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


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.


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



National Comprehensive Cancer Network


Body mass index


The Early Breast Cancer Trialists’s Collaborative Group


American Joint Committee on Cancer


Estrogen receptor


Progesterone receptor


Odds ratios


Confidence intervals



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.


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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

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