Financial toxicity in breast cancer patients receiving regional nodal irradiation: Variation by cancer subtype

IF 5.7 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Breast Pub Date : 2024-09-21 DOI:10.1016/j.breast.2024.103813

Grace L. Smith , Benjamin D. Smith , Chi-Fang Wu , Simona F. Shaitelman , Mariana Chavez-MacGregor , Rashmi Murthy , Kelsey Kaiser , Kimberly S. Ku , Julia J. Shi , Sanjay S. Shete , Ying-Shiuan Chen , Robert J. Volk , Sharon H. Giordano , Ya-Chen T. Shih , Karen E. Hoffman

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引用次数: 0

Abstract

Background

We evaluated sociodemographic and clinical predictors of financial toxicity (FT) among patients with breast cancer with higher risk clinical factors warranting regional nodal irradiation (RNI).

Methods

Among 183 participants in a clinical trial of conventional vs. hypofractionated treatment with RNI, 125 (68 %) completed a pilot survey of FT measured using the validated Economic Strain and Resilience in Cancer (ENRICh) instrument, scored from 0 (minimal) to 10 (severe) FT. Associations with predictors were evaluated using Pearson correlation coefficients and Kruskal Wallis, Mann-Whitney U, and Jonckheere-Terpstra tests. Predictors of severe FT (ENRICh≥5) were tested using multivariable logistic regression with odds ratios converted to relative risks (RR).

Results

Of the sample, all received RNI, 92 % chemotherapy, 67 % axillary dissection, 26 % mastectomy without reconstruction, and 32 % mastectomy with reconstruction. At a median follow up of 1.48 years, median FT score was 2.13 (IQR 0.93–4.6), with 20.8 % of patients experiencing severe FT. Unadjusted worse FT score was associated with younger age (P = 0.003), Hispanic ethnicity (P = 0.006), lower income (P = 0.02), shorter interval from diagnosis to FT assessment (P = 0.02), and chemotherapy receipt (P = 0.05), but not with breast surgery type (P = 0.42), axillary surgery type (P = 0.33), or pathologic T (P = 0.68) or N stage (P = 0.47). In multivariable analysis, triple negative subtype was the sole clinical factor predicting severe FT (RR = 3.38; 95 % CI 1.48–4.99; P = 0.01).

Conclusion

Among patients with breast cancer receiving RNI, triple negative subtype was associated with severe FT, suggesting that tumor receptor subtype may help identify a key breast cancer subpopulation for early FT intervention.

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接受区域结节照射的乳腺癌患者的经济毒性：不同癌症亚型的差异

背景我们评估了具有较高风险临床因素、需要进行区域性结节照射（RNI）的乳腺癌患者的社会人口学和临床经济毒性（FT）预测因素。方法在183名参加常规与低分量RNI治疗临床试验的参与者中，有125人（68%）完成了一项试验性FT调查，该调查使用经过验证的癌症中的经济压力和复原力（ENRICh）工具进行测量，FT评分从0分（最低）到10分（严重）不等。使用皮尔逊相关系数和 Kruskal Wallis、Mann-Whitney U 和 Jonckheere-Terpstra 检验对预测因素的相关性进行了评估。使用多变量逻辑回归对严重乳房纤维瘤（ENRICh≥5）的预测因素进行了检验，并将几率转换为相对风险（RR）。结果在样本中，所有患者均接受了RNI治疗，92%接受了化疗，67%接受了腋窝切除术，26%接受了乳房切除术但未进行重建，32%接受了乳房切除术但进行了重建。中位随访时间为 1.48 年，中位 FT 评分为 2.13（IQR 0.93-4.6），20.8% 的患者出现严重 FT。未经调整的较差 FT 评分与年龄较小（P = 0.003）、西班牙裔（P = 0.006）、收入较低（P = 0.02）、从诊断到进行 FT 评估的时间间隔较短（P = 0.02）和接受化疗（P = 0.05）有关，但与乳腺手术类型（P = 0.42）、腋窝手术类型（P = 0.33）或病理 T 期（P = 0.68）或 N 期（P = 0.47）无关。在多变量分析中，三阴性亚型是预测严重FT的唯一临床因素（RR = 3.38; 95 % CI 1.48-4.99; P = 0.01）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Breast 医学-妇产科学

CiteScore

8.70

自引率

2.60%

发文量

165

审稿时长

59 days

期刊介绍： The Breast is an international, multidisciplinary journal for researchers and clinicians, which focuses on translational and clinical research for the advancement of breast cancer prevention, diagnosis and treatment of all stages.