Originally published as JCO Early Release 10.1200/JCO.2008.19.1163 on March 23 2009

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Treatment Quality and Outcomes of African American Versus White Breast Cancer Patients: Retrospective Analysis of Southwest Oncology Studies S8814/S8897

From Columbia University, New York, NY; Southwest Oncology Group Statistical Center, Seattle, WA; University of Arkansas, Little Rock, AR; The Angeles Clinic and Research Institute, Santa Monica, CA; Baylor College of Medicine, Houston, TX; University of Arizona, Tuscon, AZ; and Loyola University Chicago Stritch School of Medicine, Maywood, IL.

Corresponding author: Southwest Oncology Group (SWOG-0011), 24 Frank Lloyd Wright Dr, PO Box 483, Ann Arbor, MI 4810483; e-mail: arlauska{at}med.umich.edu.

Purpose Women of African ancestry (AA) have lower WBC counts and are more likely to have treatment delays and discontinue adjuvant breast cancer therapy early compared with white women. We assessed the association between race and treatment discontinuation/delay, WBC counts, and survival in women enrolled onto breast cancer clinical trials.

Patients and Methods AA and white women from Southwest Oncology Group adjuvant breast cancer trials (S8814/S8897) were matched by age and protocol. Only the treatment arms in which patients were scheduled to receive six cycles of chemotherapy were analyzed.

Results A total of 317 pairs of patients (n = 634) were analyzed. At baseline, AA women had higher body-surface area (P < .0001) and lower WBC (P = .0009). AA women were more likely to have tumors that were 2 cm (P = .01) and hormone receptor negative (P < .0001). AA women, versus white women, were marginally more likely to discontinue treatment early (11% v 7%, respectively; P = .07) or have one or more treatment delays (85% v 79%, respectively; P = .07) and were significantly more likely to experience the combined end point (discontinuation/delay; 87% v 81%, respectively; P = .04). The mean relative dose-intensity (RDI) was similar for both groups (87% in AA women v 86% in white women); however, overall, 43% had an RDI of less than 85%. After adjusting for baseline WBC and prognostic factors in a multivariate model, AA women had worse disease-free survival (hazard ratio [HR] = 1.56; 95% CI, 1.15 to 2.11; P = .005) and overall survival (HR = 1.95; 95% CI, 1.36 to 2.78; P = .0002). The inclusion of RDI and treatment delivery/quality in the regression had little impact on the results.

Conclusion On cooperative group breast cancer trials, AA and white women had similar RDIs, but AA women were more likely to experience early discontinuation or treatment delay. Despite correcting for these factors and known predictors of outcome, AA women still had worse survival.

Supported in part by Public Health Service Cooperative Agreement Grants No. CA32102, CA38926, CA13612, CA68183, CA37981, and CA46282 awarded by the National Cancer Institute, Department of Health and Human Services. This research was also supported in part by a grant from the HOPE Foundation (D.L.H.), an American Society of Clinical Oncology Advanced Clinical Research Award (D.L.H.), and Grant No. RSGT-08-009-01-CPHPS from the American Cancer Society.

Presented in part at the 29th Annual San Antonio Breast Cancer Symposium, December 14-17, 2006, San Antonio, TX.

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

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