Use of adjuvant trastuzumab in women with human epidermal growth factor receptor 2 (HER2)‐positive breast cancer by race/ethnicity and education within the National Comprehensive Cancer Network

Freedman, Rachel A.; Hughes, Melissa E.; Ottesen, Rebecca A.; Weeks, Jane C.; He, Yulei; Wong, Yu‐Ning; Theriault, Richard L.; Keating, Nancy L.

doi:10.1002/cncr.27831

Cited by 62 publications

(35 citation statements)

References 34 publications

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“…We did observe differences in treatment by stage and age, consistent with other studies. 34,37,[39][40][41][42] Our findings of higher odds of chemotherapy for those with one comorbid condition or psychiatric disorders are contrary to other reports 37,41-44 but may have been observed because our comorbidity and depression measures did not fully capture treatment-limiting conditions or because one comorbid condition and/or mild emotional disorders were unlikely to limit treatment receipt. To our knowledge, this is the first study to examine women's knowledge about their own disease characteristics and receipt of treatments.…”

Section: Discussioncontrasting

confidence: 70%

“…This may be because of the relatively small numbers of patients in the treatment-eligible subgroups or because of our focus on a single geographic area. Nevertheless, many other studies have documented persistent disparities in treatment receipt, [30][31][32][33][34][35][36][37][38] and understanding how differences in knowledge may affect disparities among larger and broader cohorts is essential. We did observe differences in treatment by stage and age, consistent with other studies.…”

Section: Discussionmentioning

confidence: 99%

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Association of Breast Cancer Knowledge With Receipt of Guideline-Recommended Breast Cancer Treatment

Freedman

Kouri

West

et al. 2016

JOP

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QUESTION ASKED: Is knowledge about one's cancer associated with treatment receipt for women with breast cancer?SUMMARY ANSWER: Knowledge about one's tumor characteristics was strongly associated with receipt of guideline-recommended therapies, suggesting the potential importance of knowledge about one's disease. METHODS:We surveyed women with stage I-III breast cancer diagnosed during 2010-2011. We assessed if reporting correct information about one's tumor, including stage, grade, estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) status, was associated with guideline-recommended chemotherapy, radiation, and hormonal therapy using the California Cancer Registry for confirmation of tumor information. RESULTS (OR WHAT WE FOUND):Among 414 women eligible for adjuvant therapies, patients who reported correct stage and HER2 status were more likely to receive chemotherapy than those reporting incorrect information. Those correctly reporting ER status were more likely than others to receive hormonal therapy and those reporting correct stage were also more likely to receive radiation (Fig). BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: Although our observations are provocative, our results are limited by a lack of detailed information on treatment discussions, information on trastuzumab receipt, treatment adherence, patient preferences, and if/how information was conveyed to patients. Our definitions for correct information also relied on the accuracy of registry data. Finally, although knowledge about one's tumor was associated with receipt of therapy, whether a woman received treatment as a result of that knowledge or knew her tumor characteristics because she received treatment is uncertain. REAL-LIFE IMPLICATIONS:Our findings underscore the major knowledge deficits women had about their own cancers and suggest that this knowledge may be important in receipt of guidelinerecommended treatments. Our observations highlight the need for further study of the clinical, emotional, and social consequences of poor knowledge and how we can improve information delivery to patients. Interventions to improve patients' knowledge and understanding of their cancers should be tested as a strategy for improving cancer care. Abstract PurposeKnowledge about one's breast cancer characteristics is poor, but whether this knowledge affects treatment is uncertain. Among women with breast cancer, we examined whether tumor knowledge was associated with adjuvant treatment receipt. MethodsWe surveyed a population-based sample of women in Northern California with stage 0 to III breast cancer diagnosed during 2010 to 2011 (participation rate, 68.5%). Interviews were conducted between 4 months and 3 years after diagnosis. Among 414 respondents with stage I to III disease, we examined receipt of guideline-recommended chemotherapy, radiation, and hormonal therapy by reporting correct information about one's tumor, including stage, estrogen receptor, human epidermal growth factor receptor 2 (HER2), and grade (using registry data fo...

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Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Association of Breast Cancer Knowledge With Receipt of Guideline-Recommended Breast Cancer Treatment

Freedman

Kouri

West

et al. 2016

JOP

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“…Existing data indicate that African American women are less likely to complete therapy with trastuzumab than white women. 20 Pitman et al found that African American and Hispanic men wait longer between positive prostate biopsy results and radical prostatectomy than white men. 21 However, it is possible that numerous factors were responsible for this delay, and the degree to which reduced adherence can be ascribed in this case is unknown.…”

Section: Discussionmentioning

confidence: 99%

“…Health literacy may be lower in African American patients compared with white patients, 23 with resulting implications for medication adherence, receipt of appropriate treatment, and participation in preventative therapies and behaviors. 20,24,25 In addition, suboptimal relationships with health care providers and financial factors may also play a role in the differences noted in outcomes between African American and white patients even after care is established. 26 It is disappointing that over the last 20 years the survival gap between African American patients and white patients does not appear to be closing.…”

Section: Discussionmentioning

confidence: 99%

Lack of reduction in racial disparities in cancer‐specific mortality over a 20‐year period

Aizer

Wilhite

Chen

et al. 2014

Cancer

223

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BACKGROUND:To the authors' knowledge, it remains unknown whether race-based differences in cancer outcomes have changed with time. In the current study, the authors assessed whether racial disparities in cancer-specific mortality have improved over the last 20 years. METHODS: The Surveillance, Epidemiology, and End Results program was used to identify 2,713,474 patients diagnosed between 1988 and 2007 with either lung, breast, prostate, or colorectal cancer (the leading 3 causes of cancer-related mortality among each sex). After exclusions, 1,001,978 patients remained eligible for analysis. The impact of race on cancer-specific mortality was assessed using the regression model of Fine and Gray; an interaction model evaluated trends over time. RESULTS: African Americans presented with a more advanced stage of disease (P <.001) and underwent definitive therapy less often (P <.001) than whites. After adjustment for demographics and year of diagnosis, African Americans were found to have higher estimates of cancer-specific mortality than whites for all cancers combined (hazards ratio, 1.28; 95% confidence interval, 1.26-1.30 [P <.001]) and within each individual cancer (each P <.05). These differences did not change significantly between 1988 through 1997 and 1998 through 2007, except among patients with breast cancer, in whom survival disparities increased. These findings remained significant after adjustment for stage of disease at presentation and receipt of definitive therapy (hazards ratio for breast cancer mortality in African Americans vs whites: 1.37 from 1988-1997 and 1.53 from 1998-2007; P for interaction, < .001). CONCLUSIONS: The survival gap for African Americans has not closed over time. Race-based differences in outcome persist independent of stage of disease and treatment, suggesting that additional strategies beyond screening and improving access to care, such as further research into tumor biologies disproportionately affecting African Americans, are needed to improve survival for African American patients with cancer. Cancer 2014;120:1532-9.

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“…It has been argued that this is related to a higher proportion of patients with unfavorable subtypes, such as triple-negative breast cancer [19]. However, racial disparities in the receipt of breast cancer treatments have also been described [10,[22][23][24][25], and in particular, disparities in trastuzumab utilization have been observed for women in the adjuvant setting [26]. It is not clear whether racial disparities in outcomes for patients with metastatic disease vary by breast cancer subtype, particularly during an era when trastuzumab became widely available [20,27].…”

Section: Introductionmentioning

confidence: 95%

Racial differences in outcomes for patients with metastatic breast cancer by disease subtype

Vaz-Luís

Lin

Keating

et al. 2015

Breast Cancer Res Treat

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Treatment advances have differed by breast cancer subtype. We examined the impact of race on survival of women with metastatic breast cancer by disease subgroup. Using surveillance, epidemiology, and end results -Medicare data, we included white and black patients aged ≥66 with de novo metastatic breast cancer diagnosed between 1998 and 2009. Using trastuzumab as a proxy for human epidermal growth factor receptor 2 (HER2)-positive status, we defined three disease subgroups: (1) HER2-positive (received trastuzumab), (2) HER2-negative/unknown (never received trastuzumab)/hormone receptor (HR)-positive, and (3) HER2-negative/unknown/HR-negative. Multivariate Cox proportional models assessed the impact of race on overall survival (OS) and breast cancer-specific survival by subgroup. We also examined trastuzumab treatment patterns. Among 4364 women (86 % white, 14 % black), 9 % had HER2-positive, 72 % had HER2-negative/unknown/HR-positive, and 18 % had HER2-negative/unknown/HR-negative tumors. Patients with HER2-positive disease experienced longer median OS compared with others: 2.4 versus 1.8 years for women with HER2-negative/unknown/HR-positive and 0.5 years for women with HER2-negative/unknown/HR-negative disease (P < 0.001). Racial differences in OS were only observed among patients with HER2-positive tumors: median OS: 1.4 versus 2.7 years for black and white women, adjusted hazard ratio 1.45; 95 % Confidence interval 1.01-2.08. Results for breast cancer-specific survival were similar. We also observed racial differences in trastuzumab utilization, with longer median time to trastuzumab initiation and lower likelihood of continuation over time for black (vs. white) patients. Among women with de novo metastatic breast cancer, racial differences in survival were only apparent for those with inferred HER2-positive tumors. Further study of how treatment patterns affect outcomes is warranted.

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Use of adjuvant trastuzumab in women with human epidermal growth factor receptor 2 (HER2)‐positive breast cancer by race/ethnicity and education within the National Comprehensive Cancer Network

Cited by 62 publications

References 34 publications

Association of Breast Cancer Knowledge With Receipt of Guideline-Recommended Breast Cancer Treatment

Association of Breast Cancer Knowledge With Receipt of Guideline-Recommended Breast Cancer Treatment

Lack of reduction in racial disparities in cancer‐specific mortality over a 20‐year period

Racial differences in outcomes for patients with metastatic breast cancer by disease subtype

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