The association of socioeconomic status with receipt of neoadjuvant chemotherapy

Neuner, Joan; Kong, Amanda L.; Blaes, Ann; Riley, Danielle; Chrischilles, Elizabeth A.; Smallwood, Alicia; Lizarraga, Ingrid M.; Schroeder, Mary C.

doi:10.1007/s10549-018-4954-0

Cited by 13 publications

(13 citation statements)

References 27 publications

(31 reference statements)

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“…In the current analysis, we observed an association between lower income and treatment modification. Several studies have shown a relationship between lower socio-economic status (SES) and treatment modification [34,35]. For example, patients receiving adjuvant breast cancer therapy, women of lower SES background were more likely to receive dose reductions [34].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of and factors associated with treatment modification at first cycle in older adults with advanced cancer receiving palliative treatment

Mohamed

Kyi

Mohile

et al. 2021

Journal of Geriatric Oncology

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Introduction: Treatment toxicities are common in older adults with cancer and consequently, treatment modifications are sometimes considered. We evaluated the prevalence and factors associated with treatment modifications at the first cycle in older patients receiving palliative systemic treatment. Methods: Patients (n = 369) from the GAP 70+ Trial (NCT02054741; PI: Mohile) usual care arm were included. Enrolled patients were aged 70+ with advanced cancer and ≥ 1 Geriatric Assessment (GA) domain impairment. Treatment modification was defined as any change from National Comprehensive Cancer Network guidelines or published clinical trials. Baseline variables included: 1) sociodemographic factors; 2) clinical variables; 3) GA domains; and 4) physician beliefs about life expectancy. Bivariate analyses and multivariable cluster-weighted generalized estimating equation model were conducted to assess the association of baseline variables with cycle 1 treatment modifications. Results: Mean age was 77.2 years (range: 70-94); 62% had lung or gastrointestinal cancers, and 35% had treatment modifications at cycle 1. Increasing age by one year (odds ratio (OR) 1.1, 95% confidence interval [CI] 1.0-1.2), receipt of ≥second line of chemotherapy (OR 1.8, CI 1.1-3.0), functional impairment (OR 1.6, CI 1.1-2.3) and income ≤$50,000 (OR 1.7, CI 1.1-2.4) were independently associated with a higher likelihood of cycle 1 treatment modification. Conclusion: Treatment modifications occurred in 35% of older adults with advanced cancer at cycle 1. Increasing age, receipt of ≥second line of chemotherapy, functional impairment, and lower income were independently associated with treatment modifications. These findings emphasize the need for evidence-based regimens in older adults with cancer and GA impairments.

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Section: Discussionmentioning

confidence: 99%

Prevalence of and factors associated with treatment modification at first cycle in older adults with advanced cancer receiving palliative treatment

Mohamed

Kyi

Mohile

et al. 2021

Journal of Geriatric Oncology

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“…114 The electronic literature search conducted to inform this section of the neoadjuvant therapy guideline identified 14 articles (from a total of 101 abstracts) on the topic of health disparities. 88,[115][116][117][118][119][120][121][122][123][124][125][126][127] The available studies evaluated associations between a range of clinical and sociodemographic factors and the use and outcomes of neoadjuvant therapy for breast cancer. Killelea et al, 122 for example, examined racial differences in the frequency and outcomes of neoadjuvant chemotherapy use and reported that neoadjuvant chemotherapy was given more frequently to African American, Hispanic, and Asian women than to White women (P 5 .001).…”

Section: Health Disparitiesmentioning

confidence: 99%

Neoadjuvant Chemotherapy, Endocrine Therapy, and Targeted Therapy for Breast Cancer: ASCO Guideline

Korde

Somerfield

Carey

et al. 2021

JCO

433

253

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PURPOSE To develop guideline recommendations concerning optimal neoadjuvant therapy for breast cancer. METHODS ASCO convened an Expert Panel to conduct a systematic review of the literature on neoadjuvant therapy for breast cancer and provide recommended care options. RESULTS A total of 41 articles met eligibility criteria and form the evidentiary basis for the guideline recommendations. RECOMMENDATIONS Patients undergoing neoadjuvant therapy should be managed by a multidisciplinary care team. Appropriate candidates for neoadjuvant therapy include patients with inflammatory breast cancer and those in whom residual disease may prompt a change in therapy. Neoadjuvant therapy can also be used to reduce the extent of local therapy or reduce delays in initiating therapy. Although tumor histology, grade, stage, and estrogen, progesterone, and human epidermal growth factor receptor 2 (HER2) expression should routinely be used to guide clinical decisions, there is insufficient evidence to support the use of other markers or genomic profiles. Patients with triple-negative breast cancer (TNBC) who have clinically node-positive and/or at least T1c disease should be offered an anthracycline- and taxane-containing regimen; those with cT1a or cT1bN0 TNBC should not routinely be offered neoadjuvant therapy. Carboplatin may be offered to patients with TNBC to increase pathologic complete response. There is currently insufficient evidence to support adding immune checkpoint inhibitors to standard chemotherapy. In patients with hormone receptor (HR)-positive (HR-positive), HER2-negative tumors, neoadjuvant chemotherapy can be used when a treatment decision can be made without surgical information. Among postmenopausal patients with HR-positive, HER2-negative disease, hormone therapy can be used to downstage disease. Patients with node-positive or high-risk node-negative, HER2-positive disease should be offered neoadjuvant therapy in combination with anti-HER2-positive therapy. Patients with T1aN0 and T1bN0, HER2-positive disease should not be routinely offered neoadjuvant therapy. Additional information is available at www.asco.org/breast-cancer-guidelines .

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“…A positive relationship between SES and GCC is expected 14,20,21 . The divergence from the expected relationship for YAs with HR−/HER2− tumors may reflect the difference in how SES is defined across studies.…”

Section: Discussionmentioning

confidence: 88%

“…In other studies, income, education level, rural/urban residence, and insurance status are often analyzed independently as markers of SES and may give varying results. A multicenter sample found that receipt of neoadjuvant therapy was lower for women with lower incomes but was not associated with rural/urban residence 20 . In another study, patients covered by insurance plans with lower reimbursement rates were less likely to receive recommended care 21 .…”

Section: Discussionmentioning

confidence: 97%

Receipt of guideline‐concordant care among young adult women with breast cancer

White

Kurian

Stevens

et al. 2021

Cancer

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Background Little is known about the real‐world care of young adult (YA) females (aged 20‐39 years) with breast cancer. This study describes factors associated with the receipt of guideline‐concordant care (GCC) among YAs. Methods The authors identified 1259 YA women with invasive breast cancer diagnosed in 2013 in the National Cancer Institute's Patterns of Care study. Hospital records were re‐abstracted, and treatment was verified. Using the National Comprehensive Cancer Network's 2013 breast cancer guidelines, the authors assessed the receipt of GCC by cancer subtype among a subset of YAs (n = 952). Associations between sociodemographic and clinical factors and GCC receipt were examined. Results Most YAs were 35 to 39 years old (51.2%) and partnered (56.4%); half had hormone receptor–positive (HR+)/human epidermal growth factor receptor 2–negative (HER2−) tumors. GCC was found for 81.7% of YAs. Relationships between sociodemographic and clinical factors and GCC receipt differed by subtype. Stage was the only significant predictor of GCC receipt for all subtypes (stage II vs III: odds ratio [OR] for HR+/HER2+, 0.20; 95% confidence interval [CI], 0.08‐0.50; OR for HR−/HER2+, 0.13; 95% CI, 0.07‐0.25; OR for HR−/HER2−, 3.86; 95% CI, 1.55‐9.62; OR for HR+/HER2−, 2.81; 95% CI, 1.63‐5.80). Conclusions GCC is high among YAs with breast cancer. The effects of sociodemographic factors and treatment facility size on GCC differ by subtype. Consistent with recommendations, tumor biology, not age, is associated with GCC for all subtypes. Future studies should assess the effect of GCC on survival among YAs.

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The association of socioeconomic status with receipt of neoadjuvant chemotherapy

Cited by 13 publications

References 27 publications

Prevalence of and factors associated with treatment modification at first cycle in older adults with advanced cancer receiving palliative treatment

Prevalence of and factors associated with treatment modification at first cycle in older adults with advanced cancer receiving palliative treatment

Neoadjuvant Chemotherapy, Endocrine Therapy, and Targeted Therapy for Breast Cancer: ASCO Guideline

Receipt of guideline‐concordant care among young adult women with breast cancer

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