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Treatment-associated toxicities reported by patients with early-stage invasive breast cancer

Authors

  • Christopher R. Friese PhD,

    Corresponding author
    1. Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor, Michigan
    2. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
    • Corresponding author: Christopher R. Friese, PhD, RN, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, 400 North Ingalls, #4162, Ann Arbor, MI 48109-5482; Fax: (734) 647-2416; cfriese@umich.edu

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  • Jordan M. Harrison BSN,

    1. Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor, Michigan
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  • Nancy K. Janz PhD,

    1. Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
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  • Reshma Jagsi MD, DPhil,

    1. Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan
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  • Monica Morrow MD,

    1. Breast Surgical Service, Memorial Sloan Kettering Cancer Center, New York, New York
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  • Yun Li PhD,

    1. Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
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  • Ann S. Hamilton PhD,

    1. Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
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  • Kevin C. Ward PhD,

    1. Rollins School of Public Health, Emory University, Atlanta, Georgia
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  • Allison W. Kurian MD,

    1. Department of Medicine, Stanford University Medical Center, Stanford, California
    2. Department of Health Research and Policy, Stanford University Medical Center, Stanford, California
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  • Steven J. Katz MD,

    1. Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan
    2. Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
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    • The last 2 authors contributed equally to this article.

  • Timothy P. Hofer MD

    1. Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan
    2. Veterans Affairs Center for Clinical Management Research, Health Services Research and Development Service Center of Innovation, University of Michigan, Ann Arbor, Michigan
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    • The last 2 authors contributed equally to this article.


  • We acknowledge our project staff (Mackenzie Crawford and Kiyana Perrino from the Georgia Cancer Registry; Jennifer Zelaya, Pamela Lee, Maria Gaeta, Virginia Parker, and Renee Bickerstaff-Magee from the University of Southern California; and Rebecca Morrison, Rachel Tocco, Alexandra Jeanpierre, Stefanie Goodell, Rose Juhasz, Paul Abrahamse, Kent Griffith, and Irina Bondarenko from the University of Michigan). We acknowledge with gratitude our survey respondents.

Abstract

BACKGROUND

Patient-reported toxicities help to appraise the breast cancer treatment experience. Yet extant data come from clinical trials and health care claims, which may be biased. Using patient surveys, the authors sought to quantify the frequency, severity, and burden of treatment-associated toxicities.

METHODS

Between 2013 and 2014, the iCanCare study surveyed a population-based sample of women residing in Los Angeles County and Georgia with early-stage, invasive breast cancer. The authors assessed the frequency and severity of toxicities; correlated toxicity severity with unscheduled health care use (clinic visits, emergency department visits/hospitalizations) and physical health; and examined patient, tumor, and treatment factors associated with reporting increased toxicity severity.

RESULTS

The overall survey response rate was 71%. From the analyzed cohort of 1945 women, 866 (45%) reported at least 1 toxicity that was severe/very severe, 9% reported unscheduled clinic visits for toxicity management, and 5% visited an emergency department or hospital. Factors associated with reporting higher toxicity severity included receipt of chemotherapy (odds ratio [OR], 2.2; 95% confidence interval [95% CI], 2.0-2.5), receipt of both chemotherapy and radiotherapy (OR, 1.3; 95% CI, 1.0-1.7), and Latina ethnicity (OR vs whites: 1.3; 95% CI, 1.1-1.5). A nonsignificant increase in at least 1 severe/very severe toxicity report was observed for bilateral mastectomy recipients (OR, 1.2; 95% CI, 1.0-1.4).

CONCLUSIONS

Women with early-stage invasive breast cancer report substantial treatment-associated toxicities and related burden. Clinicians should collect toxicity data routinely and offer early intervention. Toxicity differences observed by treatment modality may inform decision making. Cancer 2017. © 2017 American Cancer Society.

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