weeks) and overall survival and to describe factors associated with surgical delay. The hypothesis that there is an association between time to surgery and overall survival was tested.Design, Setting, and ParticipantsThis was a case series study that used National Cancer Database (NCDB) data from female individuals diagnosed with breast cancer from 2010 to 2014 (with 5-year follow-up to 2019). The NCDB uses hospital registry data from greater than 1500 Commission on Cancer–accredited facilities, accounting for 70% of all cancers diagnosed in the US. Included participants were females 18 years or older with stage I to III ductal or lobular breast cancer who underwent surgery as the first course of treatment. Patients with prior breast cancer, missing receptor information, neoadjuvant or experimental therapy, or who were diagnosed with breast cancer on the date of their primary surgery were excluded. Multivariable Cox regression was used to evaluate factors associated with overall survival. Patients were censored at death or last follow-up. Covariates included age and tumor characteristics. Multinomial regression was performed to identify factors associated with longer time to surgery, using surgery 30 days or less from diagnosis as the reference group. Data were analyzed from March 15 to July 7, 2022.ExposuresTime to receipt of primary breast surgery.MeasuresThe primary outcome measure was overall survival.ResultsThe final cohort included 373 334 patients (median [IQR] age, 61 [51-70] years). On multivariable Cox regression analysis, time to surgery 9 weeks (57-63 days) or later after diagnosis was associated with worse overall survival (hazard ratio, 1.15; 95% CI, 1.08-1.23; P &lt; .001) compared with surgery between 0 to 4 weeks (1-28 days). By multinomial regression, factors associated with longer times to surgery (using surgery 1-30 days from diagnosis as a reference) included the following: (1) younger age, eg, the adjusted odds ratio (OR) for patients 45 years or younger undergoing surgery 31 to 60 days from diagnosis was 1.32 (95% CI, 1.28-1.38); 61 to 74 days, 1.64 (95% CI, 1.52-1.78); and greater than 74 days, 1.58 (95% CI, 1.46-1.71); (2) uninsured or Medicaid status, eg, the adjusted OR for patients with Medicaid undergoing surgery 31 to 60 days from diagnosis was 1.35 (95% CI, 1.30-1.39); 61 to 74 days, 2.13 (95% CI, 2.01-2.26); and greater than 74 days, 3.42 (95% CI, 3.25-3.61); and (3) lower neighborhood household income, eg, the adjusted OR for patients with household income less than $38,000 undergoing surgery 31 to 60 days from diagnosis was 1.35 (95% CI, 1.02-1.07); 61 to 74 days, 1.21 (95% CI, 1.15-1.27); and greater than 74 days, 1.53 (95% CI, 1.46-1.61).Conclusions and RelevanceFindings of this case series study suggest the use of 8 weeks or less as a quality metric for time to surgery. Time to surgery of greater than 8 weeks may partly be associated with disadvantageous social determinants of health.

show abstract

Association of Adjuvant Hormone Therapy Timing With Overall Survival Among Patients With Hormone Receptor–Positive Human Epidermal Growth Factor Receptor-2–Negative Early Breast Cancer Without Chemotherapy

Cited by 5 publications

References 46 publications

Survival Disparities in US Black Compared to White Women with Hormone Receptor Positive-HER2 Negative Breast Cancer

Survival Disparities in US Black Compared to White Women with Hormone Receptor Positive-HER2 Negative Breast Cancer

Treatment Disparities in Radiation and Hormone Therapy Among Women Covered by Medicaid vs Private Insurance in Cancer Registry and Claims Data

Reexamining Time From Breast Cancer Diagnosis to Primary Breast Surgery

Contact Info

Product

Resources

About