Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Ann Surg Oncol. 2021 Sep;28(9):4995-5004. doi: 10.1245/s10434-020-09533-z. Epub 2021 Jan 9.
BACKGROUND: Most minorities receive cancer care at minority-serving hospitals (MSHs) that have been associated with disparate treatment between Black and White patients. OBJECTIVE: Our aim was to examine the uptake of clinical trials that have changed axillary management in breast cancer patients at MSH and non-MSH cancer centers. METHODS: The National Cancer Database was used to identify patients eligible for the American College of Surgeons Oncology Group Z0011 and Z1071 trials, and mastectomy patients fulfilling the European AMAROS trial. Uptake of trial results (omission of axillary lymph node dissection) was analyzed between patients treated at MSHs and non-MSHs and adjusted for patient, tumor, and facility factors. MSHs were defined as the top decile of hospitals according to the proportion of Black and Hispanic patients treated. RESULTS: Of 7167 patients eligible for Z0011, 4546 for Z0171, and 9433 for AMAROS from 2015 to 2016, clinical trial uptake was seen in 1195 (74.6%) MSH and 4056 (72.9%) non-MSH patients (p = 0.173) for Z0011, 588 (41.9%) MSH and 1366 (43.5%) non-MSH patients for Z1071 (p = 0.302), and 272 (11.7%) MSH and 996 (14.0%) non-MSH patients (p = 0.005) for AMAROS. On adjusted analyses, MSH status was not significant for uptake of any of the three trials. Black race, socioeconomic status, and insurance were not associated with clinical trial uptake. CONCLUSION: The uptake of three landmark clinical trials of axillary management in breast cancer was not different at MSH and non-MSH centers despite adjustment for social determinants of health. At the Commission on Cancer-accredited centers in this analysis, MSH status did not affect the uptake of evidence-based care.
背景:大多数少数民族在少数民族服务医院(MSH)接受癌症治疗,这些医院与黑人和白人患者之间的治疗差异有关。 目的:我们的目的是研究在 MSH 和非 MSH 癌症中心接受临床试验的乳腺癌患者的入组情况,这些临床试验改变了腋窝管理。 方法:使用国家癌症数据库确定符合美国外科医师学院肿瘤学组 Z0011 和 Z1071 试验标准的患者,以及符合欧洲 AMAROS 试验标准的接受乳房切除术的患者。分析 MSH 和非 MSH 治疗患者之间试验结果(省略腋窝淋巴结清扫术)的采用情况,并根据患者、肿瘤和医疗机构因素进行调整。MSH 是根据治疗的黑人和西班牙裔患者比例,按照医院前 10%的比例定义的。 结果:在 2015 年至 2016 年期间,符合 Z0011 标准的 7167 例患者、Z0171 标准的 4546 例患者和 AMAROS 标准的 9433 例患者中,Z0011 试验的 MSH 患者中接受治疗的有 1195 例(74.6%),非 MSH 患者中有 4056 例(72.9%)(p=0.173);Z1071 试验中,MSH 患者中有 588 例(41.9%),非 MSH 患者中有 1366 例(43.5%)(p=0.302);AMAROS 试验中,MSH 患者中有 272 例(11.7%),非 MSH 患者中有 996 例(14.0%)(p=0.005)。经过调整后的分析显示,三项乳腺癌腋窝管理临床试验的 MSH 状态与采用率无关。黑人和西班牙裔种族、社会经济地位和保险与临床试验的采用率无关。 结论:尽管调整了健康的社会决定因素,但在 MSH 和非 MSH 中心,三项腋窝管理的标志性临床试验的采用率并无差异。在本分析中,经癌症委员会认证的中心,MSH 状态并不影响基于证据的治疗方法的采用。
Ann Surg Oncol. 2021-9
J Natl Cancer Inst. 2009-7-15
Breast Cancer Res Treat. 2009-5-15