Abstract
BackgroundLarge interindividual variations have been reported in chemotherapy‐induced toxicities. Little is known whether racial disparities exist in neutropenia associated with taxanes.MethodsPatients with a diagnosis of primary cancer who underwent chemotherapy with taxanes were identified from Vanderbilt University Medical Center's Synthetic Derivative. Multinomial regression models were applied to evaluate odds ratios (ORs) and 95% confidence intervals (CIs) of neutropenia associated with race, with adjustments for demographic variables, baseline neutrophil count, chemotherapy‐related information, prior treatments, and cancer site.ResultsA total of 3492 patients were included in the study. Compared with White patients, grade 2 or higher neutropenia was more frequently recorded among Black patients who received taxanes overall (42.2% vs. 32.7%, p < 0.001) or paclitaxel (43.0% vs. 36.7%, p < 0.001) but not among those who received docetaxel (32.0% vs. 30.2%, p = 0.821). After adjustments for multiple covariates, Black patients who received chemotherapy with any taxanes had significantly higher risk of grade 2 (OR = 1.53; 95% CI = 1.09–2.14) and grade 3 (OR = 1.91; 95% CI = 1.36–2.67) neutropenia but comparable risk of grade 4 neutropenia (OR = 1.19; 95% CI = 0.79–1.79). Similar association patterns were observed for Black patients who specifically received paclitaxel, but a null association was found for those treated with docetaxel.ConclusionBlack cancer patients treated with taxanes for any cancer had a higher risk of neutropenia compared with their White counterparts, especially those who received paclitaxel. More research is needed to understand the mechanism(s) underlying this racial disparity in order to enhance the delivery of patient‐centered oncology.
Highlights
Cancer is a major public health issue worldwide and the second leading cause of death in the United States (U.S.).[1]
In this single-center study, we found that Black cancer patients who received chemotherapy with taxanes had a higher risk of grade 2 or grade 3 neutropenia compared with White patients, even after adjustments for baseline neutropenia count and other treatments received
It has been frequently reported that large interindividual variations exist in toxicity associated with anticancer therapy, data on racial and/or ethnic variations in chemotherapy-induced neutropenia have been limited, and results varied across cancer sites or chemotherapy agents.17-19 To date, no studies have systematically evaluated racial differences in toxicity from taxane-induced neutropenia
Summary
Cancer is a major public health issue worldwide and the second leading cause of death in the United States (U.S.).[1]. It has been previously described that neutropenia may be a common, albeit considered benign, phenomenon among healthy African Americans This observation may necessitate chemotherapy dose modifications for safety, and thereby may contribute to widely reported racial/ethnic disparities in survival post-cancer diagnosis.[10] less is known whether race impacts the prevalence of neutropenia after receiving chemotherapy with taxanes. Because racial/ethnic minorities are historically underrepresented in clinical trials,[11] this question has not been previously addressed in clinical trial settings To fill this knowledge gap, we utilized electronic health record (EHR) data from Vanderbilt University Medical Center (VUMC) to evaluate the influence of race on the risk of taxane-induced neutropenia among patients diagnosed with a primary cancer
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