Breast Cancer

Limited research has explored national trends and associated factors of treatment refusal and its impact on overall survival in breast cancer.

Jincong Q Freeman and the team aimed to analyze treatment refusal trends and racial and ethnic disparities in overall survival (OS) among patients with breast cancer in the US.

In this retrospective cross-sectional study, researchers analyzed data from the National Cancer Database spanning from 2004 to 2020, focusing on patients with breast cancer. They assessed 4 treatment modalities, including chemotherapy, hormone therapy (HT), radiotherapy, and surgery. The chemotherapy cohort comprised patients with stage I to IV disease, while the HT cohort included those with stage I to IV hormone receptor-positive disease. The radiotherapy and surgery cohorts included patients with stage I to III disease. Data analysis was conducted between March and November 2023.

This study considered race, ethnicity, and various sociodemographic and clinicopathologic characteristics. The primary outcomes and measures included treatment decisions, categorized as received or declined, which were analyzed using logistic regression. OS was analyzed using Cox regression. The models were adjusted for the year of initial diagnosis, age, gender, health insurance status, median household income, facility type, Charlson-Deyo comorbidity score, histology, American Joint Committee on Cancer stage, molecular subtype, and tumor grade.

The results revealed that of the 2,837,446 patients studied (mean SD age, 61.6 [13.4] years; 99.1% female), with 1.7% American Indian, Alaska Native, or other patients; 3.5% Asian or Pacific Islander patients; 11.2% Black patients; 5.6% Hispanic patients; and 78.0% White patients.

Among those offered treatment, 9.6% declined chemotherapy, 6.1% declined radiotherapy, 5.0% declined hormone therapy (HT), and 0.6% declined surgery. Compared with White patients, American Indian, Alaska Native, or other patients (AOR, 1.47; 95% CI, 1.26-1.72), Asian or Pacific Islander patients (AOR, 1.29; 95% CI, 1.15-1.44), and Black patients (AOR, 2.01; 95% CI, 1.89-2.14) were more likely to decline surgery; American Indian, Alaska Native, or other patients (AOR, 1.13; 95% CI, 1.05-1.21) and Asian or Pacific Islander patients (AOR, 1.21; 95% CI, 1.16-1.27) were more likely to decline chemotherapy; and Black patients were more likely to decline radiotherapy (AOR, 1.05; 95% CI, 1.02-1.08).

Asian or Pacific Islander patients (AOR, 0.81; 95% CI, 0.77-0.85), Black patients (AOR, 0.86; 95% CI, 0.83-0.89), and Hispanic patients (AOR, 0.66; 95% CI, 0.63-0.69) were less likely to decline HT. Furthermore, Black patients who declined chemotherapy had a higher mortality risk than White patients (AHR, 1.07; 95% CI, 1.02-1.13), while there were no OS differences between Black and White patients who declined HT (AHR, 1.05; 95% CI, 0.97-1.13) or radiotherapy (AHR, 0.98; 95% CI, 0.92-1.04).

The study concluded that racial and ethnic disparities in treatment declination and OS underscore the necessity for equity-focused interventions. These may include patient education initiatives regarding treatment benefits and enhancements in patient-clinician communication and shared decision-making processes. Such interventions are vital for reducing disparities and enhancing patient survival rates.

No funding-related information was available.

Source: https://pubmed.ncbi.nlm.nih.gov/38722630/

Freeman JQ, Li JL, Fisher SG, et al. (2024). “Declination of Treatment, Racial and Ethnic Disparity, and Overall Survival in US Patients With Breast Cancer.” JAMA Netw Open. 2024 May 1;7(5):e249449. doi: 10.1001/jamanetworkopen.2024.9449. PMID: 38722630.