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Adjuvant chemotherapy dosing in low-income women: the impact of Hispanic ethnicity and patient self-efficacy

  • Epidemiology
  • Published:
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Abstract

Unwarranted breast cancer adjuvant chemotherapy dose reductions have been documented in black women, women of lower socioeconomic status, and those who are obese. No information on the quality of chemotherapy is available in Hispanic women. The purpose of this study was to characterize factors associated with first cycle chemotherapy dose selection in a multi-ethnic sample of low-income women receiving chemotherapy through the Breast and Cervical Cancer Prevention Treatment Program (BCCPT) and to investigate the impact of Hispanic ethnicity and patient self-efficacy on adjuvant chemotherapy dose selection. Survey and chemotherapy information were obtained from consenting participants enrolled in the California BCCPT. Analyses identified clinical and non-clinical factors associated with first cycle chemotherapy doses less than 90 % of expected doses. Of 552 patients who received chemotherapy, 397 (72 %) were eligible for inclusion. First cycle dose reductions were given to 14 % of the sample. In multivariate analyses, increasing body mass index and non-academic treatment site were associated with doses below 90 % of the expected doses. No other clinical or non-clinical factors, including ethnicity, were associated with first cycle doses selection. In this universally low-income sample, we identified no association between Hispanic ethnicity and other non-clinical patient factors, including patient self-efficacy, in chemotherapy dose selection. As seen in other studies, obesity was associated with systematic dose limits. The guidelines on chemotherapy dose selection in the obese may help address such dose reductions. A greater understanding of the association between type of treatment site and dose selection is warranted. Overall, access to adequate health care allows the vast majority of low-income women with breast cancer to receive high-quality breast cancer chemotherapy.

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Acknowledgments

This study was supported by Grant No. TURSG-02-081 from the American Cancer Society, Grant No. 7PB-0070 from the California Breast Cancer Research Program, Grant No. R01CA119197-0181 from the National Cancer Institute, and by a supplement to R01CA119197. Dr. Maly was further supported by Grant No. 1R01CA140481-01A1 from the National Cancer Institute.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The study complied with the ethical standards set forth for human subjects by the University of California, Los Angeles Human Subjects Protection Committee, and the University of Michigan Institutional Review Board.

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Authors and Affiliations

  1. University of Michigan Ann Arbor, Michigan 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109, USA

    Jennifer J. Griggs

  2. Department of Family Medicine, David Geffen School of Medicine, UCLA, 10880 Wilshire Blvd, Suite 1800, Los Angeles, CA, 90095-7087, USA

    Yihang Liu & Rose C. Maly

  3. RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213, USA

    Melony E. Sorbero

  4. University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA

    Christina H. Jagielski

Authors
  1. Jennifer J. Griggs
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  2. Yihang Liu
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  3. Melony E. Sorbero
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  4. Christina H. Jagielski
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  5. Rose C. Maly
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Corresponding author

Correspondence to Jennifer J. Griggs.

Additional information

A portion of this work was presented during the 2012 meeting of the American Society of Clinical Oncology Quality Care Symposium, San Diego, November 30–December 1, 2012.

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Griggs, J.J., Liu, Y., Sorbero, M.E. et al. Adjuvant chemotherapy dosing in low-income women: the impact of Hispanic ethnicity and patient self-efficacy. Breast Cancer Res Treat 144, 665–672 (2014). https://doi.org/10.1007/s10549-014-2869-y

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  • DOI: https://doi.org/10.1007/s10549-014-2869-y

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