Abstract

Abstract : Although the risk of breast cancer in African-American women is lower than in Caucasian women, African-American women have higher breast cancer fatality and case-fatality rates(1). The disparity in breast cancer outcome is not accounted for solely by differences in stage at diagnosis or in the biologic behavior of the disease(2). Differences in the quality of chemotherapy received by African-American women may provide an additional explanation for the poorer outcome among African-American women. Retrospective analyses suggest the beneficial impact of adjuvant chemotherapy on disease-free and overall survival in women with breast cancer is diminished when full doses of therapy are not received (3;4). The current recommendation is that patients undergoing adjuvant chemotherapy for breast cancer receive at least 80 to 85 percent of the planned doses (5). This multicenter study focuses on the clinical impact of suboptimal dose/dose intensity in women with HER-2/neu-positive tumors, a subgroup in whom optimal chemotherapy may be particularly critical. We are investigating the potential of relative chemotherapy dose (the ratio of actual to predicted doses) and dose intensity (which incorporates time to completion of adjuvant chemotherapy) as measures of quality of care. This study involves review of treatment records of subjects who have received chemotherapy for breast cancer and identification of the HER-2/neu oncogene on archival tumor specimens. The primary measures of chemotherapy quality (relative dose and dose intensity) will be related to the subjects' clinical outcome. The ultimate goal of the project is to design interventions targeting those factors that lead to lower dose intense chemotherapy in an effort to eliminate disparities in the quality of care of women with breast cancer.

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