title: Underuse of trimodality treatment affects survival for patients with inflammatory breast cancer: an analysis of treatment and survival trends from the National Cancer Database.
abstract: OBJECTIVE
  To analyze factors that predict the use of trimodality treatment (chemotherapy, surgery, and radiation therapy [RT]) and evaluate the impact that trimodality treatment use has on survival for patients with inflammatory breast cancer (IBC).
  
  
  METHODS
  Using the National Cancer Data Base, patients who underwent surgical treatment of nonmetastatic IBC from 1998 to 2010 were identified. We collected demographic, tumor, and treatment data and analyzed treatment and survival trends over time. Logistic regression and Cox proportional hazard models were used to examine factors predicting treatment and survival.
  
  
  RESULTS
  We identified 10,197 patients who fulfilled study criteria. The use of trimodality therapy fluctuated annually (58.4% to 73.4%). Patients who were older, diagnosed earlier in the study period, lived in regions of the country outside of the Midwest, had lower incomes or public insurance, and had a higher comorbid score were significantly less likely to receive trimodality therapy (all P < .05). Five- and 10-year survival rates were highest among patients receiving trimodality treatment (55.4% and 37.3%, respectively) compared with patients who received the combination of surgery plus chemotherapy, surgery plus RT, or surgery alone. After adjusting for potential confounding variables, use of trimodality therapy remained a significant independent predictor of survival.
  
  
  CONCLUSIONS
  Underutilization of trimodality therapy negatively impacted survival for patients with IBC. The use of trimodality therapy increased marginally with time, but there remain significant factors associated with differences in use of trimodality treatment. We have identified specific barriers to care that may be targeted to improve treatment delivery and potentially improve patient outcomes.
authors.affiliation: All authors: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Natasha M
authors.initials: NM
authors.lastname: Rueth
authors.affiliation: All authors: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Heather Y
authors.initials: HY
authors.lastname: Lin
authors.affiliation: All authors: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bedrosian
authors.affiliation: All authors: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Simona F
authors.initials: SF
authors.lastname: Shaitelman
authors.affiliation: All authors: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Naoto T
authors.initials: NT
authors.lastname: Ueno
authors.affiliation: All authors: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Yu
authors.initials: Y
authors.lastname: Shen
authors.affiliation: All authors: The University of Texas MD Anderson Cancer Center, Houston, TX. gvbabiera@mdanderson.org.
authors.forename: Gildy
authors.initials: G
authors.lastname: Babiera
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data*; D006801:Humans; D058922:Inflammatory Breast Neoplasms / Q000401:mortality* / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology