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HomeHealth and MedicalFew With Inflammatory Breast Cancer Get Guideline-Based Care

Few With Inflammatory Breast Cancer Get Guideline-Based Care

SAN ANTONIO — Guideline-concordant care is associated with improved overall survival in patients with inflammatory breast cancer. Yet, a retrospective study of patients with inflammatory breast carcinoma shows that the majority of patients don’t receive it. 

The study also showed that overall survival was lowest for Black women who didn’t receive guideline-concordant care, said Brian Diskin, MD, with the Division of Breast Surgery, Memorial Sloan Kettering Cancer Center, New York City, here at the San Antonio Breast Cancer Symposium (SABCS) 2023.

The results highlight the importance of adhering to guidelines in inflammatory breast carcinoma and suggest that improving the rates among Black patients “may help to mitigate racial disparities and survival,” Diskin told the conference. 

Inflammatory breast carcinoma is an aggressive form of breast cancer associated with worse survival outcomes compared with other subtypes of breast cancer. Yet, it’s unclear how often and consistently guideline-concordant care — defined as treatment with neoadjuvant chemotherapy followed by modified radical mastectomy without immediate reconstruction, and postmastectomy radiotherapy — is received and what factors play a role in receiving recommended care. 

To investigate, Diskin and colleagues identified 6945 women from the National Cancer Database with nonmetastatic inflammatory breast cancer treated from 2010-2018. Guideline-concordant care was defined as trimodality treatment administered in the correct sequence, with neoadjuvant chemotherapy started within 60 days of diagnosis. 

Most patients (88%) did not start neoadjuvant chemotherapy within 60 days of diagnosis. 

Black and Asian patients were less likely than White patients to start chemotherapy within 60 days (odds ratio [OR] 0.54 and 0.51, respectively; P < .001), while patients with Medicare or private insurance were more likely to receive chemotherapy within 60 days of diagnosis than uninsured patients (OR 1.37 and 1.87, respectively; P < .001).

Roughly half of all patients didn’t receive appropriate surgical treatment (modified radical mastectomy without immediate reconstruction and postmastectomy radiotherapy). 

Overall, only about one third of the cohort received guideline-concordant treatment, Diskin reported. 

Patients aged 60-69 were more likely than patients aged 40-49 to receive guideline-concordant treatment (odds ratio [OR], 1.24; P < .001), as were patients with a higher clinical nodal burden (OR, 1.34 for N1; OR, 1.28 for N2; OR, 1.15 for N3 vs N0; < .001 for N1 and N2). 

Patients treated between 2014 and 2018 were less likely to receive guideline-concordant treatment than patients treated between 2010 and 2013 (OR, 0.63; P <.001). 

Receiving guideline-concordant care and being privately insured were both positively associated with improved overall survival (OR, 0.75 and 0.62, respectively; P < .001). Conversely, triple-negative subtype and Black race were associated with worse overall survival (HR, 1.6 and 1.4, respectively; < .001). 

However, timely receipt of guideline-concordant care for Black patients with triple-negative disease did lead to improved overall survival. Among recipients of guideline-based care with triple-negative disease, there was no racial disparity in overall survival. 

Study discussant Kathryn Hudson, MD, director of survivorship and medical oncologist at Texas Oncology, Austin, said it’s important to note that Black women have a 4% lower incidence of breast cancer than White women but a 40% higher breast cancer death rate. 

“This study is important because it confirms that those who receive guideline-based care have better outcomes and that Black women have worse survival in [inflammatory breast cancer],” Hudson said. 

The finding that Black and Asian women in the study were less likely to have timely neoadjuvant chemotherapy, “likely reflects worse access to care, and this may play a role in why Black women had worse outcomes,” she added. 

Hudson said she found it “surprising” that only about one third of patients received guideline-concordant care.

In her view, “the take-home message is that improving guideline-concordant will improve outcomes for all patients with inflammatory breast cancer. And it’s really important, as a next step, to examine the barriers to guideline-concordant care in inflammatory breast cancer and continue to understand the reasons for worse [rates of] survival of Black women.”

Diskin has disclosed no relevant financial relationships. Hudson has received honoraria from the Menarini Group and Gilead.

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