Introduction: Inflammatory breast cancer (IBC) is an aggressive and lethal form of locally advanced breast cancer that makes up 1-6% of all breast cancers and has a median overall survival of less than 4 years. Physically, IBC is characterized by erythema, edema, and fine dimpling, so treatment can be delayed due to misdiagnosis as mastitis or dermatitis. Therapy for IBC tends to vary since no treatments are highly effective. Because IBC is such a rare subtype, studies have been challenged to demonstrate patterns of IBC treatment and analyze factors affecting differences in treatment. In this study we examined factors affecting the receipt of guideline-concordant care and survival for IBC patients.
Methods: Patients diagnosed with non-metastatic IBC in 2004 were identified from the Breast and Prostate Cancer Data Quality and Patterns of Care Study, containing information from cancer registry reports in seven states supplemented through medical record re-abstraction and physician verification. Variation in guideline-concordant care for IBC, based on 2003 National Comprehensive Cancer Network (NCCN) guidelines, was assessed according to patient, physician, and hospital characteristics. Additionally, survival based on receipt of guideline-concordant care was analyzed using Kaplan-Meier curves and log-rank tests.
Results: Of the 107 IBC patients in the study, only 25.8% of them received treatment that was fully concordant with guidelines. The majority of patients received guideline-concordant surgery (90.4%), with percentages lower for chemotherapy (51.9%), radiation (40.7%), and hormone therapy (78.0%). Guideline-concordant care was less common among patients with extreme categories of patient age (under 40 or over 80 years; P = 0.19), non-white race (P = 0.03), lower body mass index (BMI<25 kg/m2, P = 0.003), a surgeon graduating from medical school more than 15 years prior (P = 0.02), and smaller hospital size (<200 beds, P = 0.02).
Results suggested that IBC patients experienced longer breast cancer-specific survival if they received guideline-concordant treatment based on 2003 (P = 0.06) and 2013 (P = 0.06) NCCN guidelines.
Conclusion: Targeting factors associated with receipt of care that is not guideline-concordant may reduce survival disparities in IBC patients. Further research is needed to identify approaches to ensure that physicians are adhering to NCCN guidelines for IBC cases and to identify reasons for non-adherence to guidelines.
Citation Format: Ryan A. Denu, John M. Hampton, Adam Currey, Roger T. Anderson, Rosemary D. Cress, Steven T. Fleming, Joseph Lipscomb, Susan A. Sabatino, Xiao-Cheng Wu, J F. Wilson, Amy Trentham-Dietz. Influence of patient, physician, and hospital characteristics on the receipt of guideline-concordant care for inflammatory breast cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3727. doi:10.1158/1538-7445.AM2015-3727