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Patterns of chemotherapy receipt among patients with hormone receptor-positive, HER2-negative breast cancer

  • Epidemiology
  • Published:
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Abstract

Background

Breast cancer chemotherapy utilization not only may differ by race and age, but also varies by genomic risk, tumor characteristics, and patient characteristics. Studies in demographically diverse populations with both clinical and genomic data are necessary to understand potential disparities by race and age.

Methods

In the Carolina Breast Cancer Study Phase 3 (2008–2013), chemotherapy receipt (yes/no) and regimen type were assessed in association with age and race among hormone receptor (HR) positive and HER2-negative tumors (n = 1862). Odds ratios were estimated for the association between demographic factors and chemotherapy receipt.

Results

Monotonic decreases in frequency of adjuvant chemotherapy receipt were observed over time during the study period, while neoadjuvant chemotherapy was stable. Younger age was associated with chemotherapy receipt (OR [95% CI]: 2.9 [2.4, 3.6]) and with anthracycline-based regimens (OR [95% CI]: 1.7 [1.3, 2.4]). Participants who had Medicaid (OR [95% CI]: 1.8 [1.3, 2.5]), lived in rural settings (OR [95% CI]: 1.4 [1.0, 2.0]), or were Black (OR [95% CI]: 1.5 [1.2, 1.8]) had slightly higher odds of chemotherapy, but these associations were non-significant with adjustment for stage and grade. Associations between younger age and chemotherapy receipt were strongest among women who did not receive genomic testing.

Conclusions

While race was not strongly associated with chemotherapy receipt, younger age remains a strong predictor of chemotherapy receipt, even with adjustment for clinical factors and among women who receive genomic testing.

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Data availability

The data analyzed in this study are available from the Carolina Breast Cancer Study (https://unclineberger.org/cbcs/). Restrictions apply to the availability of these data, which were used under data use agreements for this study. Data is not publicly available; however, investigators may submit a letter of intent to gain access upon reasonable request.

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Funding

We are grateful to all the participants of the Carolina Breast Cancer Study, whose generous participation has made this research possible, as well as the study staff members. This research was supported by a grant from UNC Lineberger Comprehensive Cancer Center, which is funded by the University Cancer Research Fund of North Carolina, the Susan G Komen Foundation (OGUNC1202 to M.A. Troester), the National Cancer Institute of the National Institutes of Health (P01CA151135 to M.A. Troester), and the National Cancer Institute Specialized Program of Research Excellence (SPORE) in Breast Cancer (NIH/NCI P50CA058223). This research recruited participants &/or obtained data with the assistance of Rapid Case Ascertainment, a collaboration between the North Carolina Central Cancer Registry and UNC Lineberger. RCA is supported by a grant from the National Cancer Institute of the National Institutes of Health (P30CA016086). This work was further supported by funding from the National Institute of Health (U54CA156733 and R01CA253450 to M.A. Troester; R01AG056479 to T. Stürmer), Susan G. Komen for the Cure (TREND21686258 and SAC210102 to M.A. Troester), and a grant from UNC Lineberger Comprehensive Cancer Center, which is funded by the University Cancer Research Fund of North Carolina.

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Authors and Affiliations

  1. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA

    Linnea T. Olsson, Sarah C. Van Alsten, Jennifer L. Lund, Til Stürmer, Hazel B. Nichols & Melissa A. Troester

  2. Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Alina M. Hamilton & Melissa A. Troester

  3. Division of Hematology/Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Katherine E. Reeder-Hayes

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  1. Linnea T. Olsson
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  8. Melissa A. Troester
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Corresponding author

Correspondence to Linnea T. Olsson.

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Competing interests

Dr. Reeder-Hayes has received research funding from Pfizer Global Medical Foundation. Dr. Stürmer receives salary support as Director of Comparative Effectiveness Research (CER), NC TraCS Institute, UNC Clinical and Translational Science Award (UL1TR002489), the Center for Pharmacoepidemiology (current members: GlaxoSmithKline, UCB BioSciences, Takeda, AbbVie, Boehringer Ingelheim), from pharmaceutical companies (Novo Nordisk), and from a generous contribution from Dr. Nancy A. Dreyer to the Department of Epidemiology, University of North Carolina at Chapel Hill. Dr. Stürmer does not accept personal compensation of any kind from any pharmaceutical company. He owns stock in Novartis, Roche, and Novo Nordisk. Other authors report no financial or non-financial interests.

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Olsson, L.T., Hamilton, A.M., Van Alsten, S.C. et al. Patterns of chemotherapy receipt among patients with hormone receptor-positive, HER2-negative breast cancer. Breast Cancer Res Treat 204, 107–116 (2024). https://doi.org/10.1007/s10549-023-07164-y

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