Originally published as JCO Early Release 10.1200/JCO.2006.08.3063 on December 11 2006

This Article Full Text Full Text (PDF) Publisher's Note Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Griggs, J. J. Articles by Lyman, G. H. Search for Related Content PubMed PubMed Citation Articles by Griggs, J. J. Articles by Lyman, G. H. Related Articles Related Correspondence Social Bookmarking                            What's this?

Effect of Patient Socioeconomic Status and Body Mass Index on the Quality of Breast Cancer Adjuvant Chemotherapy

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

From the Department of Medicine, University of Rochester, Rochester, NY; RAND Corporation, Pittsburgh, PA; University of Washington, Seattle, WA; 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 East Medical Center Dr, 4310 CCGC, Ann Arbor, MI 48109-0936; e-mail: JenGrigg{at}umich.edu

PURPOSE: The purpose of this study was to investigate the relationship between socioeconomic status (SES) and the use of intentionally reduced doses of chemotherapy in the adjuvant treatment of breast cancer.

PATIENTS AND METHODS: Patients with breast cancer treated with a standard chemotherapy regimen (n = 764) were enrolled in a prospective registry after signing informed consent. Detailed information was collected on patient, disease, and treatment, including chemotherapy doses. Zip code level data on median household income, proportion of people living below the poverty level, and educational attainment were obtained from the US Census. Doses for the first cycle of chemotherapy lower than 85% of standard were considered to be reduced. Univariate analyses and multivariate logistic regression were performed to identify factors associated with the use of reduced first cycle doses.

RESULTS: In univariate analysis, individual education attainment, zip code SES measures, body mass index, and geographic region were all significantly associated with receipt of intentionally reduced doses of chemotherapy. In multivariate analysis, controlling for geography, factors independently associated with reduced doses were obesity (odds ratio [OR], 2.47; 95% CI, 1.36 to 4.51), severe obesity (OR, 4.04; 95% CI, 1.46 to 11.19), and education less than high school (OR, 3.07; 95% CI, 1.57 to 5.99).

CONCLUSION: Social disparities in breast cancer outcomes may be in part the result of lower quality chemotherapy doses in the adjuvant treatment of breast cancer. Efforts to address such prescribing patterns may help reduce SES disparities in breast cancer survival.

published online ahead of print at www.jco.org on December 11, 2006.

This research was not funded. The data collection was supported by Amgen Inc through the Awareness of Neutropenia in Chemotherapy (ANC) Study Group.

Presented in part at the San Antonio Breast Cancer Symposium, San Antonio, TX, December 8-11, 2005; and at the 42nd Annual Meeting of the American Society of Clinical Oncology, Atlanta, GA, June 2-6, 2006.

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

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

Related Correspondence

• Impact of Toxicity Assumptions on Socioeconomic Analysis of Breast Cancer Chemotherapy
  Ira E. Felman
  JCO 2007 25: 2331-2332 [Full Text]
• Impact of Toxicity Assumptions on Socioeconomic Analysis of Breast Cancer Chemotherapy
  Ira E. Felman
  JCO 2007 25: 2331-2332 [Full Text]

This article has been cited by other articles:

				M. J. Hassett and J. J. Griggs Disparities in Breast Cancer Adjuvant Chemotherapy: Moving Beyond Yes or No J. Clin. Oncol., May 1, 2009; 27(13): 2120 - 2121. [Full Text] [PDF]

				M. Jeffreys, D. Sarfati, V. Stevanovic, M. Tobias, C. Lewis, N. Pearce, and T. Blakely Socioeconomic Inequalities in Cancer Survival in New Zealand: The Role of Extent of Disease at Diagnosis Cancer Epidemiol. Biomarkers Prev., March 1, 2009; 18(3): 915 - 921. [Abstract] [Full Text] [PDF]

				K. M. Field, S. Kosmider, M. Jefford, M. Michael, R. Jennens, M. Green, and P. Gibbs Chemotherapy Dosing Strategies in the Obese, Elderly, and Thin Patient: Results of a Nationwide Survey J. Oncol. Pract, May 1, 2008; 4(3): 108 - 113. [Abstract] [Full Text] [PDF]

				G. H. Lyman Undertreatment of Cancer Patients With Chemotherapy Is a Global Concern J. Oncol. Pract, May 1, 2008; 4(3): 114 - 115. [Full Text] [PDF]

				C. J. Bradley, J. P. Clement, and C. Lin Absence of Cancer Diagnosis and Treatment in Elderly Medicaid-Insured Nursing Home Residents J Natl Cancer Inst, January 2, 2008; 100(1): 21 - 31. [Abstract] [Full Text] [PDF]

				S. K. Hussain, P. Lenner, J. Sundquist, and K. Hemminki Influence of education level on cancer survival in Sweden Ann. Onc., January 1, 2008; 19(1): 156 - 162. [Abstract] [Full Text] [PDF]

				H. Gurney and R. Shaw Obesity in Dose Calculation: A Mouse or an Elephant? J. Clin. Oncol., October 20, 2007; 25(30): 4703 - 4704. [Full Text] [PDF]

				A. Sparreboom, A. C. Wolff, R. H.J. Mathijssen, E. Chatelut, E. K. Rowinsky, J. Verweij, and S. D. Baker Evaluation of Alternate Size Descriptors for Dose Calculation of Anticancer Drugs in the Obese J. Clin. Oncol., October 20, 2007; 25(30): 4707 - 4713. [Abstract] [Full Text] [PDF]

				D. S.M. Buist, L. Ichikawa, M. N. Prout, M. U. Yood, T. S. Field, C. Owusu, A. M. Geiger, V. P. Quinn, F. Wei, and R. A. Silliman Receipt of Appropriate Primary Breast Cancer Therapy and Adjuvant Therapy Are Not Associated With Obesity in Older Women With Access to Health Care J. Clin. Oncol., August 10, 2007; 25(23): 3428 - 3436. [Abstract] [Full Text] [PDF]

				J. J. Griggs, E. Culakova, M. E.S. Sorbero, M. S. Poniewierski, D. A. Wolff, J. Crawford, D. C. Dale, and G. H. Lyman Social and Racial Differences in Selection of Breast Cancer Adjuvant Chemotherapy Regimens J. Clin. Oncol., June 20, 2007; 25(18): 2522 - 2527. [Abstract] [Full Text] [PDF]

				J. J. Griggs, E. Culakova, M. E.S. Sorbero, and G. H. Lyman In Reply J. Clin. Oncol., June 1, 2007; 25(16): 2332 - 2332. [Full Text] [PDF]

				I. E. Felman Impact of Toxicity Assumptions on Socioeconomic Analysis of Breast Cancer Chemotherapy J. Clin. Oncol., June 1, 2007; 25(16): 2331 - 2332. [Full Text] [PDF]