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

Abstract

INTRODUCTION:

The rate of refusal of chemotherapy ranges from 3% to 19%, but varies widely by patient profile and treatment setting. Using a large national registry, we explore factors significantly associated with the decision to decline chemotherapy in patients with early-stage, HR+/HER2- breast cancer (BC) despite high risk scoring on multigene sequencing analysis for OncotypeDX (ODX) or MammaPrint (MP), in which the survival benefit of chemotherapy is clear.

PATIENTS AND METHODS:

Patients with HR+/HER2- BC and high risk scoring on ODX (score >26) or MP were selected from the National Cancer Database (2004-2017). Only those who refused to get chemotherapy despite their physician's recommendations were included. Univariate frequency and proportion statistics were used to describe the patient cohort. Bivariate Chi-square analysis evaluated the association between refusal of recommended chemotherapy and sociodemographic characteristics. Significant variables (P < .05) were included in a multivariable logistic regression model.

RESULTS:

N = 43,533 patients were included (88.7% ODX, 11.3% MP). A total of n = 4415 (10.1%) patients declined chemotherapy despite recommendation by the patient's primary oncologist. Age >70 (OR: 3.46, 95% CI: 2.96-4.04, P < .001), black race (OR: 1.20, 95% CI: 1.07-1.36, P = .01), non-private insurance, lobular carcinoma histology (OR: 1.21, 95% CI: 1.09-1.35, P < .001), and tumor grade of I significantly predicted chemotherapy decline.

CONCLUSION:

Identifying and addressing many of the factors that contribute to under-treatment in minorities is to be key to reducing cancer disparity and improving equity in cancer care and outcome.

• Authors: Nadeem Bilani, Shereen El Ladki, Marita Yaghi, Olivia Main, Iktej S Jabbal, Leah Elson, Maroun Bou Zerdan, Hong Liang, Zeina Nahleh
• Journal: Clinical breast cancer (Clin Breast Cancer) Vol. 22 Issue 4 Pg. 367-373 (06 2022) ISSN: 1938-0666 [Electronic] United States
• PMID: 35190262 (Publication Type: Journal Article)
• Copyright: Copyright © 2022. Published by Elsevier Inc.

Topics

• Breast Neoplasms (drug therapy, genetics, pathology)
• Carcinoma, Lobular (drug therapy, genetics)
• Chemotherapy, Adjuvant
• Female
• Genomics
• Humans
• Neoplasm Recurrence, Local (pathology)