Abstract
We evaluated how race, insurance status, and other sociodemographic, tumor, and treatment variables influenced the response to neoadjuvant chemotherapy (NAC) in breast cancer. We performed an IRB-approved retrospective review of 298 breast cancer patients treated with NAC from 2006-2018 at our institution. Univariable and multivariable binary logistic regression analyses were performed to estimate the effects of race, insurance status, and other variables on outcomes. Outcomes of interest included pathologic complete response (pCR), partial response (pPR), and any response (pCR or pPR). Sixty-nine patients (23%) identified as African American. One hundred sixty-eight (57%) patients had private insurance, 71 (24%) had Medicare, 40 (14%) had Medicaid, and 17 (6%) had no insurance. Insurance status was a predictor for any clinical response to NAC in both univariable and multivariable analyses (p<0.01), where odds of pCR or pPR were lower for patients with Medicare compared to private insurance (OR 0.32, 95% CI: 0.15-0.70, p<0.01). Other variables significant for the response to NAC included body mass index, hormone receptor status, clinical group stage, and Ki-67. Race did not influence the response to NAC. Insurance provider, body mass index, hormone receptor status, clinical group stage, and Ki-67 may be useful predictors of treatment outcomes. Future studies that assess the impacts of insurance status and other identified factors on treatment response may help evaluate outcomes in at-risk populations with factors that preclude full benefit from NAC.
Highlights
Despite the general improvement in breast cancer (BC) survival, racial inequalities in BC mortality rates and outcomes continue
Insurance status, and other sociodemographic, tumor, and treatment variables influenced the response to neoadjuvant chemotherapy (NAC) in breast cancer
Insurance status was a predictor for any clinical response to NAC in both univariable and multivariable analyses (p
Summary
Despite the general improvement in breast cancer (BC) survival, racial inequalities in BC mortality rates and outcomes continue. Differences in survival rates have been associated with health insurance status, where Medicaid-insured and uninsured patients present with more unfavorable oncologic characteristics and higher mortality rates compared to privately insured patients [3]. The majority of these studies were conducted in the setting of adjuvant chemotherapy and not neoadjuvant chemotherapy (NAC). It is unclear whether these survival disparities continue to exist among patients receiving NAC, with some reports noting lower rates of pathologic complete response (pCR), defined as no residual cancer in the breasts and axillary lymph nodes, in AA patients and others reporting higher rates [4,5]. We aimed to identify other significant predictors of NAC outcomes that may help individualize treatment and optimize patient response
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