Griggs Jennifer J, Liu Yihang, Sorbero Melony E, Jagielski Christina H, Maly Rose C
University of Michigan Ann Arbor, Michigan 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109, USA,
Breast Cancer Res Treat. 2014 Apr;144(3):665-72. doi: 10.1007/s10549-014-2869-y. Epub 2014 Mar 5.
Unwarranted breast cancer adjuvant chemotherapy dose reductions have been documented in black women, women of lower socioeconomic status, and those who are obese. No information on the quality of chemotherapy is available in Hispanic women. The purpose of this study was to characterize factors associated with first cycle chemotherapy dose selection in a multi-ethnic sample of low-income women receiving chemotherapy through the Breast and Cervical Cancer Prevention Treatment Program (BCCPT) and to investigate the impact of Hispanic ethnicity and patient self-efficacy on adjuvant chemotherapy dose selection. Survey and chemotherapy information were obtained from consenting participants enrolled in the California BCCPT. Analyses identified clinical and non-clinical factors associated with first cycle chemotherapy doses less than 90 % of expected doses. Of 552 patients who received chemotherapy, 397 (72 %) were eligible for inclusion. First cycle dose reductions were given to 14 % of the sample. In multivariate analyses, increasing body mass index and non-academic treatment site were associated with doses below 90 % of the expected doses. No other clinical or non-clinical factors, including ethnicity, were associated with first cycle doses selection. In this universally low-income sample, we identified no association between Hispanic ethnicity and other non-clinical patient factors, including patient self-efficacy, in chemotherapy dose selection. As seen in other studies, obesity was associated with systematic dose limits. The guidelines on chemotherapy dose selection in the obese may help address such dose reductions. A greater understanding of the association between type of treatment site and dose selection is warranted. Overall, access to adequate health care allows the vast majority of low-income women with breast cancer to receive high-quality breast cancer chemotherapy.
已有文献记载，黑人女性、社会经济地位较低的女性以及肥胖女性存在不必要的乳腺癌辅助化疗剂量减少的情况。目前尚无关于西班牙裔女性化疗质量的信息。本研究的目的是在通过乳腺癌和宫颈癌预防治疗项目（BCCPT）接受化疗的低收入多民族女性样本中，确定与首个化疗周期剂量选择相关的因素，并调查西班牙裔种族和患者自我效能对辅助化疗剂量选择的影响。从参与加利福尼亚BCCPT的同意参与者处获取调查和化疗信息。分析确定了与首个化疗周期剂量低于预期剂量90%相关的临床和非临床因素。在552名接受化疗的患者中，397名（72%）符合纳入条件。14%的样本接受了首个周期的剂量减少。在多变量分析中，体重指数增加和非学术性治疗地点与低于预期剂量90%的剂量相关。没有其他临床或非临床因素，包括种族，与首个周期剂量选择相关。在这个普遍低收入的样本中，我们发现在化疗剂量选择方面，西班牙裔种族与包括患者自我效能在内的其他非临床患者因素之间没有关联。正如其他研究中所见，肥胖与系统性剂量限制有关。肥胖患者化疗剂量选择指南可能有助于解决此类剂量减少问题。有必要更深入了解治疗地点类型与剂量选择之间的关联。总体而言，获得足够的医疗保健使绝大多数低收入乳腺癌女性能够接受高质量的乳腺癌化疗。
