Socioeconomic status and breast cancer survival in Pakistani women

No data is available from developing countries correlating socioeconomic status [SES] with survival in female breast cancer patients. We decided to test the hypotheses whether SES is an independent determinant for disease stage, access to minimal expected treatment [MET] and survival. Two hundred eighty six patients diagnosed with breast cancer were recruited between April 1996 to May 1998. Patients were divided into three groups according to their SES. Prognostic factors analyzed were age, tumor size, nodal status; stage at presentation, estrogen receptor status, time elapsed before diagnosis and access to MET. Disease free survival [DFS] and overall survival [OS] were determined according to the SES of the patients. Patients were categorized into three socioeconomic groups, high [21%], middle [44%] and low [35%]. Mean age of all patients was 46 years, in patients from lower SES mean age was 43 years compared to 50 years in high SES. Mean time elapsed before diagnosis for women from high-income group was 4.3 months versus 10.6 months in low-income group. Early breast cancer was more common in affluent strata, 70% versus 41% in the lower strata. Eighty-nine% patients received MET from the affluent group compared to only 43% patients in the lower strata. Literacy rate of patients from high SES was 73.7% compared to 15% in the low SES. Five year DFS and OS are 79% and 86% for high income group, 48% and 68% for middle income group and 31%,49% for lower strata which were statistically significant [P=.0001 and P<.0001]. In our cohort of patients strong association was noted between low SES and advanced disease, delay in diagnosis, limited access to MET and inferior DFS and OS. The outcome of these patients may be improved by patient education and availability of better health care facilities

Phase 1 trial of ifosfamide and adriamycin metastatic breast cancer

A Phase I trial was conducted in patients with estrogen negative receptors [ER] or hormone refractory metastatic breast cancer to determine the maximum tolerated dose [MTD] of ifosfamide with a fixed dose of doxorubicin. A secondary objective was to determine the efficacy of the combination in metastatic breast cancer. Fifteen patients were entered in the study in cohorts of three patients at each dose level of ifosfamide. The dose of doxorubicin was fixed at 45 mg/m[2]. Five different dose levels of ifosfamide were tested ranging from dose level I of 1.5 gms/m[2]day 1-3 to level V at 2.5 gms/ m[2] day 1-3. Dose escalation of ifosfamide was stopped at 2.5 gms/ m[2]. The MTD of ifosfamide was 2.25 gms/ m[2] day 1-3 in combination with doxorubicin. All patients in the study were assessable for toxicity. Neutropenia and thrombocytopenia were the major dose limiting toxicities. Other toxicities included anemia, confusion and hematuria. Objective responses were documented in 11 of 15 patients [73.3 percent]. Median time to treatment failure [TTF] was 13 months. Median overall survival [OS] was 18 months. The combination of ifosfamide and doxorubicin was a practical well tolerated regimen. There was substantial evidence of clinical activity in this phase I trial. This combination should be further evaluated, as an attractive alternative to taxanes for patients in developing countries where cost effectiveness is important