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Poster display session

4144 - Determinants and outcomes associated with delays in adjuvant chemotherapy among breast cancer patients

Date

11 Sep 2017

Session

Poster display session

Presenters

Mariana Chavez Mac Gregor

Citation

Annals of Oncology (2017) 28 (suppl_5): v43-v67. 10.1093/annonc/mdx362

Authors

M. Chavez Mac Gregor1, X. Lei2, H. Zhao2, S.H. Giordano1

Author affiliations

  • 1 Breast Medical Oncology, Health Services Research, The University of Texas MD Anderson Cancer Center, 77030 - Houston/US
  • 2 Health Services Research, The University of Texas MD Anderson Cancer Center, 77030 - Houston/US
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Resources

Abstract 4144

Background

Adverse outcomes have been associated with delays in the administration of adjuvant chemotherapy among breast cancer patients. We evaluate the determinants and outcomes associated with delays in time to chemotherapy (TTC) in a large cohort of older breast cancer patients.

Methods

We used the NCI-Surveillance Epidemiology and End Results (SEER) and Texas Cancer Registry (TCR)-Medicare linked data bases to identify patients ≥66 years old diagnosed with localized or regional breast cancer between 2001-2011. All patients received chemotherapy within 9 months of surgery. Delayed TTC was defined as > 90 days. Multivariable logistic regression was used to identify predictors of treatment delay. A Cox Proportional Hazards model was fit to determine the association between treatment delay, overall survival (OS) and breast cancer specific survival (BCSS).

Results

25,096 patients were included, of them 2,676 (10.7%) had a TTC >90 days. In multivariable analysis factors associated with delays in TTC were: recent year of diagnosis (2011 vs 2001 OR = 1.31; 95%CI 1.03-1.67), older age (76-80 vs 66-70 OR = 1.51; 95%CI 1.33-1.72), black race (OR = 1.35; 95%CI 1.14-1.58), having state buy-in (as an indicator of poverty) (OR = 1.27; 95%CI 1.1-1.47), comorbidities (Charlson score 1 OR = 1.23;95%CI 1.09-1.37; score 2 OR = 1.57; 95%CI 1.37-1.81), mastectomy (OR = 1.49; 95%CI 1.33-1.67), mastectomy with immediate reconstruction (OR = 1.85; 95%CI 1.37-2.48), Oncotype DX testing (OR = 1.68; 95%CI 1.4-2.02), mastectomy >30 days after the initial surgery (OR = 16.91; 95%CI 12.07-23.68), brachytherapy (OR = 4.11; 95%CI 3.17-5.34) and whole breast radiation prior to chemotherapy (OR = 31.9; 95%CI 28.05-36.49). After adjusting for potential confounders, patients with TTC >90 days had worse OS (HR = 1.37; 95%CI 1.27-1.48) and BCSS (HR = 1.34; 95%CI 1.19-1.51).

Conclusions

A delay in adjuvant chemotherapy administration >90 days is associated with adverse outcomes among older breast cancer patients. Determinants of delays were sociodemographic in nature, related to patient’s characteristics and to treatment received. Every effort should be made to identify vulnerable patients and to administer chemotherapy in a timely manner.

Clinical trial identification

Legal entity responsible for the study

The University of Texas MD Anderson Cancer Center

Funding

Susan G. Komen, CIPRIT

Disclosure

All authors have declared no conflicts of interest.

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