Factors Associated With the Decision to Decline Chemotherapy in Patients With Early-stage, ER+/HER2- Breast Cancer and High-risk Scoring on Genomic Assays

Bilani, Nadeem; Ladki, Shereen; Yaghi, Marita; Main, Olivia; Jabbal, Iktej Singh; Elson, Leah; Zerdan, Maroun Bou; Liang, Hong; Nahleh, Zeina

doi:10.1016/j.clbc.2022.01.007

Cited by 3 publications

(8 citation statements)

References 26 publications

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“…We found that 1 in 10 patients declined at least 1 type of recommended treatment, 1 in 10 patients declined chemotherapy, 5.0% to 6.0% of patients declined HT or radiotherapy, and less than 1.0% of patients declined surgery. These results are aligned with prior study observations in patients with BC using the Surveillance, Epidemiology, and End Results (SEER) and early-year NCDB data . Fwelo et al and Gaitanidis et al further observed increasing trends in 2004 to 2013 and 2010 to 2017 SEER data.…”

Section: Discussionsupporting

confidence: 87%

“…4,7,[19][20][21][22] Fwelo et al21 and Gaitanidis et al 10 further observed increasing trends in 2004 to 2013 and 2010 to 2017 SEER data. However, these studies10,21 assessed surgery only; whereas we found that rates ofJAMA Network Open | Oncology…”

mentioning

confidence: 90%

“…For BC, several analyses have reported similar sociodemographic and clinical factors associated with treatment declination in this patient population. 7,10,[18][19][20][21][22] However, these studies focused on either chemotherapy or surgery only or the associations of treatment decisions with mortality, and most of them did not evaluate the pattern and long-term trends associated with treatment declination among patients with BC. Although a few studies have assessed racial and ethnic disparities in declination of surgery or chemotherapy, they largely focused on Black and Hispanic patients, and, to a lesser extent, Asian patients, 10,18,19,21 and 2 analyses included only White women.…”

Section: Introductionmentioning

confidence: 99%

“…7,10,[18][19][20][21][22] However, these studies focused on either chemotherapy or surgery only or the associations of treatment decisions with mortality, and most of them did not evaluate the pattern and long-term trends associated with treatment declination among patients with BC. Although a few studies have assessed racial and ethnic disparities in declination of surgery or chemotherapy, they largely focused on Black and Hispanic patients, and, to a lesser extent, Asian patients, 10,18,19,21 and 2 analyses included only White women. 4,7 There remain gaps in the literature regarding national trends in declination of treatment recommendations, racial and ethnic disparities, sociodemographic and clinicopathologic characteristics associated with treatment declination, and the implication of treatment declination for overall survival (OS) among patients with BC.…”

Section: Introductionmentioning

confidence: 99%

“…Previous research in colorectal, ovarian, lung, or mixed cancer cohorts has found that older age, racial and ethnic minority background (eg, Hispanic, non-Hispanic Asian or Pacific Islander, or non-Hispanic Black), low socioeconomic status, and late-stage presentations are associated with declination of therapies. For BC, several analyses have reported similar sociodemographic and clinical factors associated with treatment declination in this patient population . However, these studies focused on either chemotherapy or surgery only or the associations of treatment decisions with mortality, and most of them did not evaluate the pattern and long-term trends associated with treatment declination among patients with BC.…”

Section: Introductionmentioning

confidence: 99%

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Declination of Treatment, Racial and Ethnic Disparity, and Overall Survival in US Patients With Breast Cancer

Freeman,

Li,

Fisher

et al. 2024

JAMA Netw Open

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ImportanceDeclining treatment negatively affects health outcomes among patients with cancer. Limited research has investigated national trends of and factors associated with treatment declination or its association with overall survival (OS) among patients with breast cancer.ObjectivesTo examine trends and racial and ethnic disparities in treatment declination and racial and ethnic OS differences stratified by treatment decision in US patients with breast cancer.Design, Setting, and ParticipantsThis retrospective cross-sectional study used data for patients with breast cancer from the 2004 to 2020 National Cancer Database. Four treatment modalities were assessed: chemotherapy, hormone therapy (HT), radiotherapy, and surgery. The chemotherapy cohort included patients with stage I to IV disease. The HT cohort included patients with stage I to IV hormone receptor–positive disease. The radiotherapy and surgery cohorts included patients with stage I to III disease. Data were analyzed from March to November 2023.ExposureRace and ethnicity and other sociodemographic and clinicopathologic characteristics.Main Outcomes and MeasuresTreatment decision, categorized as received or declined, was modeled using logistic regression. OS was modeled using Cox regression. Models were controlled for year of initial diagnosis, age, sex, health insurance, median household income, facility type, Charlson-Deyo comorbidity score, histology, American Joint Committee on Cancer stage, molecular subtype, and tumor grade.ResultsThe study included 2 837 446 patients (mean [SD] age, 61.6 [13.4] years; 99.1% female), with 1.7% American Indian, Alaska Native, or other patients; 3.5% Asian or Pacific Islander patients; 11.2% Black patients; 5.6% Hispanic patients; and 78.0% White patients. Of 1 296 488 patients who were offered chemotherapy, 124 721 (9.6%) declined; 99 276 of 1 635 916 patients (6.1%) declined radiotherapy; 94 363 of 1 893 339 patients (5.0%) declined HT; and 15 846 of 2 590 963 patients (0.6%) declined surgery. Compared with White patients, American Indian, Alaska Native, or other patients (adjusted odds ratio [AOR], 1.47; 95% CI, 1.26-1.72), Asian or Pacific Islander patients (AOR, 1.29; 95% CI, 1.15-1.44), and Black patients (AOR, 2.01; 95% CI, 1.89-2.14) were more likely to decline surgery; American Indian, Alaska Native, or other patients (AOR, 1.13; 95% CI, 1.05-1.21) and Asian or Pacific Islander patients (AOR, 1.21; 95% CI, 1.16-1.27) were more likely to decline chemotherapy; and Black patients were more likely to decline radiotherapy (AOR, 1.05; 95% CI, 1.02-1.08). Asian or Pacific Islander patients (AOR, 0.81; 95% CI, 0.77-0.85), Black patients (AOR, 0.86; 95% CI, 0.83-0.89), and Hispanic patients (AOR, 0.66; 95% CI, 0.63-0.69) were less likely to decline HT. Furthermore, Black patients who declined chemotherapy had a higher mortality risk than White patients (adjusted hazard ratio [AHR], 1.07; 95% CI, 1.02-1.13), while there were no OS differences between Black and White patients who declined HT (AHR, 1.05; 95% CI, 0.97-1.13) or radiotherapy (AHR, 0.98; 95% CI, 0.92-1.04).Conclusions and RelevanceThis cross-sectional study highlights racial and ethnic disparities in treatment declination and OS, suggesting the need for equity-focused interventions, such as patient education on treatment benefits and improved patient-clinician communication and shared decision-making, to reduce disparities and improve patient survival.

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Section: Discussionsupporting

confidence: 87%

mentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Declination of Treatment, Racial and Ethnic Disparity, and Overall Survival in US Patients With Breast Cancer

Freeman,

Li,

Fisher

et al. 2024

JAMA Netw Open

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Disparities in Hormone Receptor-Positive Breast Cancer

Ogayo,

Mittendorf,

Kantor

2024

Curr Breast Cancer Rep

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

Lovejoy

Shriver

Haricharan

et al. 2023

IJERPH

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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.

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Factors Associated With the Decision to Decline Chemotherapy in Patients With Early-stage, ER+/HER2- Breast Cancer and High-risk Scoring on Genomic Assays

Cited by 3 publications

References 26 publications

Declination of Treatment, Racial and Ethnic Disparity, and Overall Survival in US Patients With Breast Cancer

Declination of Treatment, Racial and Ethnic Disparity, and Overall Survival in US Patients With Breast Cancer

Disparities in Hormone Receptor-Positive Breast Cancer

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

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