Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai West, and Morningside.
Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic Florida, FL.
Clin Breast Cancer. 2022 Jun;22(4):367-373. doi: 10.1016/j.clbc.2022.01.007. Epub 2022 Jan 22.
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 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.
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.
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.
尽管多基因测序分析（OncotypeDX [ODX] 或 MammaPrint [MP]）显示高危评分的患者接受化疗有生存获益，但仍有 3%至 19%的患者拒绝接受化疗，其比率差异较大，取决于患者特征和治疗环境。本研究使用大型国家登记处，探索了 HR+/HER2- 乳腺癌（BC）患者尽管 ODX 评分>26 或 MP 评分高风险，但拒绝接受化疗的相关因素，这些患者的生存获益明确。
从国家癌症数据库（2004-2017 年）中选择 HR+/HER2- BC 且 ODX（评分>26）或 MP 评分高风险的患者。仅纳入尽管医生建议但拒绝接受化疗的患者。使用单变量频率和比例统计描述患者队列。二项式 χ2 分析评估拒绝推荐化疗与社会人口统计学特征之间的关系。有意义的变量（P<.05）纳入多变量逻辑回归模型。
共纳入 43533 例患者（88.7% ODX，11.3% MP）。共有 4415 例（10.1%）患者尽管患者的主要肿瘤学家建议，但拒绝接受化疗。年龄>70 岁（OR：3.46，95%CI：2.96-4.04，P<.001）、黑人种族（OR：1.20，95%CI：1.07-1.36，P=.01）、非私人保险、小叶癌组织学（OR：1.21，95%CI：1.09-1.35，P<.001）和肿瘤分级为 I 级显著预测化疗失败。
确定并解决导致少数民族治疗不足的许多因素是缩小癌症差异和改善癌症护理和结局公平性的关键。
