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• W4387207860 abstract "AIAN patients have worse cancer outcomes than other races and may face barriers in accessing care. Data on healthcare utilization or outcomes for AIAN patients across healthcare systems are limited. We report patient characteristics, treatment patterns, and clinical outcomes for AIAN women with breast cancer seen at a tertiary AMC in the Pacific Northwest.We performed a retrospective chart review of self-identified AIAN women with an encounter for unilateral breast cancer between January /2000 and January 2021. Patient demographics; AJCC 8th prognostic stage; treatment (surgery, radiation, systemic therapy); were abstracted and summarized with median (interquartile range) or number (%) and compared with χ2 or t-tests. Progression-free (recurrent or new breast cancer) and overall survival (PFS; OS) were estimated per Kaplan-Meier and compared with log-rank tests.Of 21,013 patients with cancer encounters, 2,168 (10%) self-identified as AIAN and 246 (0.01%) were AIAN women with unilateral breast cancer. The median age at diagnosis was 52 (43 - 53) years; 37% lived in the same county as the AMC while 80% lived in the same state. At diagnosis, 181 (74%) had early-stage (0 - 2A), 24 (10%) locally-advanced (2B - 3), 30 (12%) non-metastatic, and 11 (4%) metastatic disease. Of the 181 (74%) women treated at the AMC, 39% lived in the same county; 86% had curative-intent therapy: 52 (71%) surgery, 114 (37%) radiation, and 65 (64%) systemic therapy; 26% had surveillance, oncoplastic surgery or non-cancer care only. Women who had surgery at the AMC were older (P < 0.01), less likely to live in the same county (40%, P = 0.4), had mostly early-stage disease (81%, P = 0.005), and were more likely to receive adjuvant therapy at the AMC (75%, P < 0.01). Patients treated for metastatic disease at the AMC (19%) rarely lived in the same county (21%, P = 0.03), or had prior treatment at the AMC (32%, P = 0.03); 92% had systemic therapy, 38% radiation, and 12% surgery. With median 6.4 (3.2 - 10.9) years follow-up, median OS for all AIAN patients was 51.4 (unreached [UR] - UR) years. Patients who presented to the AMC with metastatic disease had median OS 13.4 (8.4 - UR) years. With median 5.1 (2.6 - 9.3) years follow-up, median PFS was 20.6 (14.2 - UR) years, and longer for patients who received any curative-intent treatment at the AMC (P = 0.006).Most AIAN women with breast cancer seen at the AMC received curative treatment for early-stage disease with excellent outcomes. Most treated for metastatic disease had no prior treatment at the AMC and may be more likely to transfer care to the AMC to engage with specialized services or clinical trials, particularly for systemic therapy. Understanding the prognostic stage, treatment utilization, and outcomes of the AIAN patients served may allow us to improve cancer services and outcomes for this community." @default.
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• W4387207860 date "2023-10-01" @default.
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• W4387207860 title "Utilization of Services and Clinical Outcomes among American Indian/Alaska Native (AIAN) Women with Breast Cancer at an Academic Medical Center (AMC)" @default.
• W4387207860 doi "https://doi.org/10.1016/j.ijrobp.2023.06.653" @default.
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