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Social and Racial Differences in Selection of Breast Cancer Adjuvant Chemotherapy Regimens

Jennifer J. Griggs, Eva Culakova, Melony E.S. Sorbero, Marek S. Poniewierski, Debra A. Wolff, Jeffrey Crawford, David C. Dale, Gary H. Lyman

From the University of Rochester, Rochester, NY; RAND Corporation, Pittsburgh, PA; University of Washington, Seattle, WA; and the Duke Comprehensive Cancer Center and the Department of Medicine, Duke University, Durham, NC

Address reprint requests to Jennifer J. Griggs, MD, MPH, Department of Medicine, Hematology/Oncology, University of Michigan, 1500 E Medical Center Dr, 4310 CCGC, Ann Arbor, MI 48109-0936; e-mail: jengrigg{at}umich.edu

Purpose Breast cancer outcomes are worse among black women and women of lower socioeconomic status. The purpose of this study was to investigate racial and social differences in selection of breast cancer adjuvant chemotherapy regimens.

Methods Detailed information on patient, disease, and treatment factors was collected prospectively on 957 patients who were receiving breast cancer adjuvant chemotherapy in 101 oncology practices throughout the United States. Adjuvant chemotherapy regimens included in any of several published guidelines were considered standard. Receipt of nonstandard regimens was examined according to clinical and nonclinical factors. Differences between groups were assessed using ² tests. Multivariate logistic regression was used to identify factors associated with use of nonstandard regimens.

Results Black race (P = .008), lower educational attainment (P = .003), age 70 years (P = .001), higher stage (P < .0001), insurance type (P = .048), employment status (P = .045), employment type (P = .025), and geographic location (P = .021) were associated with the use of nonstandard regimens in univariate analyses. In multivariate analysis, black race (P = .020), lower educational attainment (P = .024), age 70 years (P = .032), and higher stage (P < .0001) were associated with receipt of nonstandard regimens.

Conclusion The more frequent use of non–guideline-concordant adjuvant chemotherapy regimens in black women and women with lower educational attainment may contribute to less favorable outcomes in these populations. Addressing such differences in care may improve cancer outcomes in vulnerable populations.

Supported by Amgen Inc (data collection only), through the Awareness of Neutropenia in Chemotherapy (ANC) Study Group. Amgen played no role in the data collection, study design, or interpretation of data.

Presented in part at the 42nd Annual Meeting of the American Society of Clinical Oncology, June 2-6, 2006, Atlanta, GA.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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