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Breed can be a factor in who completes chemotherapy against breast cancer

(Reuters Health) – White women with breast cancer are more likely to complete their prescribed chemotherapy regimen than women of color, suggests a US study. UU

Only 50 percent of non-white women in the study finished all their prescribed treatments, compared to 76 percent of white women, the researchers found.

The study included 124 women who prescribed so-called neoadjuvant chemotherapy, a treatment often recommended before surgery for patients with larger cancers because it can reduce tumors and allow for less extensive operations. Overall, 92 women, or 74 percent, completed their neoadjuvant chemotherapy.

After considering factors such as age, insurance status, and tumor size, white women were more than three times as likely to end neoadjuvant chemotherapy as black, Hispanic, and Asian women.

"There is no clear explanation available of how race affects the completion of neoadjuvant chemotherapy," said lead researcher Dr. Shayna Lefrak Showalter of the University of Virginia School of Medicine in Charlottesville.

She and her colleagues note in the journal Surgery that racial disparities in outcomes for Americans with breast cancer and other malignancies have been attributed to multiple factors. These include different types of tumor biology, less frequent detection, less aggressive treatment and lack of medical attention and follow-up treatment.

In this study, "for both white and non-white patients, the most common reason for suspending early treatment was the drug's toxicity," Showalter said by e-mail. "For patients to receive the maximum benefit from therapy, it is important that they complete the prescribed dose."

More than half of the women who stopped treatment early cited side effects, most often neurological problems or pain in women of color and gastrointestinal problems for white women. Some patients also discontinued treatment due to cancer progression, psychological or social problems or personal beliefs.

Non-white patients were more likely to have larger tumors before chemotherapy and were more likely to have insurance through government health programs such as Medicaid, but these factors did not appear to influence the likelihood of completing the treatment .

There were also no differences in the types of treatment regimens prescribed to white and non-white patients that could help explain the likelihood of completing neoadjuvant chemotherapy.

One of the objectives of neoadjuvant treatment is to increase the chances that women can undergo a lumpectomy, or breast-conserving surgery, instead of a mastectomy that removes the entire breast. However, the completion of neoadjuvant therapy did not appear to influence the possibility of women having a lumpectomy.

Another goal is to make women more likely to experience what is known as a complete pathologic response (pCR), when no tumor remains after neoadjuvant chemotherapy, because this is related to better chances of survival. But this result also does not seem to be influenced by whether the women finished all their prescribed treatments.

"Our main concern would be that incomplete neoadjuvant chemotherapy could lead to lower rates of CPR or breast-conserving surgery (ie lumpectomy)," said Erica Warner, a researcher at Harvard Medical School and General Hospital Massachusetts in Boston that is not involved in the study.

"This study found no difference in mammary surgery or CPR between those who completed neoadjuvant chemotherapy and those who did not," Warner said by email.

The study was not a controlled experiment designed to test whether race could influence the likelihood of completing neoadjuvant chemotherapy. It was also too small and brief to shed some light on the chances of survival, and included only 38 non-white patients.

"The figures are too small to draw conclusions, and most patients who stopped treatment stopped prematurely the toxicity," said Dr. Rachel Freedman, disparities researcher at the Dana-Farber Cancer Institute in Boston, who did not participate in the study.

"For me, this study points out how we need to better address patient toxicity rather than focusing on disparities," Freedman said by email.

SOURCE: bit.ly/2Mp41eQ Surgery, online May 3, 2018.


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