Opportunities For Improvement in The Administration of Neoadjuvant Chemotherapy For T4 Breast Cancer: A Comparison of The United States and Nigeria

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Opportunities For Improvement in The Administration of Neoadjuvant Chemotherapy For T4 Breast Cancer: A Comparison of The United States and Nigeria


JournalThe Oncologist
Article typeJournal research article – Clinical research
Publication date – May – 2021
Authors – Anya Romanoff ,Olalekan Olasehinde ,Debra A. Goldman ,Olusegun I. Alatise , Jeremy Constable ,Ngozi Monu , Gregory C. Knapp ,Oluwole Odujoko ,Emmanuella Onabanjo ,Adewale O. Adisa ,Adeolu O. Arowolo ,Adeleye D. Omisore ,Olusola C. Famurewa ,Benjamin O. Anderson ,Mary L. Gemignani , T. Peter Kingham
KeywordsBreast Cancer, global oncology, locally‐advanced, Neoadjuvant chemotherapy, Nigeria, T4 breast cancer
Open access – Yes
SpecialityGeneral surgery, Surgical oncology
World region Northern America, Western Africa
Country: Nigeria, United States of America
Language – English
Submitted to the One Surgery Index on May 17, 2021 at 2:26 am
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.

OSI Number – 21092

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