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Disparities in the occurrence of long term effects of bone marrow suppression after treatment in adolescent young adult breast cancer survivors
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10 2024
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Source: Ann Surg Oncol. 31(11):7511-7519
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Alternative Title:Ann Surg Oncol
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Personal Author:
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Description:Background
Many adolescent and young adult (AYA) breast cancer (BC) patients receive adjuvant therapy as initial treatment with long-term bone marrow suppression as a potential complication, but no studies have evaluated the impact of race/ethnicity on the development of bone marrow suppression in AYA BC survivors.
Methods
Female patients ages 15-39 years diagnosed with BC (2006-2018) and surviving ≥2 years were identified from the California Cancer Registry and linked to statewide hospitalization data. We estimated the cumulative incidence of developing late effects of bone marrow suppression: leukopenia, anemia, thrombocytopenia, bleeding and infection/sepsis during hospital discharge diagnoses present ≥ 2 years after diagnosis. We examined the impact of sociodemographic and clinical factors on late effects using multivariate Cox proportional hazards regression.
Results
Of 11,293 patients, 42.8% were non-Hispanic (nH) White, 28.8% Hispanic, 19.5% Asian/Pacific Islander, and 7.5% nH Black. In multivariable analyses, nH Blacks had the highest risk (vs. nH Whites) of anemia [Hazard Ratio (HR) 1.72, 95% Confidence Interval (CI) 1.47-2.02], leukopenia [HR: 1.56, CI 1.14-2.13], thrombocytopenia [HR: 1.46, CI 1.08-1.99], major infection/sepsis [HR: 1.64, CI 1.4-1.92], and bleeding [HR: 1.89, CI 1.39-2.58]. Hispanics had a higher risk of developing anemia, [HR: 1.17, CI 1.04-1.32] bleeding, [HR: 1.4, CI 1.12-1.76] and major infections/sepsis [HR: 1.36, CI 1.21-1.52]. Asian/Pacific Islanders had only a higher risk of developing bleeding [HR: 1.33, CI 1.03-1.72]. Patients from a low neighborhood socioeconomic status had a 20% higher risk of infection/sepsis [HR: 1.21, CI 1.1-1.34], but there were no associations for the other late effects.
Conclusions
We identified that AYAs of nH Black, Hispanic, and Asian/Pacific Islander race/ethnicity are at an increased risk of several late effects after adjuvant therapy compared with nH whites. From this data, providers can implement early/frequent screening of hematologic late effects in these high-risk survivors.
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Pubmed ID:39012466
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Pubmed Central ID:PMC11452271
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Funding:HHSN261201800009C/CA/NCI NIH HHSUnited States/ ; NU58DP006344/DP/NCCDPHP CDC HHSUnited States/ ; P30CA093373/University of California Davis Comprehensive Cancer Center from National Cancer Institute/ ; HHSN261201800015I/CA/NCI NIH HHSUnited States/ ; P01 CA233432/CA/NCI NIH HHSUnited States/ ; ... More +
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Volume:31
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Issue:11
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