TY - JOUR
T1 - Socioeconomic and racial disparities in the selection of chest wall boost radiation therapy in californian women after mastectomy
AU - Hess, Clayton
AU - Lee, Anna
AU - Fish, Kari
AU - Daly, Megan E
AU - Cress, Rosemary D
AU - Mayadev, Jyoti
PY - 2015/6/1
Y1 - 2015/6/1
N2 - Introduction Healthcare disparities in breast cancer treatment have been well documented. We investigated the socioeconomic status (SES) and racial factors in women with locally advanced breast cancer from the California Cancer Registry who had received postmastectomy radiation therapy (PMRT) with or without a chest wall boost (CWB). Patients and Methods The records of 4747 women with invasive breast cancer, diagnosed from 2005 to 2009, who had undergone PMRT, were reviewed and stratified by treatment with (n = 2686 [57%]) or without (n = 2061 [43%]) a CWB. Various patient demographic and biologic factors were analyzed using univariate and multivariate analysis. Results Receipt of a CWB was associated with race/ethnicity (P <.001), SES (P <.001), tumor size (P =.038), tumor grade (P =.033), human epidermal growth factor 2 (HER2) status (P =.015), American Joint Committee on Cancer stage (P =.001), number of nodes examined (P =.001), and number of positive nodes (P =.037) on univariate analysis. After controlling for confounding factors, race/ethnicity and SES remained independently predictive of a CWB. Hispanic women were more likely to receive a CWB than Asian (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.60-0.90), black (HR, 0.63; 95% CI, 0.48-0.83), or white (HR, 0.81; 95% CI, 0.69-0.95) women. Also, women of low SES were more likely to receive a CWB than women of high SES (HR, 0.74; 95% CI, 0.64-0.86). Conclusion We found that poor and Hispanic women were more commonly treated with a CWB than were more affluent and non-Hispanic women with a similar cancer stage, cancer biology, and treatment paradigm.
AB - Introduction Healthcare disparities in breast cancer treatment have been well documented. We investigated the socioeconomic status (SES) and racial factors in women with locally advanced breast cancer from the California Cancer Registry who had received postmastectomy radiation therapy (PMRT) with or without a chest wall boost (CWB). Patients and Methods The records of 4747 women with invasive breast cancer, diagnosed from 2005 to 2009, who had undergone PMRT, were reviewed and stratified by treatment with (n = 2686 [57%]) or without (n = 2061 [43%]) a CWB. Various patient demographic and biologic factors were analyzed using univariate and multivariate analysis. Results Receipt of a CWB was associated with race/ethnicity (P <.001), SES (P <.001), tumor size (P =.038), tumor grade (P =.033), human epidermal growth factor 2 (HER2) status (P =.015), American Joint Committee on Cancer stage (P =.001), number of nodes examined (P =.001), and number of positive nodes (P =.037) on univariate analysis. After controlling for confounding factors, race/ethnicity and SES remained independently predictive of a CWB. Hispanic women were more likely to receive a CWB than Asian (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.60-0.90), black (HR, 0.63; 95% CI, 0.48-0.83), or white (HR, 0.81; 95% CI, 0.69-0.95) women. Also, women of low SES were more likely to receive a CWB than women of high SES (HR, 0.74; 95% CI, 0.64-0.86). Conclusion We found that poor and Hispanic women were more commonly treated with a CWB than were more affluent and non-Hispanic women with a similar cancer stage, cancer biology, and treatment paradigm.
KW - Breast cancer
KW - Healthcare disparities
KW - Hispanic ethnicity
KW - Minority populations
KW - Postmastectomy radiation therapy
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U2 - 10.1016/j.clbc.2014.11.007
DO - 10.1016/j.clbc.2014.11.007
M3 - Article
C2 - 25499694
AN - SCOPUS:84929287877
VL - 15
SP - 212
EP - 218
JO - Clinical Breast Cancer
JF - Clinical Breast Cancer
SN - 1526-8209
IS - 3
ER -