Graduate Education Office, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Department of Hematology-Oncology, University Hospitals/Seidman Cancer Center, Breen Pavilion - 11100 Euclid Ave, Cleveland, OH, 44106, USA.
Sci Rep. 2023 Jan 22;13(1):1233. doi: 10.1038/s41598-023-27578-4.
The main objective of this work was to perform a comprehensive analysis and provide a race-stratified epidemiological report accounting for differences in treatment patterns and treatment related adverse events in Non-Hispanic women with breast cancer (BC). The cohort included women ≥ 18 years diagnosed with in-situ, early-stage, and late-stage BC (2005-2022). Treatment patterns included: surgery, breast radiation, chemotherapy, endocrine therapy, or biologic therapy. Treatment related adverse events were: chemotherapy complications, cardiovascular toxicities, immune-related adverse events, psychological affectations, or cognitive decline/dementia. The influence of race on the outcomes was measured via Cox proportional-hazards models. We included 17,454 patients (82% non-Hispanic Whites [NHW]). Most of the patients had a Charlson Comorbidity Score between 1 and 2 (68%), and TNM stage I (44.5%). Surgery was performed in 51.5% of the cases, while 30.6% received radiotherapy, 26.4% received chemotherapy, 3.1% received immunotherapy, and 41.2% received endocrine therapy. Non-Hispanic Blacks (NHB) had a lower probability of undergoing breast cancer surgery (aHR = 0.92, 95% CI 0.87-0.97) and of being prescribed endocrine therapy (aHR = 0.83, 95% CI 0.79-0.89), but a higher probability of receiving adjuvant radiotherapy (aHR = 1.40, 95% CI 1.29-1.52). Moreover, NHBs had lower risk of being diagnosed with psychological issues (aHR = 0.71, 95% CI 0.63-0.80) but a higher risk for cognitive decline/dementia (aHR = 1.30, 95% CI 1.08-1.56). In conclusion, NHB women diagnosed with BC were less likely than NHW to undergo curative intent surgery or receive endocrine therapy, and had a higher risk of cognitive decline/dementia after cancer treatment. Public policy measures are urgently needed which equalize access to quality healthcare for all patients and that promote a learning healthcare system which can improve cancer outcomes.
本研究旨在对非西班牙裔女性乳腺癌患者的治疗模式和治疗相关不良反应进行全面分析，并按种族进行分层，提供流行病学报告。该队列纳入了 2005 年至 2022 年间诊断为原位、早期和晚期乳腺癌的年龄≥18 岁的女性。治疗模式包括手术、乳房放疗、化疗、内分泌治疗或生物治疗。治疗相关不良反应包括化疗并发症、心血管毒性、免疫相关不良反应、心理影响或认知能力下降/痴呆。通过 Cox 比例风险模型衡量种族对结局的影响。我们纳入了 17454 名患者（82%为非西班牙裔白人[NHW]）。大多数患者的 Charlson 合并症评分在 1 至 2 分之间（68%），TNM 分期为 I 期（44.5%）。51.5%的患者接受了手术，30.6%的患者接受了放疗，26.4%的患者接受了化疗，3.1%的患者接受了免疫治疗，41.2%的患者接受了内分泌治疗。非西班牙裔黑人（NHB）接受乳腺癌手术的可能性较低（aHR=0.92，95%CI 0.87-0.97），接受内分泌治疗的可能性也较低（aHR=0.83，95%CI 0.79-0.89），但接受辅助放疗的可能性较高（aHR=1.40，95%CI 1.29-1.52）。此外，NHB 被诊断出心理问题的风险较低（aHR=0.71，95%CI 0.63-0.80），但认知能力下降/痴呆的风险较高（aHR=1.30，95%CI 1.08-1.56）。总之，与 NHW 相比，诊断为乳腺癌的 NHB 女性接受根治性手术或内分泌治疗的可能性较低，且癌症治疗后认知能力下降/痴呆的风险较高。迫切需要采取公共政策措施，确保所有患者都能公平获得高质量的医疗保健，并促进学习型医疗保健系统，以改善癌症结局。
