38 Influence of Race on Attainment of Textbook Oncologic Outcome Following Modified Radical Mastectomy for Breast Cancer

38 Influence of Race on Attainment of Textbook Oncologic Outcome Following Modified Radical Mastectomy for Breast Cancer

Background

Textbook oncologic outcome (TOO) is an outcome measure attained when all desired short-term quality metrics are met following an oncologic operation. The aim of this study was to determine if race/ethnicity is associated with the attainment of TOO among patients with breast cancer who underwent modified radical mastectomy (MRM) or MRM with contralateral prophylactic mastectomy (CPM).

Methods

A retrospective study was performed using data from the National Cancer Database from 2004 to 2017, where it was queried for patients with breast cancer who underwent MRM or MRM with CPM. Patients who achieved TOO were those who met 4 individual oncologic criteria: resection with negative microscopic margins, American Joint Committee on Cancer (AJCC)–compliant lymph node evaluation, no extended length of stay (LOS), and no 30-day readmission. Multivariate logistic regression models were used to determine if race/ethnicity groups were associated with the likelihood of achieving TOO.

Results

Significant socioeconomic differences were observed among the racial and ethnic groups, with patients who were Black having lower median household incomes and those who were Hispanic having a higher proportion of uninsured patients. Patients who were Black were less likely to meet TOO criteria for R0 resection (95%) and no prolonged LOS (61.9%). Patients who were Hispanic were more likely to achieve adequate lymphadenectomy (72.4%) and no 30-day readmission (92.8%) but less likely to have no prolonged LOS (69.6%). Patients who were Hispanic had an increased likelihood of achieving TOO (adjusted objective response [aOR], 1.09; P = .009), while patients who were Black had a decreased likelihood (aOR, 0.87; P < .001) compared with patients who were White.

Conclusions

In conclusion, this study suggests that racial/ethnic disparities do exist in the attainment of TOO following MRM for breast cancer. Physicians should be knowledgeable of these disparities when involved in the management of breast cancer patients in the hopes of optimizing treatment.