Social and racial disparities in the use of non-standard breast cancer adjuvant chemotherapy regimens

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6036 Background: Economically disadvantaged and black women have worse stage-specific breast cancer outcomes than other women, even after controlling for tumor histologic features. Disparities quality of chemotherapy may contribute to differences in outcome. The purpose of this study was to investigate the use of non-standard breast cancer adjuvant chemotherapy regimens in black women and those of lower socioeconomic status (SES). Methods: Detailed information on patient, disease, and treatment factors was collected prospectively on 1,006 patients receiving adjuvant chemotherapy for early-stage breast cancer in 115 oncology practices throughout the US. All patients signed informed consent. Regimens included in the guidelines of the National Comprehensive Cancer Network were considered standard regimens; all others were considered non-standard. Receipt of non-standard regimens was examined according to clinical and non-clinical factors. Differences between groups were assessed using a chi-square test. Multivariate logistic regression was used to identify factors associated with use of non-standard regimens. Results: Non-standard regimens were used in the treatment of 136 (14%) of the participants. Black patients were twice as likely to receive a non-standard regimen as whites (23% vs. 12%, p = .0014). Patients with less than a high school education were twice as likely to receive a non-standard regimen compared with those with a college education (21% vs. 8%, p = 0.0011). Other factors associated with non-standard chemotherapy regimens were past chemotherapy exposure (p < .0001), higher stage disease (p < .0001) and geographic location (p = 0.0059). Age, comorbidity, body mass index, type of insurance, and employment status were not associated with receipt of non-standard chemotherapy. In multivariate analysis, all variables that were significant in the bivariate analysis remained independently associated with receipt of non-standard chemotherapy. Conclusions: The more frequent use of non-guideline concordant adjuvant chemotherapy regimens in black women and women with lower SES may contribute to their less favorable outcomes. These findings offer an opportunity to improve patient care and perhaps cancer outcomes. [Table: see text]