Low-income women with breast cancer are less likely to initiate chemotherapy
Chemotherapy following surgery has remained the cornerstone of systemic therapy for patients with hormone receptor-negative breast cancer since 1990. Delaying or omitting initiation of adjuvant chemotherapy may contribute to breast cancer recurrence and mortality. Although guidelines for breast cancer treatment have focused on women under the age of 70, emerging evidence suggests clear benefits for older women as well. A team of North Carolina-based researchers used Surveillance Epidemiology and End Results Medicare linked data to examine patterns of care for 6,678 elderly women diagnosed with stage II or stage III hormone receptor-negative breast cancer in 1994 to 2002, with claims data through 2007. The overall use of guideline-recommended adjuvant chemotherapy was low at 43 percent. In general, low-income status, increasing age, and higher burden of coexisting conditions were all associated with significantly lower odds of postoperative chemotherapy initiation at 4 months after diagnosis.
Having cancer-positive lymph nodes, being diagnosed as stage II, being married, and being diagnosed in later years were generally associated with significantly higher odds of initiating chemotherapy within 4 months. The researchers investigated whether structural/organizational factors, including distance to care and institutional affiliations, and select sociodemographic characteristics accounted for treatment differences. They found that the characteristics of the surgical facility where women were treated were not predictive of initiation of adjuvant chemotherapy within 4 months of diagnosis. The researchers concluded that older women in good functional health who may benefit from chemotherapy may need better access to information about risks/benefits of adjuvant chemotherapy and improved access to chemotherapy providers through better referral processes and transportation. This study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00032).
See "Predictors of timing of adjuvant chemotherapy in older women with hormone receptor-negative, stages II-III breast cancer," by Stephanie B. Wheeler, Ph.D., William R. Carpenter, Ph.D., Jeffrey Peppercorn, M.D., M.P.H., and others in Breast Cancer Research and Treatment 131, pp. 207-216, 2012.