title: Factors Affecting the Completion of Adjuvant Chemotherapy in Early-Stage Breast Cancer.
abstract: BACKGROUND
  Despite the survival benefit associated with adjuvant chemotherapy in early-stage breast cancer, many do not complete treatment. This study identified factors associated with noncompletion of adjuvant chemotherapy among a select population of women with early-stage breast cancer.
  
  
  METHODS
  The study sample was obtained from a multicenter study designed to evaluate patient-assistance program usage among early-stage breast cancer patients requiring adjuvant therapy. In this study, 333 patients with stages I and II breast cancer undergoing surgery from October 2006 to September 2009 completed 6-month follow-up surveys assessing their experiences with care, health status, social support, self-efficacy, and treatment beliefs. In- and outpatient medical records were abstracted to assess treatment completion. Of the 333 patients, 198 initiated adjuvant chemotherapy and formed our study cohort. The study compared patients who did and did not complete adjuvant chemotherapy.
  
  
  RESULTS
  The median patient age was 53 years (range 28-86 years). According to self-identification, 41 % of the patients were non-Hispanic white and 21 % were black. A total of 13 patients (7 %) did not complete adjuvant chemotherapy. In the bivariate analysis, the patients not completing chemotherapy were more likely to be black and unmarried women with low emotional social support and a poor body image after treatment. In the multivariate analysis, black race [odds ratio (OR) 5.62; 95 % confidence interval (CI) 1.63-20.36] and poor body image (OR 9.75; 95 % CI 2.12-95.95) were independently associated with noncompletion of chemotherapy.
  
  
  CONCLUSIONS
  Overall chemotherapy noncompletion rates were low among women exposed to patient-assistance programs. However, poor body image and black race were independent predictors of uncompleted chemotherapy. The true impact of race in this group may result from social factors that occur more often among black women, including poor social support.
authors.affiliation: Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Sylvia A
authors.initials: SA
authors.lastname: Reyes
authors.affiliation: Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Tari A
authors.initials: TA
authors.lastname: King
authors.affiliation: Department of Population Health Science & Policy, Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Kezhen
authors.initials: K
authors.lastname: Fei
authors.affiliation: Department of Population Health Science & Policy, Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Rebeca
authors.initials: R
authors.lastname: Franco
authors.affiliation: Department of Population Health Science & Policy, Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA. nina.bickell@mssm.edu.
authors.forename: Nina A
authors.initials: NA
authors.lastname: Bickell
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D054624:Health Status Disparities; D006801:Humans; D055118:Medication Adherence; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012944:Social Support; D044465:White People