Breast
Oluwadamilola M. Fayanju, MD, MA, MPHS, FACS
The Helen O. Dickens Presidential Associate Professor & Chief of Breast Surgery
The University of Pennsylvania / Penn Medicine
Philadelphia, Pennsylvania, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Identifying characteristics associated with non-receipt of GCC can facilitate targeted interventions to improve disparities. Here, we identify factors associated with likelihood of GCC receipt after breast cancer diagnosis.
Methods:
We used the National Cancer Database to identify women≥18y who were diagnosed 2010-2018 with stage 0-III invasive breast cancer, underwent breast surgery, and had complete treatment data. We defined GCC criteria and eligibility (Table) by treatment modality (chemotherapy, endocrine therapy [ET], post-lumpectomy & post-mastectomy radiation [RT]) and by timeliness of treatment initiation (≤60d of diagnosis). We used multivariable logistic regression to identify factors predicting GCC receipt.
Results:
1,122,697 patients were identified. 80.7% (n=238,600) of chemo-indicated, 77.6% (n=732,427) of ET-indicated, and 57.5% (n=534,413) of RT-indicated patients received modality-specific GCC; 84.1% (n=944,251) initiated treatment≤60d of diagnosis. Overall, only 37% (n=415,992) of patients received all the GCC for which they were eligible. Being Black or Hispanic (vs White), Charlson-Deyo Combined Comorbidity score (CDCC)≥2 (vs 0), and having Medicaid or no insurance (vs private) were associated with decreased odds of initiating treatment≤60d of diagnosis and of receiving chemo GCC and post-lumpectomy RT GCC; CDCC ≥2 (vs 0) was associated with increased odds of ET GCC receipt (all p< 0.05, Table). Being Hispanic (vs White: OR 0.92, 95% CI 0.90-0.94); having Medicaid or no insurance (vs private, e.g., Medicaid OR 0.89, 95% CI 0.87-0.91); undergoing mastectomy (vs lumpectomy: OR 0.30, 95% CI 0.29-0.30); and having DCIS (i.e., Stage 0, vs Stage I cancer: OR 0.27, 95% CI 0.23-0.32) were associated with lower odds of receiving all indicated GCC (all p< 0.01).
Conclusions:
Less than 40% of women received all treatments for which they were eligible, though for early-stage disease (e.g., DCIS), omission of some treatment may represent intentional de-escalation. Race/ethnicity, insurance, surgery type, comorbidities, and disease stage were associated with receipt of both overall and modality-specific GCC, suggesting opportunities for intervention and disparity mitigation.