Predictors of inadequate chemotherapy intensity among breast cancer patients in rural Georgia Público

Regan, Nicole Jeannette (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/ft848q88b?locale=es
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Abstract

Abstract

Predictors of inadequate chemotherapy intensity among breast cancer patients in rural Georgia

By Nicole J Regan

Background: Breast cancer is the most common malignancy among women in the United States and is the second largest cause of cancer deaths in females. Despite decreasing trends in incidence and mortality rates, significant racial disparities in breast cancer outcomes remain. Relative dose intensity (RDI) of adjuvant chemotherapy is considered an important determinant of breast cancer survival but few studies have examined its predictors and, to our knowledge, none have focused on patients diagnosed and treated in the rural setting.

Methods: We conducted a study of women who resided in the largely rural area of Southwest Georgia (SWGA), and who were diagnosed with first primary, early stage breast cancer between January 1st, 2001 and December 31, 2003. Eligible cases received at least their first 12 months of care in SWGA and were identified through the Georgia Comprehensive Cancer Registry. A total of 199 women had available dose date information on all adjuvant chemotherapy. Data on each patient were abstracted from medical records by trained research staff. RDI was calculated by dividing the dose intensity (dose/week) of each chemotherapeutic agent listed in the treatment plan over that actually received. The mean RDI across all agents was calculated to estimate average relative dose intensity (ARDI).

Results: Overall, 23% of patients received chemotherapy with a low ARDI (< 85%). A lower proportion of black patients received ARDI of <85% than white patients (16.0% vs 27.1%) although the difference was not statistically significant. Receipt of low ARDI was more common among patients who had Medicare without a supplement, Medicaid, or no insurance at all (p=0.014). No other predictors examined, including marital status, were significantly associated with receipt of low RDI.

Conclusions: We found no evidence that chemotherapy-treated black breast cancer patients in SWGA experience lower ARDI compared to whites. Although not statistically significant the association was in the opposite direction of the racial disparities reported elsewhere. Our findings require confirmation in other rural areas, and if confirmed, further exploration of the mechanisms that may make rural black patients less susceptible to reductions in RDI.

Table of Contents

TABLE OF CONTENTS

Introduction......................................................................................................................... 1

Methods............................................................................................................................... 3

Results................................................................................................................................. 7

Discussion............................................................................................................................ 9

References......................................................................................................................... 14

Tables................................................................................................................................. 18

Figures..................................................................................................................................22

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