title: Factors associated with receipt of breast cancer adjuvant chemotherapy in a diverse population-based sample.
abstract: OBJECTIVE
  Disparities in receipt of adjuvant chemotherapy may contribute to higher breast cancer fatality rates among black and Hispanic women compared with non-Hispanic whites. We investigated factors associated with receipt of chemotherapy in a diverse population-based sample.
  
  
  METHODS
  Women diagnosed with breast cancer between August 2005 and May 2007 (N = 3,252) and reported to the Detroit, Michigan, or Los Angeles County Surveillance, Epidemiology, and End Results (SEER) registry were recruited to complete a survey. Multivariable analyses examined factors associated with chemotherapy receipt.
  
  
  RESULTS
  The survey was sent to 3,133 patients; 2,290 completed a survey (73.1%), and 1,403 of these patients were included in the analytic sample. In multivariable models, disease characteristics were significantly associated with the likelihood of receiving chemotherapy. Low-acculturated Hispanics were more likely to receive chemotherapy than non-Hispanic whites (odds ratio [OR], 2.00; 95% CI, 1.31 to 3.04), as were high-acculturated Hispanics (OR, 1.43; 95% CI, 1.03 to 1.98). Black women were less likely to receive chemotherapy than non-Hispanic whites, but the difference was not significant (OR, 0.83; 95% CI, 0.64 to 1.08). Increasing age (even in women age < 50 years) and Medicaid insurance were associated with lower rates of chemotherapy receipt.
  
  
  CONCLUSIONS
  In this population-based sample, disease characteristics were strongly associated with receipt of chemotherapy, indicating that clinical benefit guides most treatment decisions. We found no compelling evidence that black women and Hispanics receive chemotherapy at lower rates. Interventions that address chemotherapy use rates according to age and insurance status may improve quality of systemic treatment.
authors.affiliation: University of Michigan, North Campus Research Complex, 2800 Plymouth Rd, Bldg 16, 400S, Ann Arbor, MI 48109-2800, USA. jengrigg@umich.edu
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Griggs
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Hawley
authors.forename: John J
authors.initials: JJ
authors.lastname: Graff
authors.forename: Ann S
authors.initials: AS
authors.lastname: Hamilton
authors.forename: Reshma
authors.initials: R
authors.lastname: Jagsi
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Janz
authors.forename: Mahasin S
authors.initials: MS
authors.lastname: Mujahid
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Friese
authors.forename: Barbara
authors.initials: B
authors.lastname: Salem
authors.forename: Paul H
authors.initials: PH
authors.lastname: Abrahamse
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Katz
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000208:ethnology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D016015:Logistic Models; D015141:Los Angeles / Q000453:epidemiology; D008408:Mastectomy / Q000706:statistics & numerical data*; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D018426:SEER Program; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult