Effect of socioeconomic status as measured by education level on survival in breast cancer clinical trials.
Abstract
OBJECTIVES: This paper aims to investigate the effect of socioeconomic status, as
measured by education, on the survival of breast cancer patients treated on 10 studies
conducted by the Cancer and Leukemia Group B. METHODS: Sociodemographic data, including
education, were reported by the patient at trial enrollment. Cox proportional hazards
model stratified by treatment arm/study was used to examine the effect of education
on survival among patients with early stage and metastatic breast cancer, after adjustment
for known prognostic factors. RESULTS: The patient population included 1020 patients
with metastatic disease and 5146 patients with early stage disease. Among metastatic
patients, factors associated with poorer survival in the final multivariable model
included African American race, never married, negative estrogen receptor status,
prior hormonal therapy, visceral involvement, and bone involvement. Among early stage
patients, significant factors associated with poorer survival included African American
race, separated/widowed, post/perimenopausal, negative/unknown estrogen receptor status,
negative progesterone receptor status, >4 positive nodes, tumor diameter >2 cm, and
education. Having not completed high school was associated with poorer survival among
early stage patients. Among metastatic patients, non-African American women who lacked
a high school degree had poorer survival than other non-African American women, and
African American women who lacked a high school education had better survival than
educated African American women. CONCLUSIONS: Having less than a high school education
is a risk factor for death among patients with early stage breast cancer who participated
in a clinical trial, with its impact among metastatic patients being less clear. Post-trial
survivorship plans need to focus on women with low social status, as measured by education.
Type
Journal articleSubject
AdultAfrican Americans
Aged
Breast Neoplasms
Clinical Trials as Topic
Educational Status
Female
Humans
Middle Aged
Multivariate Analysis
Proportional Hazards Models
Risk Factors
Social Class
Survival Rate
United States
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https://hdl.handle.net/10161/16122Published Version (Please cite this version)
10.1002/pon.2094Publication Info
Herndon, James E; Kornblith, Alice B; Holland, Jimmie C; & Paskett, Electra D (2013). Effect of socioeconomic status as measured by education level on survival in breast
cancer clinical trials. Psychooncology, 22(2). pp. 315-323. 10.1002/pon.2094. Retrieved from https://hdl.handle.net/10161/16122.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
James Emmett Herndon II
Professor of Biostatistics & Bioinformatics
Current research interests have application to the design and analysis of cancer clinical
trials. Specifically, interests include the use of time-dependent covariables within
survival models, the design of phase II cancer clinical trials which minimize some
of the logistical problems associated with their conduct, and the analysis of longitudinal
studies with informative censoring (in particular, quality of life studies of patients
with advanced cancer).

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