Advertisement

Breast Cancer Research and Treatment

, Volume 130, Issue 3, pp 897–904 | Cite as

The impact of obesity on receipt of adjuvant chemotherapy for breast cancer in the National Comprehensive Cancer Network (NCCN) centers

  • A. M. Brewster
  • C. Etzel
  • R. Zhou
  • Y. Wong
  • S. Edge
  • D. W. Blayney
  • J. Wilson
  • C. Hudis
  • R. Ottesen
  • M. E. Hughes
  • J. C. Weeks
  • R. L. Theriault
Epidemiology

Abstract

Disparities in the receipt of adjuvant chemotherapy for early stage breast cancer is an important factor influencing mortality. We investigated whether greater body mass index (BMI) decreases receipt of adjuvant chemotherapy among women with operable breast cancer. In the NCCN breast cancer outcomes database, we identified women aged ≤70 with newly diagnosed stage I, II, or III breast cancer between 1997 and 2007, for whom use of adjuvant chemotherapy was classified as either standard-of-care or discretionary based on their clinical characteristics. Body mass index was assessed in categories (<18.5 kg/m2 [underweight], 18.5 to <25 kg/m2 [normal], 25 to <30 kg/m2 [overweight], 30–39 kg/m2 [obese], ≥40 kg/m2 [extreme obese]). Multivariable logistic regression analysis was used to examine the association between BMI and receipt of chemotherapy in each classification group. 9,527 women were eligible for the study; 40% normal weight or less; 31% overweight; 24% obese; and 5% extremely obese. In multivariable analysis, there was no significant association between BMI and receipt of chemotherapy in either classification group. Among women for whom chemotherapy would be considered standard-of-care, older age (P < 0.001), comorbidity (P < 0.001), and non-Hispanic black ethnicity (P = 0.002) were associated with a lower likelihood of receipt of chemotherapy; however, the effect of ethnicity was not modified by obesity. Among women treated for operable breast cancer in the NCCN centers, BMI had no impact on receipt of adjuvant chemotherapy and did not modify the lower likelihood of chemotherapy among non-Hispanic black patients. Further investigation is needed into other factors that contribute to patient disparities in the receipt of chemotherapy in major academic centers.

Keywords

Obesity Breast neoplasms Chemotherapy Adjuvant Standard-of-care Healthcare Disparities 

Abbreviations

NCCN

National Comprehensive Cancer Network

BMI

Body mass index

EBCTCG

The Early Breast Cancer Trialists’s Collaborative Group

AJCC

American Joint Committee on Cancer

ER

Estrogen receptor

PR

Progesterone receptor

ORs

Odds ratios

CIs

Confidence intervals

Notes

Acknowledgments

This work was Supported in part by Grant No. CA089393 from the National Cancer Institute to Dana-Farber Cancer Institute and by the National Comprehensive Cancer Network.

References

  1. 1.
    Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365(9472):1687–1717Google Scholar
  2. 2.
    Giordano SH, Hortobagyi GN, Kau SW, Theriault RL, Bondy ML (2005) Breast cancer treatment guidelines in older women. J Clin Oncol 23(4):783–791PubMedCrossRefGoogle Scholar
  3. 3.
    Griggs JJ, Culakova E, Sorbero ME, Poniewierski MS, Wolff DA, Crawford J, Dale DC, Lyman GH (2007) Social and racial differences in selection of breast cancer adjuvant chemotherapy regimens. J Clin Oncol 25(18):2522–2527PubMedCrossRefGoogle Scholar
  4. 4.
    Harlan LC, Greene AL, Clegg LX, Mooney M, Stevens JL, Brown ML (2005) Insurance status and the use of guideline therapy in the treatment of selected cancers. J Clin Oncol 23(36):9079–9088PubMedCrossRefGoogle Scholar
  5. 5.
    Du X, Goodwin JS (2001) Patterns of use of chemotherapy for breast cancer in older women: findings from medicare claims data. J Clin Oncol 19(5):1455–1461PubMedGoogle Scholar
  6. 6.
    Bhargava A, Du XL (2009) Racial and socioeconomic disparities in adjuvant chemotherapy for older women with lymph node-positive, operable breast cancer. Cancer 115(13):2999–3008PubMedCrossRefGoogle Scholar
  7. 7.
    Shavers VL, Harlan LC, Stevens JL (2003) Racial/ethnic variation in clinical presentation, treatment, and survival among breast cancer patients under age 35. Cancer 97(1):134–147PubMedCrossRefGoogle Scholar
  8. 8.
    White J, Morrow M, Moughan J, Owen J, Pajak T, DesHarnais S, Winchester DP, Wilson JF (2003) Compliance with breast-conservation standards for patients with early-stage breast carcinoma. Cancer 97(4):893–904PubMedCrossRefGoogle Scholar
  9. 9.
    Bickell NA, Wang JJ, Oluwole S, Schrag D, Godfrey H, Hiotis K, Mendez J, Guth AA (2006) Missed opportunities: racial disparities in adjuvant breast cancer treatment. J Clin Oncol 24(9):1357–1362PubMedCrossRefGoogle Scholar
  10. 10.
    DeMichele A, Putt M, Zhang Y, Glick JH, Norman S (2003) Older age predicts a decline in adjuvant chemotherapy recommendations for patients with breast carcinoma: evidence from a tertiary care cohort of chemotherapy-eligible patients. Cancer 97(9):2150–2159PubMedCrossRefGoogle Scholar
  11. 11.
    Li CI, Malone KE, Daling JR (2003) Differences in breast cancer stage, treatment, and survival by race and ethnicity. Arch Intern Med 163(1):49–56PubMedCrossRefGoogle Scholar
  12. 12.
    Freedman RA, Virgo KS, He Y, Pavluck AL, Winer EP, Ward EM, Keating NL (2010) The association of race/ethnicity, insurance status, and socioeconomic factors with breast cancer care. Cancer 117(1):180–189PubMedCrossRefGoogle Scholar
  13. 13.
    Naeim A, Hurria A, Leake B, Maly RC (2006) Do age and ethnicity predict breast cancer treatment received? A cross-sectional urban population based study. Breast cancer treatment: age and ethnicity. Crit Rev Oncol Hematol 59(3):234–242PubMedCrossRefGoogle Scholar
  14. 14.
    Haas JS, Earle CC, Orav JE, Brawarsky P, Keohane M, Neville BA, Williams DR (2008) Racial segregation and disparities in breast cancer care and mortality. Cancer 113(8):2166–2172PubMedCrossRefGoogle Scholar
  15. 15.
    Flegal KM, Carroll MD, Ogden CL, Curtin LR (2010) Prevalence and trends in obesity among US adults, 1999–2008. JAMA 303(3):235–241PubMedCrossRefGoogle Scholar
  16. 16.
    Colleoni M, Li S, Gelber RD, Price KN, Coates AS, Castiglione-Gertsch M, Goldhirsch A (2005) Relation between chemotherapy dose, oestrogen receptor expression, and body-mass index. Lancet 366(9491):1108–1110PubMedCrossRefGoogle Scholar
  17. 17.
    Griggs JJ, Sorbero ME, Lyman GH (2005) Undertreatment of obese women receiving breast cancer chemotherapy. Arch Intern Med 165(11):1267–1273PubMedCrossRefGoogle Scholar
  18. 18.
    Madarnas Y, Sawka CA, Franssen E, Bjarnason GA (2001) Are medical oncologists biased in their treatment of the large woman with breast cancer? Breast Cancer Res Treat 66(2):123–133PubMedCrossRefGoogle Scholar
  19. 19.
    Rosner GL, Hargis JB, Hollis DR, Budman DR, Weiss RB, Henderson IC, Schilsky RL (1996) Relationship between toxicity and obesity in women receiving adjuvant chemotherapy for breast cancer: results from cancer and leukemia group B study 8541. J Clin Oncol 14(11):3000–3008PubMedGoogle Scholar
  20. 20.
    Buist DS, Ichikawa L, Prout MN, Yood MU, Field TS, Owusu C, Geiger AM, Quinn VP, Wei F, Silliman RA (2007) 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 25(23):3428–3436PubMedCrossRefGoogle Scholar
  21. 21.
    Delva J, O’Malley PM, Johnston LD (2006) Racial/ethnic and socioeconomic status differences in overweight and health-related behaviors among American students: national trends 1986–2003. J Adolesc Health 39(4):536–545PubMedCrossRefGoogle Scholar
  22. 22.
    Kim D, Subramanian SV, Gortmaker SL, Kawachi I (2006) US state- and county-level social capital in relation to obesity and physical inactivity: a multilevel, multivariable analysis. Soc Sci Med 63(4):1045–1059PubMedCrossRefGoogle Scholar
  23. 23.
    Amarasinghe A, D’Souza G, Brown C, Oh H, Borisova T (2009) The influence of socioeconomic and environmental determinants on health and obesity: a West Virginia case study. Int J Environ Res Public Health 6(8):2271–2287PubMedCrossRefGoogle Scholar
  24. 24.
    Yen TW, Kuerer HM, Ottesen RA, Rouse L, Niland JC, Edge SB, Theriault RL, Weeks JC (2007) Impact of randomized clinical trial results in the national comprehensive cancer network on the use of tamoxifen after breast surgery for ductal carcinoma in situ. J Clin Oncol 25(22):3251–3258PubMedCrossRefGoogle Scholar
  25. 25.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383PubMedCrossRefGoogle Scholar
  26. 26.
    Katz JN, Chang LC, Sangha O, Fossel AH, Bates DW (1996) Can comorbidity be measured by questionnaire rather than medical record review? Med Care 34(1):73–84PubMedCrossRefGoogle Scholar
  27. 27.
    (1998) Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults–the evidence report. National Institutes of Health. Obes Res 6(Suppl 2): 51S–209SGoogle Scholar
  28. 28.
    Gerend MA, Pai M (2008) Social determinants of black-white disparities in breast cancer mortality: a review. Cancer Epidemiol Biomarkers Prev 17(11):2913–2923PubMedCrossRefGoogle Scholar
  29. 29.
    Hassett MJ, Griggs JJ (2009) Disparities in breast cancer adjuvant chemotherapy: moving beyond yes or no. J Clin Oncol 27(13):2120–2121PubMedCrossRefGoogle Scholar
  30. 30.
    Hunter RJ, Navo MA, Thaker PH, Bodurka DC, Wolf JK, Smith JA (2009) Dosing chemotherapy in obese patients: actual versus assigned body surface area (BSA). Cancer Treat Rev 35(1):69–78PubMedCrossRefGoogle Scholar
  31. 31.
    Greenman CG, Jagielski CH, Griggs JJ (2008) Breast cancer adjuvant chemotherapy dosing in obese patients: dissemination of information from clinical trials to clinical practice. Cancer 112(10):2159–2165PubMedCrossRefGoogle Scholar
  32. 32.
    Protani M, Coory M, Martin JH (2010) Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat 123(3):627–635PubMedCrossRefGoogle Scholar
  33. 33.
    Ewertz M, Jensen MB, Gunnarsdottir KA, Hojris I, Jakobsen EH, Nielsen D, Stenbygaard LE, Tange UB, Cold S (2010) Effect of obesity on prognosis after early-stage breast cancer. J Clin Oncol 29(1):25–31PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2011

Authors and Affiliations

  • A. M. Brewster
    • 1
  • C. Etzel
    • 1
  • R. Zhou
    • 1
  • Y. Wong
    • 2
  • S. Edge
    • 3
  • D. W. Blayney
    • 4
  • J. Wilson
    • 5
  • C. Hudis
    • 6
  • R. Ottesen
    • 7
  • M. E. Hughes
    • 8
  • J. C. Weeks
    • 8
  • R. L. Theriault
    • 1
  1. 1.The University of Texas M.D. Anderson Cancer CenterHoustonUSA
  2. 2.Fox Chase Cancer CenterPhiladelphiaUSA
  3. 3.Roswell Park Cancer InstituteBuffaloUSA
  4. 4.Stanford Cancer CenterStanfordUSA
  5. 5.Ohio State University Comprehensive Cancer CenterColumbusUSA
  6. 6.Memorial Sloan Kettering Cancer CenterNew YorkUSA
  7. 7.City of Hope Comprehensive Cancer CenterDuarteUSA
  8. 8.Dana-Farber Cancer InstituteBostonUSA

Personalised recommendations