Missed opportunities: Racial disparities in adjuvant breast cancer treatment
Missed opportunities: Racial disparities in adjuvant breast cancer treatment
复制标题
DOI：
10.1200/jco.2005.04.5799
复制
发表时间：
2006-03-20
影响因子：
45.3
通讯作者：
Guth, AA
中科院分区：
文献类型：
--
作者：
Bickell, NA;Wang, JJ;Guth, AA
目的未充分利用辅助治疗是少数民族乳腺癌患者存活率低的一个潜在的重要和可补救的解释。我们试图衡量早期乳腺癌辅助治疗使用不足的种族差异，并确定相关因素。方法横断面研究，回顾了1999年至2000年美国癌症联合委员会I期或11期乳腺癌的677名女性的所有住院和门诊医疗记录。未充分使用定义为保乳手术后未进行放射治疗，激素受体阴性肿瘤切除后未进行辅助化疗，或受体阳性肿瘤未进行激素治疗。结果145例(21%)女性患者存在未充分使用适当辅助治疗的情况：白人16%，黑人34%，西班牙裔23%(P<；.001)。咨询内科肿瘤学家的女性不太可能经历必要的辅助治疗不足(使用不足的相对风险[RR]=0.2；95%CI，0.1至0.3)。少数民族妇女(RR=2.0；95%CI，1.3~3.1)、合并症水平较高(RR=1.4~1.95%CI，1.1~1.8)和缺乏保险(RR=1.9；95%CI，0.9~4.0)的女性使用不足的风险更大。结论少数民族早期乳腺癌患者未能接受必要辅助治疗的风险是白人女性的两倍，尽管肿瘤咨询率与白人女性相似。肿瘤学转诊对于减少治疗差异是必要的，但不足以确保患者获得有效的辅助治疗。
Purpose Underuse of adjuvant therapy is a potentially important and remediable explanation for the inferior survival of minority women with breast cancer. We sought to measure a racial disparity in the underuse of adjuvant treatments for early-stage breast cancer and to identify associated factors.Methods Cross-sectional study with review of all inpatient and outpatient medical records of 677 women treated surgically for a primary American Joint Committee on Cancer stage I or 11 breast cancer in 1999 to 2000. Underuse was defined as omissions of radiation therapy after breast-conserving surgery, adjuvant chemotherapy after resection of hormone-receptor-negative tumors I cm, or hormonal therapy for receptor-positive tumors >= 1 cm.Results One hundred forty-five (21%) of 677 women experienced underuse of appropriate adjuvant therapy: 16% in whites, 34% in blacks, and 23% in Hispanics (P < .001). Women referred to medical oncologists were less likely to experience underuse of necessary adjuvant treatments (relative risk [RR] for underuse = 0.2; 95% Cl, 0.1 to 0.3). Women who were minorities (RR = 2.0; 95% CI, 1.3 to 3.1), had higher levels of comorbidity (RR = 1.4-1 95% CI, 1.1 to 1.8) and lacked insurance (RR = 1.9; 95% CI, 0.9 to 4.0) were at greater risk for underuse.Conclusion Minority women with early-stage breast cancer have double the risk of white women for failing to receive necessary adjuvant treatments despite rates of oncologic consultation similar to those for white women. Oncology referrals are necessary to reduce treatment disparities but are not sufficient to ensure patients' receipt of efficacious adjuvant treatment.