Abstract PO-092: Racial survivial disparities in triple negative metastatic breast cancer (MBC)
Authors: Rosenzweig Margaret Q. , Nugent Bethany , McQuire Meaghan , Xhao Jian Q. 
Published: January 2022

Breast cancer racial survival disparity is often explained through late-stage presentation and the high prevalence of triple-negative breast cancer (TNMBC) and poor dose intensity of treatment among Black women. This study attempted to equalize disease factors through analysis of only women with triple-negative breast cancer and evaluating the course of care only through the TNMBC course. The racial differences of neighborhood deprivation index (NDI) and baseline depression, and anxiety symptoms at the diagnosis of TNMBC were examined. The aims of the study were to 1. Compare the time to first TNMBC disease progression and overall survival of women with TNMBC and compare by race. 2. Document NDI, baseline anxiety and depression at the diagnosis of TNMBC and compare by race. Methods: Retrospective review of patients deceased from TNMBC between November 1, 2016, through December 2019 at a National Cancer Institute-designated medical oncology breast cancer clinic. Overall survival (OS) and time to first disease progression (TTFP) calculated in days from metastatic diagnosis, anxiety and depression scores obtained through the Generalized Anxiety and Depression scores (GAD-7) and the Patient Health Questionnaire (PHQ-9) measuring depression. Both from self-report at the first TNMBC visit, higher scores indicating higher symptoms. NDI obtained from zip code (higher scores = more deprivation). Dose intensity of first treatment (DIFT) - percentage drugs received/prescribed. Analysis of variance, descriptive statistics, and independent t-tests used for comparative analysis; Hedge's g was calculated for effect sizes due to uneven sample sizes. Results: There were n=54 total patients, n=45- White, n=9 Black. Age - Black, 55.3 (SD 13.0), White 56.3(SD 12.9). NDI -Black 74.9 (SD 19.3), White 55.6 (SD 19.5), p=.009, Hedge's g =0.99. DIFT - Black .88%, White, .84% (p=.523). PFS first treat- Black, 13.8(SD 8), White 20.8 (SD29.6), p= .183, Hedge's g =0.26. Overall TNMBC survival -Black 26.1 months (SD 13.5), White 46.7 months (SD 53.6),p=.032, Hedge's g = 0.414. GAD - Black,9.3 (SD-9.5), White -6.14 (5.8), p=.307, Hedge's g - .48. PHQ - Black 5.7 (SD 7.0), White 4.2 (SD 5.1), and p=.59, Hedge's g= 0.25. Discussion: Despite equalizing the stage and subtype of MBC, there is a wide racial survival disparity that is not explained by the dose intensity of the first treatment. A possible explanatory pathway is that neighborhood deprivation, more severe among Black patients, may be causing high anxiety and mild depression, leading to worse overall TNMBC survival. These data provide the impetus to pursue stress from neighborhood deprivation as an etiology for TNMBC racial survival disparity. Obtaining measurement and markers of stress and depression over the TNMBC illness trajectory, better characterizing neighborhoods for multiple aspects of deprivation and seeking strategies to improve the support that neighborhoods can offer women with TNMBC may help to identify targets for mitigation of factors leading to poor TNMBC survival outcomes.

Citation Format: Margaret Q. Rosenzweig, Bethany Nugent, Meaghan McQuire, Jian Q. Xhao. Racial survivial disparities in triple negative metastatic breast cancer (MBC) [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-092.