Abstract PS18-07: Trends in Guideline Concordant Care for Inflammatory Breast Cancer: An analysis of the National Cancer Database
Authors: Diskin Brian , Tadros Audree , Sevilimedu Varadan , Xu Amy , Vingan Perri , Nelson Jonas , Iwai Yoshiko , Morrow Monica , Fayanju Oluwadamilola (Lola) 
Published: May 2024

Background:

Inflammatory breast carcinoma (IBC) is an aggressive form of breast cancer associated with worse survival outcomes compared with other subtypes of breast cancer. Black patients with IBC have worse survival outcomes than White patients. Trimodality treatment (TMT) which includes neoadjuvant chemotherapy (NCT) followed by modified radical mastectomy without immediate reconstruction (MRM), and postmastectomy radiotherapy (PMRT), has been associated with improved survival outcomes for patients with IBC. Whether receipt of TMT varies by race, ethnicity, and insurance status and its impact on survival is largely unknown.

Methods:

Adult female patients with non-metastatic IBC treated from 2010-2018 were identified from the NCDB. Guideline concordant care (GCC) was defined as TMT administered in the correct sequence. In addition, clinical tumor/nodal stage, age, race, ethnicity, facility type, patient location, insurance status, and pathologic complete response (pCR) were examined for each patient. Additional quality metrics of GCC examined included time to initiation of NACT &lt; 60 days (TTNC) and proper surgical care defined as complete axillary lymph node dissection (&gt;6 lymph nodes removed) at the time of MRM without reconstruction. Univariate and multivariate mixed methods were performed to determine association between patient, treatment, and facility-level factors and receipt of GCC, TTNC &lt; 60 days, and proper surgical care. OS was estimated using the Kaplan-Meier method, and the log-rank test was used to compare groups.

Results:

7,374 women with non-metastatic IBC were included. 78% were White, 17% Black, and 2.5% Asian/Pacific Islander patients; 7.7% identified as Hispanic and 92% as non-Hispanic. The majority had private insurance (51%), 29% Medicare, 14% Medicaid, 4.9% uninsured, and 1.3% other government insurance.Only 2,418 patients (32.7%) received GCC with only 29% undergoing MRM without reconstruction.Receipt of GCC was more common among patients age &gt;50 years, patients with higher clinical nodal burden and those treated from 2010-2013 (p=0.001).Receipt of GCC did not differ by race, ethnicity, insurance status, or location.92% (6,005/7,374 patients) received NAC within 60 days of diagnosis. Both Black (OR 0.58, 95% CI 0.46-0.74, p= &lt; 0.001) and Asian (OR 0.52, 95% CI 0.30-0.90, p= &lt; 0.001) patients with IBC were less likely to have TTNC &lt; 60 days when compared to White patients. Non-Hispanic patients (OR 2.24, 95% CI 1.65-3.03, p= &lt; 0.001) and those with private insurance (OR 1.82, 95% CI 1.23-2.68, p= &lt; 0.001) were more likely to have TTNC within 60 days of diagnosis. Patients with lower clinical nodal burden(cN0) were less likely to undergo proper surgery compared to patients with higher nodal burden(cN1-3) (p &lt; 0.001). In addition, patients treated in a more contemporary cohort (2014-2018) were less likely to undergo proper surgery compared to patients treated earlier (2010-2013) (OR 0.82, 95% CI 0.73-0.92, p&lt; 0.001).Among IBC patients receiving GCC, Black patients had significantly worse overall survival compared to White patients (p &lt; 0.001)

Conclusions:

The majority of patients with IBC do not receive GCC and GCC has decreased since 2014 with fewer patients undergoing appropriate surgical treatment. The very low level of GCC indicates a need for multidisciplinary education, while improvement in TTNC may improve outcomes among racial/ethnic minorities.

Citation Format: Brian Diskin, Audree Tadros, Varadan Sevilimedu, Amy Xu, Perri Vingan, Jonas Nelson, Yoshiko Iwai, Monica Morrow, Oluwadamilola (Lola) Fayanju. Trends in Guideline Concordant Care for Inflammatory Breast Cancer: An analysis of the National Cancer Database [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PS18-07.