The association of socioeconomic status with receipt of neoadjuvant chemotherapy. Breast Cancer Res Treat 2019 Jan;173(1):179-188
Date
09/21/2018Pubmed ID
30232683Pubmed Central ID
PMC6687292DOI
10.1007/s10549-018-4954-0Scopus ID
2-s2.0-85053679946 (requires institutional sign-in at Scopus site) 21 CitationsAbstract
BACKGROUND: There are advantages to neoadjuvant chemotherapy in operable breast cancer, particularly for those with higher-risk cancers, but little is known about factors that are associated with the use of neoadjuvant chemotherapy outside of clinical trials. We examined whether use of neoadjuvant chemotherapy instead of adjuvant chemotherapy varies by nonclinical factors such as patient socioeconomic status or rural residence.
METHODS: Women diagnosed with breast cancer in 2013-2014 at eight medical institutions were surveyed by mail regarding their experiences with breast cancer treatment, and this information was linked to hospital-based cancer registries. We examined the use of neoadjuvant chemotherapy among women with histologically confirmed invasive stage I-III breast cancer and used regression models to examine the association of socioeconomic status with chemotherapy timing. We also explored potential mechanisms for those differences.
RESULTS: Over 29% of the chemotherapy sample overall received neoadjuvant chemotherapy. Neoadjuvant receipt was lower for those with income < $100,000 (AOR 0.56, 95% CI 0.2-0.9) even with adjustment for other demographics, stage, and biomarker status, and findings for education and a variable for both lowest education and income < $100,000 were similar. Rural/urban residence was not associated with neoadjuvant receipt. Differences by income in perceptions of the importance of neoadjuvant chemotherapy advantages and disadvantages did not appear to explain the differences in use by income.
CONCLUSIONS: In a multicenter sample of breast cancer patients, lower income was strongly associated with less receipt of neoadjuvant chemotherapy. Since patients with lower socioeconomic status are more likely to present with later-stage disease, this pattern has the potential to contribute to breast cancer outcome disparities.
Author List
Neuner JM, Kong A, Blaes A, Riley D, Chrischilles E, Smallwood A, Lizarraga I, Schroeder MAuthor
Amanda L. Kong MS, MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Aged, 80 and over
Breast Neoplasms
Chemotherapy, Adjuvant
Female
Humans
Income
Middle Aged
Midwestern United States
Neoadjuvant Therapy
Patient Preference
Rural Health
Social Class
