Chemotherapy Declination Among Patients With Early-Stage Hormone Receptor-Positive/Human Epidermal Growth Factor Receptor 2-Negative Breast Cancer and High Oncotype DX Recurrence Scores.
retrospective_cohort · Level III
Where this comes from
- Record sourced from PubMed, PMID 42048620.
- Also identified by DOI 10.1200/OP-25-01106.
- No licence information is recorded for this record.
- Because redistribution is not established, this page shows the abstract only. Follow the links below for the full text.
Abstract
Although the 21-gene Oncotype DX assay predicts chemotherapy (CT) benefit in hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer (BC), some patients decline CT despite their physician recommendations. We examined factors associated with CT declination and its impact on overall survival (OS) among patients with early-stage disease and high recurrence scores (RS). Patients aged 18 years and older diagnosed with clinical stage I-II HR-positive/HER2-negative BC who underwent definitive surgery between 2018 and 2022 and had RS > 25 were identified in the National Cancer Database. Multivariable logistic regression was used to identify factors associated with CT declination. Multivariable Cox proportional hazards regression was used to examine the association between CT declination and OS in a 1:5 propensity score-matched cohort. Among 30,326 patients with RS > 25, 10.9% declined CT. 15.5% of patients who declined CT also declined hormonal therapy. Higher RS was associated with lower odds of CT declination (adjusted odds ratio [aOR], 0.97; 95% CI, 0.96 to 0.97). A more recent year of diagnosis and Hispanic race (aOR, 0.83; 95% CI, 0.70 to 0.98) were associated with lower odds of CT declination, while older age and Black race (aOR, 1.29; 95% CI, 1.15 to 1.45) were associated with higher odds. Patients on Medicaid (aOR, 1.53; 95% CI, 1.31 to 1.79) and Medicare (aOR, 1.19; 95% CI, 1.05 to 1.34) had higher odds of declination compared with those on private insurance. Having pathologic Nodal 1 (pN1) disease was associated with lower odds of declination than pN0 disease. Notably, CT declination was associated with an increased risk of death (aHR, 1.43; 95% CI, 1.20 to 1.69). Despite a decrease in CT declination over time, disparities persist, and declination is associated with worse OS. Further research is needed to understand these disparities and improve cancer care delivery and outcomes.