Surgery Refusal Among Black and Hispanic Women with Non-Metastatic Breast Cancer

Relation, Theresa; Ndumele, Amara; Bhattacharyya, Oindrila; Li, Yaming; Obeng‐Gyasi, Samilia; Eskander, Mariam F.; Tsung, Allan; Oppong, Bridget A.

doi:10.1245/s10434-022-11832-6

Cited by 9 publications

(5 citation statements)

References 28 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%

“…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%

See 2 more Smart Citations

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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“…Several cancer-directed surgeries, such as radical prostatectomy (RP), cytotherapeutic ablation, focal photodynamic therapy, and surgical treatment for metastases, play an important role in the management of prostate cancer (PCa) [3]. However, while CDS provides potential benefits to patients with many kinds of solid tumors, there were a considerable number of patients who were not recommended to undergo CDS, or who refused the treatment for varying reasons [2,4,5]. CDS such as RP is considered a curative treatment for localized PCa, while it may also be used simply as one part of a multimodal therapeutic regimen for selected patients with local advanced PC and limited benefits for likelihood of survival.…”

Section: Introductionmentioning

confidence: 99%

Cancer-directed surgery brings survival benefits for patients with advanced prostate cancer: a population-based propensity-score matching study

Chen¹,

Lu²,

Horie³

et al. 2023

J. Cancer

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Purpose:The purpose of this study was to evaluate the survival benefits of cancer-directed surgery (CDS) for localized prostate cancer (PCa) as well as advanced PCa. Methods: We retrospectively used the Surveillance, Epidemiology, and End Results (SEER) database and conducted a propensity score matching (PSM) study to investigate survival benefits and influencing factors of CDS in patients with PCa, especially for those with advanced PCa. Results: 19,729 cases were included. Patients who were recommended CDS had lower stages of disease (81.01% vs. 77.32% at stages I and II, p<0.01) than those who were not recommended CDS. It was primarily age, diagnosis year, cancer stage (American Joint Committee on Cancer Staging System), Gleason score, race, and home location and prostate-specific antigen, that influenced whether CDS was recommended or not (all p<0.05). Patients with PCa had lower rates of cancer specific mortality (CSM) and overall mortality (OM) when CDS was performed (CDS performed=CDSP). The unselected patients with CDSP decreased both rates of CSM by 79% and OM by 26% (both p<0.001). CDSP also benefited the young patients (with age ≤74 years old) with stage IV disease, promoting a rate decrease by 28% in CSM and by 31% in OM (both p<0.001). Conclusions: We found a decline in CSM and OM for unselected patients with PCa and patients less than 74 years old with stage IV disease. CDS as part of a multimodal treatment concept should be considered for an alternative treatment for patients with advanced PCa.

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A Public Health Emergency

Pleasant

2024

Obstetrics and Gynecology Clinics of North America

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Surgery Refusal Among Black and Hispanic Women with Non-Metastatic Breast Cancer

Cited by 9 publications

References 28 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

Cancer-directed surgery brings survival benefits for patients with advanced prostate cancer: a population-based propensity-score matching study

A Public Health Emergency

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