Difference In Duration Of Treatment Research Articles

Outpatient versus inpatient IV antibiotic management for pediatric oncology patients with low risk febrile neutropenia: A randomised trial

This randomized controlled trial (RCT) [1] compared outpatient versus inpatient antibiotic therapy in a group of children presenting with low risk febrile neutropenia against a background of hematological malignancies. The investigators focused on Quality of Life (QoL) using a 13-point scale, and efficacy of treatment. Children (1–21 y) receiving chemotherapy for acute leukemia or solid tumors at a tertiary care hospital in Melbourne, who presented with fever (defined appropriately) were administered one dose of intravenous cefipime pending the neutrophil count. Those with confirmed neutropenia (<500/mm3) and a low-risk status (defined as absence of septic shock or comorbidities requiring hospitalization) were randomized to receive outpatient or inpatient intravenous cefipime 12 hourly until a positive blood culture became available or the clinical condition warranted change in management. Parents and children in the outpatient arm had better QoL scores for almost all items (although many did not achieve statistical significance), and no significant difference in treatment duration, fever duration, microbiologically proven infection, identified focus of infection, or complications. Six episodes in the outpatient arm required readmission to hospital.

Specific Detection of Bjerkandera adusta by Polymerase Chain Reaction and Its Incidence in Fungus-Associated Chronic Cough

Chronic cough is a common symptom at outpatient care. An uncontrollable cough with difficulty in treatment is called chronic idiopathic cough. Recent reports have demonstrated that the presence of basidiomycetous fungi in sputum is an important clinical finding that assists in clarifying the cause of chronic cough in some cases. Research has suggested that Bjerkandera adusta is related to fungus-associated chronic cough (FACC). FACC is defined as a chronic cough associated with basidiomycetous fungi found in induced sputum and can be treated with antifungal medication. B. adusta is one of the basidiomycetous fungi that exist in cosmopolitan environments. The aim of this study was to develop a B. adusta detection method using polymerase chain reaction (PCR) with a specific primer set and to research the incidence of B. adusta in FACC. The new method successfully detected B. adusta from FACC patients. The incidence of B. adusta in FACC was 42.86%. Antifungal drugs were effective in most cases. Significant differences in treatment duration between B. adusta patients and non-B. adusta patients were observed. It is therefore suggested that the presence of B. adusta may be one of the allergic intractable factors of chronic cough. This finding may provide identifiable differences in clinical manifestations between B. adusta and non-B. adusta in FACC and lead to possible differing remedies to treat the two forms. PCR can specifically detect B. adusta from patients suffering from chronic cough and provides a new diagnosis for FACC associated with B. adusta.

Financial implication for being the national centre for the treatment and management of pelvic and acetabular fractures in Ireland: The need for a new budget strategy?

Financial implication for being the national centre for the treatment and management of pelvic and acetabular fractures in Ireland: The need for a new budget strategy?

Should studies of maintenance therapy be maintained in women with ovarian cancer?

Should studies of maintenance therapy be maintained in women with ovarian cancer?

Comparing cisplatin-based combination chemotherapy with EMA/CO chemotherapy for the treatment of high risk gestational trophoblastic neoplasia

BackgroundCisplatin-based chemotherapy (etoposide 100mg/m2 days 1–5, methotrexate 300mg/m2 day 1, cyclophosphamide 600mg/m2 day 1, actinomycin D 0.6mg/m2 day 2 and cisplatin 60mg/m2 day 4, EMACP) was compared to EMA/CO (etoposide 100mg/m2 days 1–2, methotrexate 300mg/m2 day 1 and actinomycin D 0.5mg i.v. bolus day 1 and 0.5mg/m2 day 2, alternating with cyclophosphamide 600mg/m2 day 8 and vincristine 1mg/m2 day 8) for the treatment of high-risk gestational trophoblastic neoplasia (GTN). Patients and methodsIn the Netherlands, 83 patients were treated with EMACP and 103 patients with EMA/CO. Outcome measures were remission rate, median number of courses to achieve normal human chorionic gonadotrophin (hCG) concentrations, toxicity, recurrent disease rate and disease specific survival. ResultsRemission rates were similar (EMACP 91.6%, EMA/CO 85.4%). The median number of courses of EMA/CO to reach hCG normalisation for single-agent resistant disease and primary high-risk disease was three and five courses, respectively, compared to 1.5 (p=0.001) and three (p<0.001) courses of EMACP. Patients treated with EMACP more often developed fever, renal toxicity, nausea and diarrhoea compared to patients treated with EMA/CO. Patients treated with EMA/CO more often had anaemia, neuropathy and hepatotoxicity. ConclusionEMACP combination chemotherapy is an effective treatment for high-risk GTN, with a remission rate comparable to EMA/CO. However, the difference in duration of treatment is only slightly shorter with EMACP. Cisplatin-based chemotherapy in the form of EMACP in this study was not proven more effective than EMA/CO.

Duration of first-line antiretroviral therapy with tenofovir and emtricitabine combined with atazanavir/ritonavir, efavirenz or lopinavir/ritonavir in the Italian ARCA cohort

To explore the durability of three first-line tenofovir/emtricitabine-based regimens in combination with atazanavir/ritonavir, efavirenz or lopinavir/ritonavir in HIV-1-infected patients. A retrospective, longitudinal, multicentre analysis of adult patients enrolled in the Antiretroviral Resistance Cohort Analysis (ARCA), a national prospective observational cohort of HIV-1-infected patients followed up at more than 100 clinical and laboratory units in Italy. Patients eligible were those starting first-line antiretroviral therapy between 1 June 2004 and 15 April 2011 and who were followed up for at least 6 months. The primary endpoint was durability, defined as the time from antiretroviral therapy initiation to first treatment modification. Time-dependent events were analysed by the Kaplan-Meier approach and the Cox proportional hazard model. There are 26,000 HIV-infected patients in the ARCA database, of whom 1654 met study inclusion criteria. Six hundred and thirty-nine (38.6%) received efavirenz, 321 (19.4%) received atazanavir/ritonavir and 694 (41.9%) received lopinavir/ritonavir as a first-line regimen. Over a total observation period of 88 months, equivalent to more than 2805 person-years of follow-up, 618 patients underwent treatment modification. Lopinavir/ritonavir, given twice daily, was associated with a higher discontinuation rate than efavirenz- and atazanavir-based regimens [hazard ratio (HR) 1.83, 95% confidence interval (CI) 1.56-2.15, P = 0.001]. Comparing the once-daily regimens, the rate of discontinuation of efavirenz was higher than that of atazanavir/ritonavir (HR 1.39, 95% CI 1.06-1.83, P = 0.016). Significant differences in treatment duration were observed among the three studied regimens. Once-daily regimens exhibited greater durability than the twice-daily regimen. Among the specific regimens examined, tenofovir/emtricitabine plus atazanavir/ritonavir showed the greatest durability.

Effect of marital status on duration of treatment for mental illness

There is a well-established link between marital status and mental health, but previous research has produced mixed results about the reasons for this relationship. Some studies propose that marriage provides protection from stressors and increases personal coping abilities (the causation perspective), whereas other studies argue that marriage markets “weed out” individuals predisposed to illness (the selection perspective). This article addresses the causation-versus-selection debate by examining the effect of marital status on duration of treatment for mental illness. The empirical analysis uses longitudinal data and GEE models to estimate group-level differences in duration of treatment. The results suggest that marriage does not appear to confer a health advantage in terms of duration of treatment. However, the study demonstrates that the never-married experience longer treatment time than the married, divorced, and widowed.

Treatment Duration for Patients with Drug-Resistant Tuberculosis, United States

Treatment Duration for Patients with Drug-Resistant Tuberculosis, United States

DTIC and GM-CSF in the treatment of patients with metastatic melanoma.

e19045 Background: To describe patients with metastatic melanoma being treated with mono-therapy, dacarbazine (DTIC) or granulocyte-macrophage colony-stimulating factor (GM-CSF). Methods: Using a large U.S. medical claims database, patients were identified between 2005 and 2010 using ≥2 melanoma diagnoses (ICD-9-CM: 172.xx, V10.82) and ≥2 diagnoses for metastasis (ICD-9-CM: 197.xx, 198.xx). Patients who received mono-therapy with DTIC or GM-CSF as the first documented drug therapy after metastatic diagnosis were identified. Patient demographic and clinical characteristics and treatment duration were compared between patients treated with DTIC and those who received GM-CSF. Furthermore, comparisons were also made between the two treatment groups after 1-to-1 matching on age, gender, and baseline comorbidities. Results: A total of 81 patients with metastatic melanoma receiving first-line DTIC and 24 patients with metastatic melanoma receiving first-line GM-CSF were included in this analysis. On average, DTIC patients were 8.5 years older (p = 0.009) and had higher baseline Charlson Comorbidity Index scores (D0.43, p = 0.005) than GM-CSF patients. The mean duration of first line treatment was 94 days on DTIC and 135 days on GM-CSF. The mean length of follow-up from the start of first line was 257 days on DTIC and 451 days on GM-CSF. After each GM-CSF patient was matched with a DTIC patient on age, gender, and baseline Charlson Comorbidity Index score, the mean duration of first line treatment was 79 days on matched DTIC and 135 days on GM-CSF, and the mean length of follow-up from the start of first line was 317 days on matched DTIC and 451 days on GM-CSF. Conclusions: Patients with metastatic melanoma who received DTIC treatment were older and had higher comorbidity index scores but shorter treatment duration than those who received GM-CSF; the difference in treatment duration remained after DTIC patients were matched with GM-CSF patients on age, gender and comorbidity index scores.

Ambulatory Intravenous Antibiotic Therapy for Children With Preseptal Cellulitis

This study aimed to compare the use of outpatient ambulatory care versus admission for intravenous antibiotics in the management of preseptal cellulitis. This is a retrospective consecutive cohort study of children younger than 16 years presenting to an Inner London Paediatric Emergency Department with signs and symptoms of preseptal cellulitis. A total of 94 cases were identified during a 17-month period. Of them, 30 children were prescribed oral antibiotics. One child did not receive treatment. Of the 63 children prescribed with intravenous antibiotics, 42 were managed on an ambulatory basis and 21 were admitted. There was no significant difference in duration of treatment in days between those on ambulatory management and those admitted (2.79 ± 0.8 vs 2.76 ± 1.9, P = 0.94) or in the rate of complications. The net cost saving was $205,924 (£131,065; &OV0556;147,578) overall, equal to $4900 (£3120; &OV0556;3513) per patient. Ambulatory intravenous antibiotics with daily review are a safe and cost-effective alternative to inpatient admission in simple preseptal cellulitis for children in our population who require parenteral antibiotics.

Temporal trends in clomiphene citrate use: a population-based study

To examine temporal trends in clomiphene citrate use and sociodemographic characteristics associated with treatment initiation and duration. Retrospective cohort study. British Columbia, Canada, 1996 to 2008. Women aged 20 to 49 years. None. Temporal trends in treatment prevalence and incidence rates were assessed using Cochran-Armitage test for trend; differences in treatment duration were assessed using Wilcoxon and Kruskal-Wallis tests. Incidence rate ratios and 95% confidence intervals were estimated using Poisson regression. A province-wide database of all dispensed prescriptions was used to identify clomiphene citrate users. Rural versus urban residence and neighborhood's socioeconomic quintile were identified based on postal codes. Overall, 26,993 women were prescribed clomiphene citrate between 1996 and 2008. Prevalence rates declined from 4.1 to 3.7 clomiphene users per 1,000 women during this period, while the incidence rates remained stable (2.2 new users per 1,000 women per year). Both prevalence and incidence rates declined among women aged 20 to 29 years, and showed a statistically significant increase among women aged 30 to 44 years. Women aged 30 to 34 years had the highest incidence of clomiphene use (4.5 per 1,000 women per year). Urban residence and low versus high socioeconomic status were associated with higher rates of treatment initiation. Older age (40 to 49 years) and urban residence were associated with shorter duration of use. The increase in the incidence rates of clomiphene citrate use among women aged 30 to 44 years indicates a growing demand for fertility treatments in this population and may have contributed to the increase in multiple births.

COPD exacerbations in general practice: variability in oral prednisolone courses.

BackgroundThe use of oral corticosteroids as treatment of COPD exacerbations in primary care is well established and evidence-based. However, the most appropriate dosage regimen has not been determined and remains controversial. Corticosteroid therapy is associated with a number of undesirable side effects, including hyperglycaemias, so differences in prescribing might be relevant. This study examines the differences between GPs in dosage and duration of prednisolone treatment in patients with a COPD exacerbation. It also investigates the number of general practitioners (GPs) who adjust their treatment according to the presence of diabetic co-morbidity.MethodsCross-sectional study among 219 GPs and 25 GPs in training, located in the Northern part of the Netherlands.ResultsThe response rate was 69%. Nearly every GP prescribed a continuous dose of prednisolone 30 mg per day. Among GPs there were substantial differences in treatment duration. GPs prescribed courses of five, seven, ten, or fourteen days. A course of seven days was most common. The duration of treatment depended on exacerbation and disease severity. A course of five days was especially prescribed in case of a less severe exacerbation. In a more severe exacerbation duration of seven to fourteen days was more common. Hardly any GP adjusted treatment to the presence of diabetic co-morbidity.ConclusionUnder normal conditions GPs prescribe prednisolone quite uniformly, within the range of the current Dutch guidelines. There is insufficient guidance regarding how to adjust corticosteroid treatment to exacerbation severity, disease severity and the presence of diabetic co-morbidity. Under these circumstances, there is a substantial variation in treatment duration.

Randomized controlled trial of cognitive–behavioural therapy for coexisting depression and alcohol problems: short‐term outcome

Alcohol use disorders and depression co-occur frequently and are associated with poorer outcomes than when either condition occurs alone. The present study (Depression and Alcohol Integrated and Single-focused Interventions; DAISI) aimed to compare the effectiveness of brief intervention, single-focused and integrated psychological interventions for treatment of coexisting depression and alcohol use problems. Participants (n = 284) with current depressive symptoms and hazardous alcohol use were assessed and randomly allocated to one of four individually delivered interventions: (i) a brief intervention only (single 90-minute session) with an integrated focus on depression and alcohol, or followed by a further nine 1-hour sessions with (ii) an alcohol focus; (iii) a depression focus; or (iv) an integrated focus. Follow-up assessments occurred 18 weeks after baseline. Compared with the brief intervention, 10 sessions were associated with greater reductions in average drinks per week, average drinking days per week and maximum consumption on 1 day. No difference in duration of treatment was found for depression outcomes. Compared with single-focused interventions, integrated treatment was associated with a greater reduction in drinking days and level of depression. For men, the alcohol-focused rather than depression-focused intervention was associated with a greater reduction in average drinks per day and drinks per week and an increased level of general functioning. Women showed greater improvements on each of these variables when they received depression-focused rather than alcohol-focused treatment. Integrated treatment may be superior to single-focused treatment for coexisting depression and alcohol problems, at least in the short term. Gender differences between single-focused depression and alcohol treatments warrant further study.

Leflunomide use in New Zealand. A national prospective post‐marketing study

This post-marketing study aimed to record rates of retention, adverse effects and efficacy of leflunomide in the treatment of rheumatoid arthritis (RA). The secondary objectives were to make a semi-quantitative assessment of response to treatment and to examine the effect of a loading dose on adverse events and treatment duration. Rheumatologists in New Zealand contributed to a prospective leflunomide treatment registry. Baseline data were collected on leflunomide initiation and information about treatment experience was sought every 6 months. Each patient was followed for 2 years. Kaplan-Meier analysis was used to evaluate differences in stopping rates between lack of efficacy and adverse effects. Hazard analysis was used to evaluate the effect of using a loading dose on retention rate. Three hundred and eight patients were enrolled in the study; complete follow-up data were available for 244 patients. Retention of patients on leflunomide was 64% at 12 months and 49.4% at 2 years. Reasons for stopping were adverse events (54 patients), loss of effect (25 patients) and miscellaneous reasons (14 patients). Use of a loading dose had no effect on retention; there was no difference in treatment duration between those who stopped from adverse effects or loss of efficacy. Leflunomide was effective in treating RA in a group that had longer duration of disease and greater prior use of disease-modifying agents than the groups studied in clinical trials. Rates of withdrawal were lower than those reported in other post-marketing studies, but were higher than those from phase III clinical trials.

Women's Past-Year Prostitution Status and Receipt of Substance Abuse Treatment Services

The study compared services received in substance abuse treatment programs by women who reported involvement in prostitution and by those who did not. Women (N=1,604) in a national study of substance abuse programs completed a structured interview assessing substance abuse, demographic characteristics, and past-year prostitution at program entry. At discharge, information was gathered on treatment modality (residential including inpatient, or outpatient), duration, and amounts of medical, mental health, and psychosocial services received during treatment. Analyses compared women involved in prostitution and those not involved. Women involved in prostitution were more likely to enter residential treatment. No differences between involvement groups were found in residential treatment duration, services received in residential treatment, or length of outpatient enrollment. In outpatient programs, women involved in prostitution received more psychosocial services. Substance abuse treatment programs appear responsive to the greater needs of women involved in prostitution. However, more research is needed on outcomes.

Orthodontic Treatment Following Orthognathic Surgery: How Long Does It Take and Why? A Retrospective Study

This study was conducted to examine the duration of postoperative orthodontic treatment of patients who underwent combined orthodontic and orthognathic treatment and investigate factors that might influence this, to assess the strength of association between preoperative and postoperative orthodontic treatment duration, and to perform a retrospective power calculation to assess the likelihood of this study detecting a clinically significant (weeks) difference. Records of patients who had undergone combined orthodontic and orthognathic treatment between 1998 and 2003 (n = 69) were obtained from 3 consultant orthodontists at 3 major hospitals in Leeds, UK. The duration of postoperative orthodontic treatment was calculated as the date of the operation to the date of fixed appliance removal. Variables investigated included patient age and gender, malocclusion, type of operation, presence of open bite, extractions (excluding third molars), hospital, operator, missed appointments/breakages and debonding, and retainer arrangements. The median duration of postoperative treatment was 7.5 months (range, 5 to 11 months). None of the variables clearly affected this duration; no correlation was found between preoperative and postoperative treatment times (r(s) = -.07; P > .05). A retrospective power calculation demonstrated a 57.5% likelihood of this study detecting a difference of 8 weeks between 2 groups. Patients should be informed that the postoperative orthodontic phase of combined orthognathic-orthodontic treatment may last approximately 5 to 11 months. No association was found between preoperative and postoperative treatment duration. Many more patients will have to be recruited to assess whether specific variables result in a clinically significant difference in treatment duration.

Randomized strategical trial of chemotherapy in metastatic colorectal cancer (FFCD 2000–05): Preliminary results

4069 Background: The survival benefit of using a combination therapy instead of keeping it for a second line (L2) has not been demonstrated in metastatic colorectal cancer. The purpose of this trial was to compare the efficacy of simplified LV5FU2 (s) followed by FOLFOX6 (arm A) to FOLFOX6 followed by FOLFIRI (arm B) on progression-free survival after two lines of chemotherapy. We present here preliminary results relating to toxicity, observance and overall survival. Methods: Inclusion criteria: a) non resectable metastases of histologically proven colorectal adenocarcinoma , b) evaluable disease (WHO criteria), c) absence of previous chemotherapy other than adjuvant. Treatment was as follows: LV5FU2s = at day 1, folinic acid 400 mg/m2, 5-FU bolus 400 mg/m2 and continuous infusion over 46 hours 2,400 mg/m2/2 weeks; FOLFOX6 = LV5FU2s + oxaliplatin 100 mg/m2 at day 1; FOLFIRI = LV5FU2s + irinotecan 180 mg/m2 at day 1. Results: 410 pts out of 570 initially planned (early stopping due to slow accrual and new treatments) were included from 02/2002 to 02/2006 (205 in each arm). Median follow-up was 25 months. The median number (range) of cycles (28 days) in first line (L1) was respectively 5 (1–24) and 6 (1–24) in the arms A and B (p=0.01), and for L2 (152 and 144 pts in the arms A/B): 5 (1–17) and 3 (1–33) (NS). In the arms A and B, 74% and 70% of pts had L2. L1 was stopped for toxicity for 1% and 16% of the pts in arms A and B (p&lt;0.0001); L2 respectively for 15% and 2% pts (p&lt;0.0001). The percentages of pts presenting at least a grade 3–4 hematologic toxicity (mainly neutropenia) by arm were: 6% versus 37% (p&lt;0.0001) for L1 and 30% versus 27% (NS) for L2; grade 3–4 non hematological toxicity (grade 2–4 neurotoxicity): 26% (1%) versus 56% (64%)(p&lt;0.0001; p&lt;0.0001) for L1 and 54% (60%) versus 46% (40%) of the pts for L2 (NS; p&lt;0.01). No toxic death was observed in the arm A against 5 in the arm B: 3 in L1 and 2 in L2. Overall survival medians were 17 and 16 months in arms A/B (logrank p=0.64) (preliminary results, 291 observed deaths). Conclusions: This trial does not show any substantial difference in treatment duration and overall survival between both arms and shows a more important toxicity in the arm with first line combined chemotherapy. No significant financial relationships to disclose.

A randomized evaluation of the acute efficacy, acceptability and tolerability of Flutter and active cycle of breathing with and without postural drainage in non-cystic fibrosis bronchiectasis

Airway clearance is integral to the management of bronchiectasis, yet there is no evidence as to the optimal modality. The aim of this randomized prospective study was to evaluate the acute efficacy, acceptability and tolerability of three airway clearance techniques in non-cystic fibrosis (non-CF) bronchiectasis. Flutter, active cycle of breathing technique (ACBT) and ACBT with postural drainage (ACBT-PD) were evaluated in random order over a week in 36 patients (mean age 62 years, range 33-83), with stable non-CF bronchiectasis. Total sputum wet weight for ACBT-PD was twice that of either ACBT alone or Flutter. No objective difference in treatment duration was noted. All three techniques were well accepted and tolerated. Patient preference was 16 (44%) for Flutter, eight (22%) ACBT and 12 (33%) for ACBT-PD. Patient demography, factors such as upper airways or reflux symptoms, previous use or acute efficacy did not predict preference. This is the first randomized systematic evaluation of acute efficacy, acceptability and tolerability of Flutter, ACBT and ACBT-PD in non-CF bronchiectasis. All three techniques were well tolerated but ACBT-PD proved superior in terms of acute efficacy. Patient preference for treatment modality could not be predicted.

Reappraisal of cervical spine subluxation in Thai patients with rheumatoid arthritis.

Subluxation of the cervical spine is one of a number of devastating complications of rheumatoid arthritis. In spite of this, the features of cervical spine subluxation in Thai patients with rheumatoid arthritis have never previously been studied. We enrolled 134 patients with rheumatoid arthritis who were being followed at the rheumatology clinic, Ramathibodi Hospital, during 1978-2001. Radiological examinations were made in lateral neck flexion, extension and open-mouth views. Symptoms of neck pain and the results of relevant neurological examinations were recorded at the time of imaging. Other data on clinical features and treatments since diagnosis were reviewed retrospectively. The overall prevalence of cervical spine subluxation was 68.7%, which can be categorised into anterior (26.9%), posterior (14.9%), lateral (17.2%), vertical (16.4%) atlantoaxial and subaxial subluxation (28.4%). The percentages of cervical subluxation in patients who had suffered from the disease for 1, 5, 10 or more than 10 years were 77.8%, 64.9%, 70% and 64.7%, respectively. None of the patients had neurological deficits. No correlation between neck pain and cervical spine subluxation was established. The number of patients treated with corticosteroids was significantly higher in the subluxation group than in the non-subluxation group ( p=0.04). However, no difference in duration of treatment and cumulative dosages of steroids was displayed between the two groups. It was concluded that the prevalence of cervical spine subluxation in Thai patients with rheumatoid arthritis is much higher than the average, even in the early phase of the disease. Hence, radiological examination of the cervical spine should be included in the initial evaluation of Thai RA patients. Corticosteroid use was associated with cervical subluxation, regardless of dose and duration of treatment. The possible explanations are that steroids may directly cause ligament laxity, osteoporosis and decreasing muscle mass, which leads to accelerated subluxation, or that steroid treatments are used in more severe cases which have a higher tendency towards cervical subluxation.

Ethnic neutropenia and treatment delay in African American women undergoing chemotherapy for early-stage breast cancer.

Disparities in breast cancer survival have been observed between African American and white women. There are also known differences in mean baseline white blood cell (WBC) count among racial and ethnic groups. If the WBC count falls below conventionally defined treatment thresholds for patients undergoing adjuvant chemotherapy, reduced doses or treatment delays may occur, which could lead to race-based differences in treatment duration. We used the tumor registry at Columbia-Presbyterian Medical Center to identify 1178 women with newly diagnosed stage I and II breast cancer from whom we collected base-line information for 73 African American women and 126 age- and tumor stage-matched white women. Of these women, 43 African American and 93 white women underwent adjuvant chemotherapy. African American women had statistically significantly lower WBC counts than white women at diagnosis (6.2 x 10(9)/L for African American women versus 7.4 x 10(9)/L for white women, difference = 1.2, 95% confidence interval [CI] = 0.2 to 1.2; P =.02) and after treatment (5.3 x 10(9)/L for African American women versus 6.4 x 10(9)/L for white women, difference = 1.1, 95% CI = 0.2 to 2.5; P =.03). Overall, African American women required a statistically significantly longer duration of treatment than white women (19 weeks versus 15 weeks, respectively, difference = 4 weeks, 95% CI = 0.5 to 7.2 weeks; P =.03). The lower baseline WBC counts and longer duration of treatment for early-stage breast cancer in African American women compared with those in white women result in lower dose intensity of treatment for African American women, possibly contributing to observed racial differences in breast cancer survival.