title: Treatment quality and outcomes of African American versus white breast cancer patients: retrospective analysis of Southwest Oncology studies S8814/S8897.
abstract: OBJECTIVE
  Women of African ancestry (AA) have lower WBC counts and are more likely to have treatment delays and discontinue adjuvant breast cancer therapy early compared with white women. We assessed the association between race and treatment discontinuation/delay, WBC counts, and survival in women enrolled onto breast cancer clinical trials.
  
  
  METHODS
  AA and white women from Southwest Oncology Group adjuvant breast cancer trials (S8814/S8897) were matched by age and protocol. Only the treatment arms in which patients were scheduled to receive six cycles of chemotherapy were analyzed.
  
  
  RESULTS
  A total of 317 pairs of patients (n = 634) were analyzed. At baseline, AA women had higher body-surface area (P < .0001) and lower WBC (P = .0009). AA women were more likely to have tumors that were > or = 2 cm (P = .01) and hormone receptor negative (P < .0001). AA women, versus white women, were marginally more likely to discontinue treatment early (11% v 7%, respectively; P = .07) or have one or more treatment delays (85% v 79%, respectively; P = .07) and were significantly more likely to experience the combined end point (discontinuation/delay; 87% v 81%, respectively; P = .04). The mean relative dose-intensity (RDI) was similar for both groups (87% in AA women v 86% in white women); however, overall, 43% had an RDI of less than 85%. After adjusting for baseline WBC and prognostic factors in a multivariate model, AA women had worse disease-free survival (hazard ratio [HR] = 1.56; 95% CI, 1.15 to 2.11; P = .005) and overall survival (HR = 1.95; 95% CI, 1.36 to 2.78; P = .0002). The inclusion of RDI and treatment delivery/quality in the regression had little impact on the results.
  
  
  CONCLUSIONS
  On cooperative group breast cancer trials, AA and white women had similar RDIs, but AA women were more likely to experience early discontinuation or treatment delay. Despite correcting for these factors and known predictors of outcome, AA women still had worse survival.
authors.affiliation: Columbia University, New York, NY, USA.
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Unger
authors.forename: William E
authors.initials: WE
authors.lastname: Barlow
authors.forename: Laura F
authors.initials: LF
authors.lastname: Hutchins
authors.forename: Silvana
authors.initials: S
authors.lastname: Martino
authors.forename: C Kent
authors.initials: CK
authors.lastname: Osborne
authors.forename: Robert B
authors.initials: RB
authors.lastname: Livingston
authors.forename: Kathy S
authors.initials: KS
authors.lastname: Albain
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D001943:Breast Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000208:ethnology* / Q000401:mortality; D017024:Chemotherapy, Adjuvant; D017326:Clinical Trials, Phase III as Topic; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007958:Leukocyte Count; D008875:Middle Aged; D016896:Treatment Outcome; D044465:White People