Opportunities for Improvement in the Administration of Neoadjuvant Chemotherapy for T4 Breast Cancer: A Comparison of the U.S. and Nigeria
Open Access
- 6 May 2021
- journal article
- research article
- Published by Oxford University Press (OUP) in The Oncologist
- Vol. 26 (9), e1589-e1598
- https://doi.org/10.1002/onco.13814
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) is an integral component of T4 breast cancer (BCa) treatment. We compared response to NAC for T4 BCa in the U.S. and Nigeria to direct future interventions. MATERIALS AND METHODS Cross‐sectional retrospective analysis included all non‐metastatic T4 BCa patients treated from 2010‐2016 at Memorial Sloan Kettering Cancer Center (New York, U.S.) and Obafemi Awolowo University Teaching Hospitals Complex (Ile Ife, Nigeria). Pathologic complete response (pCR) and survival were compared and factors contributing to disparities evaluated. RESULTS 308 patients met inclusion criteria: 157 (51%) in the U.S. and 151 (49%) in Nigeria. All U.S. patients received NAC and surgery compared with 93 (62%) Nigerian patients. 56/93 (60%) Nigerian patients completed their prescribed course of NAC. In Nigeria, older age and higher socioeconomic status were associated with treatment receipt. Fewer patients in Nigeria had immunohistochemistry performed (100% U.S. vs. 18% Nigeria). Of those with available receptor subtype, 18% (28/157) of U.S. patients were triple negative vs. 39% (9/23) of Nigerian patients. Overall pCR was seen in 27% (42/155) of U.S. patients and 5% (4/76) of Nigerian patients. Five‐year survival was significantly shorter in Nigeria vs. the U.S. (61% vs. 72%). However, among the subset of patients who received multimodality therapy, including NAC and surgery with curative intent, 5‐year survival (67% vs. 72%) and 5‐year recurrence‐free survival (48% vs. 61%) did not significantly differ between countries. CONCLUSION Addressing health system, socioeconomic, and psychosocial barriers is necessary for administration of complete NAC to improve BCa outcomes in Nigeria. Implications for Practice This cross‐sectional retrospective analysis of T4 breast cancer patients in Nigeria and the U.S. found a significant difference in pathologic complete response to neoadjuvant chemotherapy (5% Nigeria vs. 27% U.S.). Five‐year survival was shorter in Nigeria, but in patients receiving multimodality treatment, including neoadjuvant chemotherapy and surgery with curative intent, 5‐year overall and recurrence‐free survival did not differ between countries. Capacity‐building efforts in Nigeria should focus on access to pathology services to direct systemic therapy, and promoting receipt of complete chemotherapy to improve outcomes.Keywords
This publication has 32 references indexed in Scilit:
- Radiation therapy: A major factor in the five-year survival analysis of women with breast cancer in Lagos, NigeriaRadiotherapy and Oncology, 2014
- Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trialsThe Lancet, 2014
- Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysisThe Lancet, 2014
- Disparities in Breast Cancer Treatment and Outcomes: Biological, Social, and Health System Determinants and Opportunities for ResearchThe Oncologist, 2013
- Status of radiotherapy resources in Africa: an International Atomic Energy Agency analysisThe Lancet Oncology, 2013
- Acceptance and adherence to treatment among breast cancer patients in Eastern NigeriaThe Breast, 2011
- African ancestry and higher prevalence of triple‐negative breast cancerCancer, 2010
- Breast Cancer in Nigeria: Is Non-Adherence to Chemotherapy Schedules a Major Factor in the Reported Poor Treatment Outcome?The Breast Journal, 2010
- Guideline implementation for breast healthcare in low-income and middle-income countriesCancer, 2008
- Preoperative Chemotherapy: Updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27Journal of Clinical Oncology, 2008