Racial disparity in the dose and dose intensity of breast cancer adjuvant chemotherapy
Racial disparity in the dose and dose intensity of breast cancer adjuvant chemotherapy
复制标题
DOI：
10.1023/a:1025481505537
复制
发表时间：
2003-09-01
影响因子：
3.8
通讯作者：
Dick, AW
中科院分区：
文献类型：
--
作者：
Griggs, JJ;Sorbero, MES;Dick, AW
目的。本研究旨在探讨种族和肥胖对辅助化疗剂量和剂量强度的影响。我们从1985年至1997年在两个地理区域的10个治疗地点接受治疗的489名妇女的肿瘤记录中提取了患者/肿瘤特征、治疗过程、医生减少第一周期剂量的意图以及减少剂量/延迟剂量的原因等数据。将给药剂量和剂量强度与标准方案进行比较。多变量回归模型确定了种族和体重指数（BMI）对剂量比例（实际：预期剂量）和相对剂量强度（RDI）的影响，控制了患者特征、合并症、化疗方案、部位和治疗年份。Logistic回归探讨了种族和BMI与使用第一周期剂量减少的关系。非洲裔美国人化疗剂量比例和RDI低于白人（0.80比0.85,p= 0.03； 0.76比0.80,p= 0.01）。在多变量分析中，非超重非洲裔美国人的剂量比例比白人低0.09 (p= 0.002)， RDI低0.10 （p< 0.001）。肥胖与低剂量比例（p< 0.01）和RDI （p< 0.03）相关。种族和BMI与第一周期剂量减少独立相关。非超重的非裔美国人（p< 0.05）和超重和肥胖的非裔美国人和白人妇女（p< 0.001）比非超重的白人妇女更有可能减少第一周期剂量。我们确定了非裔美国人与超重和肥胖妇女在化疗管理方面的系统性差异。这些差异可能导致文献记载的结果差异。
Purpose. The purpose of this study was to investigate the impact of race and obesity on dose and dose intensity of adjuvant chemotherapy.Methods. We abstracted data on patient/tumor characteristics, treatment course, physicians' intention to give a first cycle dose reduction, and reasons for dose reductions/ delays from oncology records of 489 women treated from 1985 to 1997 in 10 treatment sites in two geographical regions. Administered doses and dose intensity were compared to standard regimens. Multivariate regression models determined the impact of race and body mass index (BMI) on dose proportion ( actual: expected doses) and relative dose intensity (RDI) controlling for patient characteristics, comorbidity, chemotherapy regimen, site, and year of treatment. Logistic regressions explored race and BMI versus use of first cycle dose reductions.Results. African-Americans received lower chemotherapy dose proportion and RDI than whites (0.80 vs. 0.85, p= 0.03 and 0.76 vs. 0.80, p= 0.01). In multivariate analyses, dose proportion was 0.09 lower ( p= 0.002), and RDI was 0.10 ( p< 0.001) lower in non-overweight African-Americans than whites. Obesity was associated with lower dose proportion ( p< 0.01) and RDI ( p< 0.03). Race and BMI were independently associated with first cycle dose reductions. Non-overweight African-Americans ( p< 0.05) and overweight and obese African-American and white women ( p< 0.001) were more likely to have first cycle dose reductions than non-overweight whites.Conclusion. We identified systematic differences in the administration of chemotherapy given to African-Americans and to overweight and obese women. These differences may contribute to documented disparities in outcome.