Olga Kantor1,2,3, Cecilia Chang4, Katharine Yao5,6, Judy Boughey6,7, Christina Roland6,8, Amanda B Francescatti6, Sarah Blair6,9, Diana Dickson Witmer6,10, Kelly K Hunt6,8, Heidi Nelson6,7, Anna Weiss2,3,6, Tawakalitu Oseni11. 1. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. 2. Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. 3. Breast Oncology Program, Dana-Farber Cancer Institute, Boston, MA, USA. 4. Research Institute, NorthShore University HealthSystem, Evanston, IL, USA. 5. Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. 6. American College of Surgeons Cancer Programs, Chicago, IL, USA. 7. Department of Surgery, Mayo Clinic, Rochester, MN, USA. 8. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 9. Department of Surgery, University of San Diego, San Diego, CA, USA. 10. Department of Surgery, Helen F Graham Cancer Center and Research Institute, Newark, DE, USA. 11. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. toseni@mgh.harvard.edu.
Abstract
BACKGROUND: Most minorities receive cancer care at minority-serving hospitals (MSHs) that have been associated with disparate treatment between Black and White patients. OBJECTIVE: Our aim was to examine the uptake of clinical trials that have changed axillary management in breast cancer patients at MSH and non-MSH cancer centers. METHODS: The National Cancer Database was used to identify patients eligible for the American College of Surgeons Oncology Group Z0011 and Z1071 trials, and mastectomy patients fulfilling the European AMAROS trial. Uptake of trial results (omission of axillary lymph node dissection) was analyzed between patients treated at MSHs and non-MSHs and adjusted for patient, tumor, and facility factors. MSHs were defined as the top decile of hospitals according to the proportion of Black and Hispanic patients treated. RESULTS: Of 7167 patients eligible for Z0011, 4546 for Z0171, and 9433 for AMAROS from 2015 to 2016, clinical trial uptake was seen in 1195 (74.6%) MSH and 4056 (72.9%) non-MSH patients (p = 0.173) for Z0011, 588 (41.9%) MSH and 1366 (43.5%) non-MSH patients for Z1071 (p = 0.302), and 272 (11.7%) MSH and 996 (14.0%) non-MSH patients (p = 0.005) for AMAROS. On adjusted analyses, MSH status was not significant for uptake of any of the three trials. Black race, socioeconomic status, and insurance were not associated with clinical trial uptake. CONCLUSION: The uptake of three landmark clinical trials of axillary management in breast cancer was not different at MSH and non-MSH centers despite adjustment for social determinants of health. At the Commission on Cancer-accredited centers in this analysis, MSH status did not affect the uptake of evidence-based care.
BACKGROUND: Most minorities receive cancer care at minority-serving hospitals (MSHs) that have been associated with disparate treatment between Black and White patients. OBJECTIVE: Our aim was to examine the uptake of clinical trials that have changed axillary management in breast cancerpatients at MSH and non-MSHcancer centers. METHODS: The National Cancer Database was used to identify patients eligible for the American College of Surgeons Oncology Group Z0011 and Z1071 trials, and mastectomy patients fulfilling the European AMAROS trial. Uptake of trial results (omission of axillary lymph node dissection) was analyzed between patients treated at MSHs and non-MSHs and adjusted for patient, tumor, and facility factors. MSHs were defined as the top decile of hospitals according to the proportion of Black and Hispanic patients treated. RESULTS: Of 7167 patients eligible for Z0011, 4546 for Z0171, and 9433 for AMAROS from 2015 to 2016, clinical trial uptake was seen in 1195 (74.6%) MSH and 4056 (72.9%) non-MSHpatients (p = 0.173) for Z0011, 588 (41.9%) MSH and 1366 (43.5%) non-MSHpatients for Z1071 (p = 0.302), and 272 (11.7%) MSH and 996 (14.0%) non-MSHpatients (p = 0.005) for AMAROS. On adjusted analyses, MSH status was not significant for uptake of any of the three trials. Black race, socioeconomic status, and insurance were not associated with clinical trial uptake. CONCLUSION: The uptake of three landmark clinical trials of axillary management in breast cancer was not different at MSH and non-MSH centers despite adjustment for social determinants of health. At the Commission on Cancer-accredited centers in this analysis, MSH status did not affect the uptake of evidence-based care.
Authors: Kathy S Albain; Joseph M Unger; John J Crowley; Charles A Coltman; Dawn L Hershman Journal: J Natl Cancer Inst Date: 2009-07-07 Impact factor: 13.506
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