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Adamson AS, Jackson BE, Baggett CD, Thomas NE, Haynes AB, Pignone MP. Association of Receipt of Systemic Treatment for Melanoma With Insurance Type in North Carolina. Med Care 2023; 61:829-835. [PMID: 37708348 PMCID: PMC10844879 DOI: 10.1097/mlr.0000000000001921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
BACKGROUND Previous studies of hospital-based patients with metastatic melanoma suggest sociodemographic factors, including insurance type, may be associated with the receipt of systemic treatments. OBJECTIVES To examine whether insurance type is associated with the receipt of systemic treatment among patients with melanoma in a broad cohort of patients in North Carolina. METHODS We conducted a retrospective cohort study between 2011 and 2017 of patients with stages III-IV melanoma using data from the North Carolina Central Cancer Registry linked to Medicare, Medicaid, and private health insurance claims across the state. The primary outcome was the receipt of any systemic treatment, and the secondary outcome was the receipt of immunotherapy. RESULTS A total of 372 patients met the inclusion criteria. The average age was 68 years old (interquartile range: 56-76) and 61% were male. Within the cohort 48% had Medicare only, 29% had private insurance, 12% had both Medicare and Medicaid, and 11% had Medicaid only. A total of 186 (50%) patients received systemic treatment for melanoma, 125 (67%) of whom received immunotherapy. The use of systemic therapy, including immunotherapy, increased significantly over time. Having Medicaid-only insurance was independently associated with a 45% lower likelihood of receiving any systemic treatment [0.55 (95% CI: 0.35, 0.85)] and a 43% lower likelihood of receipt of immunotherapy [0.57 (95% CI: 0.34, 0.95)] compared with private insurance. CONCLUSIONS Stage III-IV melanoma patients with Medicaid-only insurance were less likely to receive systemic therapy or immunotherapy than patients with private insurance or Medicare insurance. This finding raises concerns about insurance-based disparities in treatment access.
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Affiliation(s)
- Adewole S. Adamson
- Department of Internal Medicine, Dell Medical School,
University of Texas at Austin, Austin, TX, USA
- LIVESTRONG Cancer Institutes, The University of Texas at
Austin, Austin, Texas, USA
- Department of Dermatology, University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
| | - Bradford E. Jackson
- Lineberger Comprehensive Cancer Center, University of North
Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christopher D. Baggett
- Lineberger Comprehensive Cancer Center, University of North
Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
| | - Nancy E. Thomas
- Department of Dermatology, University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North
Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alex B. Haynes
- LIVESTRONG Cancer Institutes, The University of Texas at
Austin, Austin, Texas, USA
- Department of Surgery and Perioperative Care, Dell Medical
School, The University of Texas at Austin, Austin, Texas
| | - Michael P. Pignone
- Department of Internal Medicine, Dell Medical School,
University of Texas at Austin, Austin, TX, USA
- LIVESTRONG Cancer Institutes, The University of Texas at
Austin, Austin, Texas, USA
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Ye M, Kahana E, Deimling G, Perzynski A, Stange K. Beyond the treatment: The role of race, sex, and education in health trajectories between cancer survivors and noncancer older adults. J Geriatr Oncol 2023; 14:101532. [PMID: 37229884 PMCID: PMC10330899 DOI: 10.1016/j.jgo.2023.101532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/21/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION The number of older, long-term cancer survivors is increasing. However, little is known about how cancer and aging affect the health trajectories of older adults differently. In addition, the impact of race, sex, and education on the processes of aging and the cancer experience needs further investigation. The current study aims to address this knowledge gap by combining two National Cancer Institute (NIC)-funded longitudinal studies conducted in Cleveland from 1998 to 2010. MATERIALS AND METHODS The unique cross-sequential design facilitates a comparison between the health changes in long-term (five years +) older cancer survivors (breast, prostate, and colorectal cancer) and demographically matched older adults without a history of cancer in the same geographic area within the same period. The study also captured comprehensive information on how socioeconomic status interacts with cancer and aging over time. General linear models were employed in the data analysis. RESULTS The findings showed that early cancer experience did not affect long-term cancer survivors' health status in later life. Conversely, comorbidities, being an African American, being female, and having education less than a college degree significantly decreased the health trajectory in later life for all older adults. Moreover, compared to other groups, older African American cancer survivors reported a dramatic decrease in self-reported health after controlling for other conditions. DISCUSSION Study findings can inform public policy and social services to offer comprehensive treatment plans and help individuals overcome their diseases and lead longer and healthier lives.
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Affiliation(s)
- Minzhi Ye
- Kent State University The School of Lifespan Development and Educational Science, 111E, Nixson Hall, 1225 Theatre Drive, Kent, OH 44243, USA.
| | - Eva Kahana
- Case Western Reserve University Department of Sociology, Rm 226, Mather Memorial Building, 11220 Bellflower Rd, Cleveland, OH 44106, USA
| | - Gary Deimling
- Case Western Reserve University Department of Sociology, Rm 226, Mather Memorial Building, 11220 Bellflower Rd, Cleveland, OH 44106, USA
| | - Adam Perzynski
- The MetroHealth System Population Health Research Institute, 2500 Metrohealth Dr., Rammelkamp, Bldg., 2nd Floor, Cleveland, OH 44109, USA
| | - Kurt Stange
- Case Western Reserve University Center for Community Health Integration, School of Medicine 10900 Euclid Ave. Cleveland, OH 44106, USA
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Reporting on Race and Racial Disparities in Breast Cancer: The Neglect of Racism as a Driver of Inequitable Care. Ann Surg 2023; 277:329-334. [PMID: 36745761 DOI: 10.1097/sla.0000000000005191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study reviews the surgical literature on racial disparities in breast cancer mortality, specifically evaluating the inclusion, justification, and discussion of race and ethnicity as a driver of disparities. SUMMARY OF BACKGROUND DATA The volume of research on racial disparities has increased over the past 2 decades, but we hypothesize that there is considerable variation in how race is contextualized, defined, and captured in the disparities literature, leading to its questionable validity and relevance as a covariate. Recent guidelines for reporting have been suggested, but not yet applied. METHODS A rubric was developed to evaluate the reporting of race and/or ethnicity. A systematic review (2010-2020) was performed to identify studies reporting on racial disparities in breast cancer surgery and mortality. We then evaluated these original articles based on key domains of race and/or ethnicity: justification for inclusion, formal definition, methodology used for classification, and type of racism contributing to disparity. RESULTS Of the 52 studies assessed, none provided a formal definition for race and/or ethnicity. A justification for the inclusion of race and/or ethnicity was provided in 71% of the studies. Although 81% of studies discussed at least 1 potential driver of observed racial disparities, only 1 study explicitly named racism as a driver of racial disparities. CONCLUSIONS Significant improvement in the reporting on racial disparities in breast cancer surgical literature is warranted. A more rigorous framework should be applied by both researchers and publishers in reporting on race, racial health disparities, and racism.
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Simon MS, Raychaudhuri S, Hamel LM, Penner LA, Schwartz KL, Harper FWK, Thompson HS, Booza JC, Cote M, Schwartz AG, Eggly S. A Review of Research on Disparities in the Care of Black and White Patients With Cancer in Detroit. Front Oncol 2021; 11:690390. [PMID: 34336677 PMCID: PMC8320812 DOI: 10.3389/fonc.2021.690390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/08/2021] [Indexed: 02/01/2023] Open
Abstract
Racial disparities in cancer incidence and outcomes are well-documented in the US, with Black people having higher incidence rates and worse outcomes than White people. In this review, we present a summary of almost 30 years of research conducted by investigators at the Karmanos Cancer Institute's (KCI's) Population Studies and Disparities Research (PSDR) Program focusing on Black-White disparities in cancer incidence, care, and outcomes. The studies in the review focus on individuals diagnosed with cancer from the Detroit Metropolitan area, but also includes individuals included in national databases. Using an organizational framework of three generations of studies on racial disparities, this review describes racial disparities by primary cancer site, disparities associated with the presence or absence of comorbid medical conditions, disparities in treatment, and disparities in physician-patient communication, all of which contribute to poorer outcomes for Black cancer patients. While socio-demographic and clinical differences account for some of the noted disparities, further work is needed to unravel the influence of systemic effects of racism against Black people, which is argued to be the major contributor to disparate outcomes between Black and White patients with cancer. This review highlights evidence-based strategies that have the potential to help mitigate disparities, improve care for vulnerable populations, and build an equitable healthcare system. Lessons learned can also inform a more equitable response to other health conditions and crises.
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Affiliation(s)
- Michael S. Simon
- Department of Oncology, Wayne State University, Detroit, MI, United States
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, United States
| | - Sreejata Raychaudhuri
- Department of Hematology/Oncology, Ascension Providence Hospital/Michigan State University College of Human Medicine (MSUCHM), Southfield, MI, United States
| | - Lauren M. Hamel
- Department of Oncology, Wayne State University, Detroit, MI, United States
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, United States
| | - Louis A. Penner
- Department of Oncology, Wayne State University, Detroit, MI, United States
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, United States
| | - Kendra L. Schwartz
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, United States
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, United States
| | - Felicity W. K. Harper
- Department of Oncology, Wayne State University, Detroit, MI, United States
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, United States
| | - Hayley S. Thompson
- Department of Oncology, Wayne State University, Detroit, MI, United States
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, United States
| | - Jason C. Booza
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, United States
- Department of Academic and Student Programs, Wayne State University, Detroit, MI, United States
| | - Michele Cote
- Department of Oncology, Wayne State University, Detroit, MI, United States
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, United States
| | - Ann G. Schwartz
- Department of Oncology, Wayne State University, Detroit, MI, United States
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, United States
| | - Susan Eggly
- Department of Oncology, Wayne State University, Detroit, MI, United States
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, United States
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Shahrabi Farahani F, Paapsi K, Innos K. The impact of sociodemographic factors on the utilization of radiation therapy in breast cancer patients in Estonia: a register-based study. Int J Equity Health 2021; 20:152. [PMID: 34193144 PMCID: PMC8247084 DOI: 10.1186/s12939-021-01497-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/11/2021] [Indexed: 11/18/2022] Open
Abstract
Background Radiation therapy is an important part of multimodal breast cancer treatment. The aim was to examine the impact of sociodemographic factors on radiation therapy use in breast cancer (BC) patients in Estonia, linking cancer registry data to administrative databases. Methods Estonian Cancer Registry provided data on women diagnosed with BC in Estonia in 2007–2018, including TNM stage at diagnosis. Use of radiation therapy within 12 months of diagnosis was determined from Estonian Health Insurance Funds claims, and sociodemographic characteristics from population registry. Receipt of radiation therapy was evaluated over time and by clinical and sociodemographic factors. Poisson regression with robust variance was used to calculate univariate and multivariate prevalence rate ratios (PRR) with 95 % confidence intervals (CI) for receipt of radiation therapy among stage I–III BC patients age < 70 years who underwent primary surgery. Results Overall, of 8637 women included in the study, 4310 (50 %) received radiation therapy within 12 months of diagnosis. This proportion increased from 39 to 58 % from 2007 to 2009 to 2016–2018 (p < 0.001). Multivariate regression analysis showed that compared to women with stage I BC, those with more advanced stage were less likely to receive radiation therapy. Receipt of radiation therapy increased significantly over time and was nearly 40 % higher in 2016–2018 than in 2007–2009. Use of radiation therapy was significantly lower for women with the lowest level of education compared to those with a university degree (PRR 0.88, 95 % CI 0.80–0.97), and for divorced/widowed women (PRR 0.95, 95 % CI 0.91–0.99) and single women (PRR 0.92, 95 % CI 0.86–0.99), compared to married women. Age at diagnosis, nationality and place of residence were not associated with receipt of radiation therapy. Conclusions The study showed considerable increase in the use of radiation therapy in Estonia over the study period, which is in line with increases in available equipment. The lack of geographic variations suggests equal access to therapy for patients living in remote regions. However, educational level and marital status were significantly associated with receipt of radiation therapy, highlighting the importance of psychosocial support in ensuring equal access to care.
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Affiliation(s)
- Fereshteh Shahrabi Farahani
- School of Information Technologies, Department of Health Technologies, Tallinn University of Technology, Digital Health MSc Programme, Tallinn, Estonia
| | - Keiu Paapsi
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia
| | - Kaire Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia.
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Emerson MA, Achacoso NS, Benefield HC, Troester MA, Habel LA. Initiation and adherence to adjuvant endocrine therapy among urban, insured American Indian/Alaska Native breast cancer survivors. Cancer 2021; 127:1847-1856. [PMID: 33620753 PMCID: PMC8191495 DOI: 10.1002/cncr.33423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/16/2020] [Accepted: 12/20/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND It has been shown that racial/ethnic disparities exist with regard to initiation of and adherence to adjuvant endocrine therapy (AET). However, the relationship among American Indian/Alaska Native (AIAN) individuals is poorly understood, particularly among those who reside in urban areas. We evaluated whether AET initiation and adherence were lower among AIAN individuals than those of other races/ethnicities who were enrolled in the Kaiser Permanente of Northern California (KPNC) health system. METHODS We identified 23,680 patients from the period 1997 to 2014 who were eligible for AET (first primary, stage I-III, hormone receptor-positive breast cancer) and used KPNC pharmacy records to identify AET prescriptions and refill dates. We assessed AET initiation (≥1 filled prescription within 1 year of diagnosis) and AET adherence (proportion of days covered ≥80%) every year up to 5 years after AET initiation. RESULTS At the end of the 5-year follow-up period, 83% of patients were AET initiators, and 58% were AET adherent. Compared with other races/ethnicities, AIAN women had the second-lowest rate of AET initiation (non-Hispanic Black [NHB], 78.0%; AIAN, 78.6%; Hispanic, 83.0%; non-Hispanic White [NHW], 82.5%; Asian/Pacific Islander [API], 84.7%), the lowest rate of AET adherence after 1 year and 5 years of follow-up (70.3% and 50.8%, respectively), and the greatest annual decline in AET adherence during the 4- to 5-year period of follow-up (a 13.8% decrease in AET adherence [from 64.6% to 50.8%]) after initiation of AET. In adjusted multivariable models, AIAN, Hispanic, and NHB women were less likely than NHW women to be AET adherent. At the end of the 5-year period, total underutilization (combining initiation and adherence) in AET-eligible patients was greatest among AIAN (70.6%) patients, followed by NHB (69.6%), Hispanic (63.2%), NHW (58.7%), and API (52.3%) patients, underscoring the AET treatment gap. CONCLUSION Our results suggest that AET initiation and adherence are particularly low for insured AIAN women.
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Affiliation(s)
- Marc A. Emerson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ninah S. Achacoso
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Halei C. Benefield
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Melissa A. Troester
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Laurel A. Habel
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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Pérez M, Kreuter MW, Yan Y, Thompson T, Sefko J, Golla B, Margenthaler JA, Colditz G, Jeffe DB. Feasibility and Acceptability of an Interactive Cancer-Communication Video Program Using African American Breast Cancer Survivor Stories. JOURNAL OF HEALTH COMMUNICATION 2020; 25:566-575. [PMID: 33048635 PMCID: PMC8043508 DOI: 10.1080/10810730.2020.1821132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
To examine the feasibility and acceptability of an interactive video program of African American breast cancer survivor stories, we explored story reactions among African American women with newly diagnosed breast cancer and associations between patient factors and intervention use. During a randomized controlled trial, patients in the intervention arm completed a baseline/pre-intervention interview, received the video intervention, and completed a post-intervention 1-month follow-up interview. Additional video exposures and post-exposure interviews occurred at 6- and 12-month follow-ups. Multivariable linear mixed-effects models examined interview and clinical data in association with changes in minutes and actions using the program. After Exposure1, 104 of 108 patients allocated to the intervention reported moderate-to-high levels of positive emotional reactions to stories and identification with storytellers. Exposure1 mean usage was high (139 minutes) but declined over time (p <.0001). Patients receiving surgery plus radiation logged about 50 more minutes and actions over 12-month follow-up than patients receiving surgery only (p <.05); patients reporting greater trust in storytellers logged 18.6 fewer actions over time (p =.04). Patients' topical interests evolved, with patients watching more follow-up care and survivorship videos at Exposure3. The intervention was feasible and evaluated favorably. New videos might satisfy patients' changing interests.
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Affiliation(s)
- Maria Pérez
- School of Medicine, Department of Medicine, Washington
University in St. Louis, Saint Louis, Missouri, USA
| | - Matthew W. Kreuter
- The Brown School, Washington University in St. Louis, Saint
Louis, Missouri, USA
- Alvin J.Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Yan Yan
- Alvin J.Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, Saint Louis, Missouri, USA
- School of Medicine, Department of Surgery, Washington
University in St. Louis, St. Louis, Missouri, USA
| | - Tess Thompson
- The Brown School, Washington University in St. Louis, Saint
Louis, Missouri, USA
| | - Julianne Sefko
- School of Medicine, Department of Surgery, Washington
University in St. Louis, St. Louis, Missouri, USA
| | - Balaji Golla
- The Brown School, Washington University in St. Louis, Saint
Louis, Missouri, USA
| | - Julie A. Margenthaler
- Alvin J.Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, Saint Louis, Missouri, USA
- School of Medicine, Department of Surgery, Washington
University in St. Louis, St. Louis, Missouri, USA
| | - Graham Colditz
- Alvin J.Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, Saint Louis, Missouri, USA
- School of Medicine, Department of Surgery, Washington
University in St. Louis, St. Louis, Missouri, USA
| | - Donna B. Jeffe
- School of Medicine, Department of Medicine, Washington
University in St. Louis, Saint Louis, Missouri, USA
- Alvin J.Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, Saint Louis, Missouri, USA
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Lovejoy LA, Eaglehouse YL, Hueman MT, Mostoller BJ, Shriver CD, Ellsworth RE. Evaluation of Surgical Disparities Between African American and European American Women Treated for Breast Cancer Within an Equal-Access Military Hospital. Ann Surg Oncol 2019; 26:3838-3845. [PMID: 31410609 DOI: 10.1245/s10434-019-07706-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Survival disparities between African American women (AAW) and European American women (EAW) with invasive breast cancer may be attributable, in part, to access to or quality of medical care. In this study, we evaluated surgical disparities between AAW and EAW treated within an equal-access military treatment facility (MTF). METHODS All AAW (N = 271) and EAW (N = 628) with Stage I-III breast cancer who had their initial diagnosis performed at Murtha Cancer Center at Walter Reed National Military Medical Center were identified. Differences in surgical interval (time between diagnosis and definitive breast surgery) and surgical procedures were evaluated using χ2 and Student t-tests while survival was analyzed using Kaplan-Meier survival estimates and log-rank tests. A P value < 0.05 was used to define significance. RESULTS Surgical intervals did not differ significantly between populations with an average of 36.3 days in AAW and 33.9 days in EAW. Frequency of the percentage of women undergoing reexcision, mastectomy, and prophylactic removal of the contralateral breast did not differ significantly between populations. Likewise, frequency of sentinel lymph node biopsy and 5-year survival were not significantly different between AAW compared to EAW. DISCUSSION Surgical intervals and procedures were similar between AAW and EAW treated within an equal-access MTF. These data demonstrate that the availability of quality surgical care to all patients with stage I-III breast cancer may eliminate survival disparities between AAW and EAW, emphasizing the importance of equalizing access to breast care.
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Affiliation(s)
- Leann A Lovejoy
- Chan Soon-Shiong Institute of Molecular Medicine, Windber, PA, USA
| | - Yvonne L Eaglehouse
- Clinical Breast Care Project, Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, and Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Matthew T Hueman
- Clinical Breast Care Project, Murtha Cancer Center Research Program, Uniformed Services University and Walter Reed National Military Medical Center, Bethesda, MD, USA
| | | | - Craig D Shriver
- Clinical Breast Care Project, Murtha Cancer Center Research Program, Uniformed Services University and Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Rachel E Ellsworth
- Clinical Breast Care Project, Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, and Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA. .,Clinical Breast Care Project, Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, and Henry M. Jackson Foundation for the Advancement of Military Medicine, Windber, PA, USA.
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He X, Chen W, Tang D, Wen F, Zhang P, Li Q. Factors related to the receipt of adjuvant therapy among patients with gastric cancer in Western China. Eur J Cancer Care (Engl) 2019; 28:e13012. [PMID: 30748055 DOI: 10.1111/ecc.13012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 10/23/2018] [Accepted: 01/17/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Adjuvant therapy following curative resection has been shown to be associated with significant survival benefits in patients with gastric cancer (GC); however, this treatment is not available to some patients. The aim was to investigate factors associated with the receipt of adjuvant therapy among GC patients. METHODS This is a retrospective study including patients with stage IB-IIIC gastric adenocarcinoma who underwent curative resection between November 2010 and July 2014. Patients were identified using a database from West China Hospital, Sichuan University. Univariate and multivariable analyses examined factors associated with adjuvant therapy receipt. RESULTS A total of 1,476 patients were included. Among these, 852 patients were eligible, with 157 patients not receiving adjuvant therapy. Age, education, income, residence, medical insurance, employment status and visiting an oncologist were independently associated with adjuvant therapy receipt by univariate analysis. After adjustment for other factors, medical insurance (p = 0.005), employment status (p = 0.008) and visiting an oncologist (p < 0.001) remained significantly correlated, and income was near the threshold of a significant difference (p = 0.050). CONCLUSION Our study indicates that disparities do exist in determining the receipt of adjuvant therapy in GC patients according to income, insurance and employment status, and highlight the importance of visiting an oncologist postoperatively.
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Affiliation(s)
- Xiaofeng He
- Department of Medical Oncology, Division of Abdominal Cancer, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Department of Medical Oncology, The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Wenwen Chen
- Department of Medical Oncology, The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Dan Tang
- Department of Medical Oncology, The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Feng Wen
- Department of Medical Oncology, Division of Abdominal Cancer, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Pengfei Zhang
- Department of Medical Oncology, Division of Abdominal Cancer, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiu Li
- Department of Medical Oncology, Division of Abdominal Cancer, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Enewold L, Penn DC, Stevens JL, Harlan LC. Black/white differences in treatment and survival among women with stage IIIB-IV breast cancer at diagnosis: a US population-based study. Cancer Causes Control 2018; 29:657-665. [PMID: 29860614 DOI: 10.1007/s10552-018-1045-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/26/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Non-Hispanic black (NHB) women with breast cancer have poorer survival than non-Hispanic white (NHW) women. Although NHB women are more often diagnosed at later stages, it is less established whether racial disparities exist among women diagnosed with late-stage breast cancer, particularly when care is provided in the community setting. METHODS Treatment and survival were examined by race/ethnicity among women diagnosed in 2012 with stage IIIB-IV breast cancer using the National Cancer Institute's population-based Patterns of Care Study. Medical records were re-abstracted and treating physicians were contacted to verify therapy. Vital status was available through 2014. RESULTS A total of 533 women with stage IIIB-C and 625 with stage IV tumors were included; NHW women comprised about 70% of each group. Among women with stage IIIB-C disease, racial/ethnicity variations in systemic treatment were not observed but there was a borderline association indicating worse all-cause mortality among NHB women (hazard ratio 1.52; 95% confidence interval (CI) 0.96-2.41). In contrast, among women with stage IV disease, borderline associations indicating NHB women were more likely to receive chemotherapy (OR 1.44, 95% CI 0.90-2.30) and, among those with hormone receptor-positive tumors, less likely to receive endocrine therapy (OR 0.60, 95% CI 0.35-1.04). All-cause mortality did not vary by race/ethnicity for stage IV disease (hazard ratio 0.92; 95% CI 0.68-1.25). CONCLUSIONS More research is needed to identify additional factors associated with the potential survival disparities among women with stage IIIB-C disease and potential treatment disparities among women with stage IV disease.
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Affiliation(s)
- Lindsey Enewold
- NCI/DCCPS/HDRP/HARB, Bethesda, MD, 20892, USA. .,NCI/HDRP, Room 3E506, 9609 Medical Center Drive, MSC 9762, Bethesda, MD, 20892-9762, USA.
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Kuijer A, Verloop J, Visser O, Sonke G, Jager A, van Gils C, van Dalen T, Elias S. The influence of socioeconomic status and ethnicity on adjuvant systemic treatment guideline adherence for early-stage breast cancer in the Netherlands. Ann Oncol 2017; 28:1970-1978. [DOI: 10.1093/annonc/mdx204] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Influence of comorbidity on chemotherapy use for early breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat 2017; 165:17-39. [DOI: 10.1007/s10549-017-4295-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 05/13/2017] [Indexed: 10/19/2022]
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13
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Hormone receptor status of contralateral breast cancers: analysis of data from the US SEER population-based registries. Breast Cancer 2016; 24:400-410. [DOI: 10.1007/s12282-016-0716-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022]
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Felder TM, Do DP, Lu ZK, Lal LS, Heiney SP, Bennett CL. Racial differences in receipt of adjuvant hormonal therapy among Medicaid enrollees in South Carolina diagnosed with breast cancer. Breast Cancer Res Treat 2016; 157:193-200. [PMID: 27120468 DOI: 10.1007/s10549-016-3803-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 04/19/2016] [Indexed: 12/29/2022]
Abstract
Several factors contribute to the pervasive Black-White disparity in breast cancer mortality in the U.S., such as tumor biology, access to care, and treatments received including adjuvant hormonal therapy (AHT), which significantly improves survival for hormone receptor-positive breast cancers (HR+). We analyzed South Carolina Central Cancer Registry-Medicaid linked data to determine if, in an equal access health care system, racial differences in the receipt of AHT exist. We evaluated 494 study-eligible, Black (n = 255) and White women (n = 269) who were under 65 years old and diagnosed with stages I-III, HR+ breast cancers between 2004 and 2007. Bivariate and multivariate analyses were conducted to assess receipt of ≥1 AHT prescriptions at any point in time following (ever-use) or within 12 months of (early-use) breast cancer diagnosis. Seventy-two percent of the participants were ever-users (70 % Black, 74 % White) and 68 % were early-users (65 % Black, 71 % White) of AHT. Neither ever-use (adjusted OR (AOR) = 0.75, 95 % CI 0.48-1.17) nor early-use (AOR = 0.70, 95 % CI 0.46-1.06) of AHT differed by race. However, receipt of other breast cancer-specific treatments was independently associated with ever-use and early-use of AHT [ever-use: receipt of surgery (AOR = 2.15, 95 % CI 1.35-3.44); chemotherapy (AOR = 1.97, 95 % CI 1.22-3.20); radiation (AOR = 2.33, 95 % CI 1.50-3.63); early-use: receipt of surgery (AOR = 2.03, 95 % CI 1.30-3.17); chemotherapy (AOR = 1.90, 95 % CI 1.20-3.03); radiation (AOR = 1.73, 95 % CI 1.14-2.63)]. No racial variations in use of AHT among women with HR+ breast cancers insured by Medicaid in South Carolina were identified, but overall rates of AHT use by these women is low. Strategies to improve overall use of AHT should include targeting breast cancer patients who do not receive adjuvant chemotherapy and/or radiation.
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Affiliation(s)
- Tisha M Felder
- College of Nursing, University of South Carolina, 1601 Greene Street, Room 620, Columbia, SC, 29208, USA.
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Suite 200, Columbia, SC, 29208, USA.
| | - D Phuong Do
- Public Health Policy and Administration, Zilber School of Public Health, University of Wisconsin-Milwaukee, 1240 N. 10th Street, Milwaukee, WI, 53201, USA
| | - Z Kevin Lu
- Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, 715 Sumter Street, Columbia, SC, 29208, USA
| | - Lincy S Lal
- Management, Policy & Community Health, University of Texas School of Public Health, University of Texas Health Science Center, 1200 Herman Pressler Drive, Houston, TX, 77030, USA
| | - Sue P Heiney
- College of Nursing, University of South Carolina, 1601 Greene Street, Room 617, Columbia, SC, 29208, USA
| | - Charles L Bennett
- Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, 715 Sumter Street, Columbia, SC, 29208, USA
- SmartState Center for Medication Safety and Efficacy, University of South Carolina, 715 Sumter Street, Columbia, SC, 29208, USA
- Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA
- Arnold School of Public Health, University of South Carolina, 921 Assembly St, Columbia, SC, 29201, USA
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Roberts MC, Wheeler SB, Reeder-Hayes K. Racial/Ethnic and socioeconomic disparities in endocrine therapy adherence in breast cancer: a systematic review. Am J Public Health 2015; 105 Suppl 3:e4-e15. [PMID: 25905855 DOI: 10.2105/ajph.2014.302490] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
We examined the current literature to understand factors that influence endocrine therapy (ET) adherence among racial/ethnic and socioeconomic subpopulations of breast cancer patients. We searched PubMed and PsycINFO databases for studies from January 1, 1978, to June 20, 2014, and January 1, 1991, to June 20, 2014, respectively, and hand-searched articles from relevant literature reviews. We abstracted and synthesized results within a social ecological framework. Fourteen articles met all inclusion criteria. The majority of included articles reported significant underuse of ET among minority and low-income women. Modifiable intrapersonal, interpersonal, and community-level factors are associated with ET use, and these factors vary across subgroups. Both race/ethnicity and socioeconomic status are associated with ET use in most settings. Variation in factors associated with ET use across subgroups indicates the need for more nuanced research and targeted interventions among breast cancer patients.
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Affiliation(s)
- Megan C Roberts
- Megan C. Roberts, Stephanie B. Wheeler, and Katherine Reeder-Hayes are with the Lineberger Comprehensive Cancer Center, University of North Carolina (UNC), Chapel Hill. Megan C. Roberts and Stephanie B. Wheeler are also with the Department of Health Policy and Management, Gillings School of Global Public Health, UNC, Chapel Hill. Katherine Reeder-Hayes is also with the Division of Hematology/Oncology, School of Medicine, UNC, Chapel Hill
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16
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Rizzo JA, Sherman WE, Arciero CA. Racial disparity in survival from early breast cancer in the department of defense healthcare system. J Surg Oncol 2015; 111:819-23. [DOI: 10.1002/jso.23884] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 12/15/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Julie A. Rizzo
- U.S. Institute of Surgical Research; Fort Sam Houston Texas
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17
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Reeder-Hayes KE, Wheeler SB, Mayer DK. Health disparities across the breast cancer continuum. Semin Oncol Nurs 2015; 31:170-7. [PMID: 25951746 DOI: 10.1016/j.soncn.2015.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To provide a brief overview of disparities across the spectrum of breast cancer incidence, treatment, and long-term care during the survivorship period. DATA SOURCES Review of the literature including research reports, review articles, and clinically based articles available through PubMed and CINAHL. CONCLUSION Minority women generally experience worse breast cancer outcomes despite a lower incidence of breast cancer than whites. A variety of factors contribute to this disparity, including advanced stage at diagnosis, higher rates of aggressive breast cancer subtypes, and lower receipt of appropriate therapies including surgery, chemotherapy, and radiation. Disparities in breast cancer care also extend into the survivorship trajectory, including lower rates of endocrine therapy use among some minority groups, as well as differences in follow-up and survivorship care. IMPLICATIONS FOR NURSING PRACTICE Breast cancer research should include improved minority representation and analyses by race, ethnicity, and socioeconomic status. While we cannot yet change the biology of this disease, we can encourage adherence to screening and treatment and help address the many physical, psychological, spiritual, and social issues minority women face in a culturally sensitive manner.
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Sheppard VB, Faul LA, Luta G, Clapp JD, Yung RL, Wang JHY, Kimmick G, Isaacs C, Tallarico M, Barry WT, Pitcher BN, Hudis C, Winer EP, Cohen HJ, Muss HB, Hurria A, Mandelblatt JS. Frailty and adherence to adjuvant hormonal therapy in older women with breast cancer: CALGB protocol 369901. J Clin Oncol 2014; 32:2318-27. [PMID: 24934786 DOI: 10.1200/jco.2013.51.7367] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Most patients with breast cancer age ≥ 65 years (ie, older patients) are eligible for adjuvant hormonal therapy, but use is not universal. We examined the influence of frailty on hormonal therapy noninitiation and discontinuation. PATIENTS AND METHODS A prospective cohort of 1,288 older women diagnosed with invasive, nonmetastatic breast cancer recruited from 78 sites from 2004 to 2011 were included (1,062 had estrogen receptor-positive tumors). Interviews were conducted at baseline, 6 months, and annually for up to 7 years to collect sociodemographic, health care, and psychosocial data. Hormonal initiation was defined from records and discontinuation from self-report. Baseline frailty was measured using a previously validated 35-item scale and grouped as prefrail or frail versus robust. Logistic regression and proportional hazards models were used to assess factors associated with noninitiation and discontinuation, respectively. RESULTS Most women (76.4%) were robust. Noninitiation of hormonal therapy was low (14%), but in prefrail or frail (v robust) women the odds of noninitiation were 1.63 times as high (95% CI, 1.11 to 2.40; P = .013) after covariate adjustment. Nonwhites (v whites) had higher odds of noninitiation (odds ratio, 1.71; 95% CI, 1.04 to 2.80; P = .033) after covariate adjustment. Among initiators, the 5-year continuation probability was 48.5%. After adjustment, the risk of discontinuation was higher with increasing age (P = .005) and lower for stage ≥ IIB (v stage I) disease (P = .003). CONCLUSION Frailty is associated with noninitiation of hormonal therapy, but it does not seem to be a major predictor of early discontinuation in older patients.
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Affiliation(s)
- Vanessa B Sheppard
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA.
| | - Leigh Anne Faul
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - George Luta
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Jonathan D Clapp
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Rachel L Yung
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Judy Huei-Yu Wang
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Gretchen Kimmick
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Claudine Isaacs
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Michelle Tallarico
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - William T Barry
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Brandelyn N Pitcher
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Clifford Hudis
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Eric P Winer
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Harvey J Cohen
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Hyman B Muss
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Arti Hurria
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
| | - Jeanne S Mandelblatt
- Vanessa B. Sheppard, Leigh Anne Faul, George Luta, Jonathan D. Clapp, Judy Huei-yu Wang, Claudine Isaacs, Michelle Tallarico, and Jeanne S. Mandelblatt, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Rachel L. Yung and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Gretchen Kimmick, William T. Barry, Brandelyn N. Pitcher, and Harvey J. Cohen, Duke University Medical Center; William T. Barry and Brandelyn N. Pitcher, Cancer and Leukemia Group B Statistical Center, Durham; Hyman B. Muss, University of North Carolina Chapel Hill, Chapel Hill, NC; Clifford Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Arti Hurria, City of Hope, Los Angeles, CA
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Reeder-Hayes KE, Meyer AM, Dusetzina SB, Liu H, Wheeler SB. Racial disparities in initiation of adjuvant endocrine therapy of early breast cancer. Breast Cancer Res Treat 2014; 145:743-51. [PMID: 24789443 DOI: 10.1007/s10549-014-2957-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 04/05/2014] [Indexed: 12/11/2022]
Abstract
Endocrine therapy (ET) is the cornerstone of adjuvant therapy for hormone-receptor positive (HR+) breast cancer. The survival gap between African-American (AA) and white women with breast cancer is most pronounced in HR+ subtypes, and could be related to differences in ET use. The relationship between race and initiation of ET is not well defined. We investigated patterns of ET initiation by race in a diverse cohort of women covered by commercial health insurance. We identified 2,640 women with incident HR+ breast cancer in the North Carolina Central Cancer Registry whose records linked to commercial insurance claims using the Integrated Cancer Information and Surveillance System (ICISS) database. The sample included women age <65 years diagnosed with stage I-III HR+ cancers between 2004 and 2009. We used multivariate Poisson regression to examine the effect of race on likelihood of initiating ET. 14 % of women did not initiate ET within 12 months of diagnosis. AA women were 17 % less likely to initiate ET than whites (aRR 0.83, 95 % CI 0.74-0.93). When analyzed by subset, racial disparities persisted among women who received chemotherapy (aHR 0.67, 95 % CI 0.56-0.80) but not among women who did not receive chemotherapy (aHR 0.96, 95 % CI 0.76-1.21). AA women in our sample were less likely to initiate ET than whites, and this disparity was concentrated among chemotherapy-treated women. ET under-utilization may contribute to the racial survival gap in HR+ breast cancer, and represents an opportunity for intervention to reduce breast cancer disparities.
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Affiliation(s)
- Katherine E Reeder-Hayes
- University of North Carolina Lineberger Comprehensive Cancer Center, Campus Box 7295, Chapel Hill, NC, 27599-7295, USA,
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20
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Januszewski A, Tanna N, Stebbing J. Ethnic variation in breast cancer incidence and outcomes--the debate continues. Br J Cancer 2014; 110:4-6. [PMID: 24398563 PMCID: PMC3887313 DOI: 10.1038/bjc.2013.775] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- A Januszewski
- Division of Surgery and Cancer, Imperial College London, ICTEM Building, London W12 0NN, UK
| | - N Tanna
- Division of Surgery and Cancer, Imperial College London, ICTEM Building, London W12 0NN, UK
| | - J Stebbing
- Division of Surgery and Cancer, Imperial College London, ICTEM Building, London W12 0NN, UK
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21
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Pérez M, Sefko JA, Ksiazek D, Golla B, Casey C, Margenthaler JA, Colditz G, Kreuter MW, Jeffe DB. A novel intervention using interactive technology and personal narratives to reduce cancer disparities: African American breast cancer survivor stories. J Cancer Surviv 2013; 8:21-30. [PMID: 24030573 DOI: 10.1007/s11764-013-0308-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 08/30/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE There has been a paucity of interventions developed for African American women to address persistent health disparities between African American and Caucasian breast cancer patients. We developed and piloted a technologically innovative, culturally targeted, cancer-communication intervention for African American breast cancer patients using African American breast cancer survivor stories. METHODS We rated 917 clips from a video library of survivors' stories for likability, clarity and length, and emotional impact (scaled responses) and categorized each clip by theme (Coping, Support and Relationships, Healthcare Experiences, Follow-up Care, Quality of Life, and Treatment Side Effects). We selected 207 clips told by 35 survivors (32-68 years old; 4-30 years after diagnosis), fitting one of 12 story topics, for inclusion in the interactive video program loaded onto a touch-screen computer. Videos can be searched by storyteller or story topics; stories with the strongest emotional impact were displayed first in the video program. RESULTS We pilot tested the video program with ten African American breast cancer survivors (mean age, 54; range 39-68 years), who, after training, watched videos and then evaluated the stories and video-program usability. Survivor stories were found to be "interesting and informative," and usability was rated highly. Participants identified with storytellers (e.g., they "think a lot like me," "have values like mine") and agreed that the stories convinced them to receive recommended surveillance mammograms. CONCLUSIONS This novel, cancer-communication technology using survivor stories was very favorably evaluated by breast cancer survivors and is now being tested in a randomized controlled clinical trial. IMPLICATIONS FOR CANCER SURVIVORS Breast cancer survivors can draw support and information from a variety of sources, including from other breast cancer survivors. We developed the survivor stories video program specifically for African American survivors to help improve their quality of life and adherence to follow-up care. Breast cancer survivors' experiences with treatment and living with cancer make them especially credible messengers of cancer information. Our novel, interactive technology is being tested in a randomized controlled trial and will be more broadly disseminated to reach a wider audience.
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Affiliation(s)
- Maria Pérez
- Washington University School of Medicine, 660 S. Euclid, Saint Louis, MO, 63110, USA,
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Meyer AM, Reeder-Hayes KE, Liu H, Wheeler SB, Penn D, Weiner BJ, Carpenter WR. Differential receipt of sentinel lymph node biopsy within practice-based research networks. Med Care 2013; 51:812-8. [PMID: 23942221 PMCID: PMC4080805 DOI: 10.1097/mlr.0b013e31829c8ca4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Practice-based research networks (PBRNs) are promising for accelerating not only research, but also dissemination of research-based evidence into broader community practice. Sentinel lymph node biopsy (SLNB) is an innovation in breast cancer care associated with equivalent survival and lower morbidity, as compared with standard axillary lymph node dissection. We examined the diffusion of SLNB into practice and whether affiliation with the Community Clinical Oncology Program (CCOP), a cancer-focused PBRN, was associated with more rapid uptake of SLNB. RESEARCH DESIGN Surveillance Epidemiology and End Results-Medicare data were used to study women diagnosed with stage I or II breast cancer in the years 2000-2005 and undergoing breast-conserving surgery with axillary staging (n=6226). The primary outcome was undergoing SLNB. CCOP affiliation of the surgical physician was ascertained from NCI records. Multivariable generalized linear modeling with generalized estimating equations was used to measure association between CCOP exposure and undergoing SLNB, controlling for potential confounders. RESULTS Women treated by a CCOP physician had significantly higher odds of receiving SLNB compared with women treated by a non-CCOP physician (OR 2.68; 95% CI, 1.35-5.34). The magnitude of this association was larger than that observed among patients treated by physicians operating in medical school-affiliated hospitals (OR 1.76; 95% CI, 1.30-2.39). CONCLUSIONS Women treated by CCOP-affiliated physicians were more likely to undergo SLNB irrespective of the hospital's medical school affiliation, suggesting that the CCOP PBRN may play a role in the rapid adoption of research-based innovation in community practice.
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Affiliation(s)
- Anne-Marie Meyer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7293, USA.
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Wheeler SB, Reeder-Hayes KE, Carey LA. Disparities in breast cancer treatment and outcomes: biological, social, and health system determinants and opportunities for research. Oncologist 2013; 18:986-93. [PMID: 23939284 PMCID: PMC3780646 DOI: 10.1634/theoncologist.2013-0243] [Citation(s) in RCA: 175] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 07/10/2013] [Indexed: 11/17/2022] Open
Abstract
Racial disparities in breast cancer mortality have been widely documented for several decades and persist despite advances in receipt of mammography across racial groups. This persistence leads to questions about the roles of biological, social, and health system determinants of poor outcomes. Cancer outcomes are a function not only of innate biological factors but also of modifiable characteristics of individual behavior and decision making as well as characteristics of patient-health system interaction and the health system itself. Attempts to explain persistent racial disparities have mostly been limited to discussion of differences in insurance coverage, socioeconomic status, tumor stage at diagnosis, comorbidity, and molecular subtype of the tumor. This article summarizes existing literature exploring reasons for racial disparities in breast cancer mortality, with an emphasis on treatment disparities and opportunities for future research. Because breast cancer care requires a high degree of multidisciplinary team collaboration, ensuring that guideline recommended treatment (such as endocrine therapy for hormone receptor positive patients) is received by all racial/ethnic groups is critical and requires coordination across multiple providers and health care settings. Recognition that variation in cancer care quality may be correlated with race (and socioeconomic and health system factors) may assist policy makers in identifying strategies to more equally distribute clinical expertise and health infrastructure across multiple user populations.
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Affiliation(s)
- Stephanie B. Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health
- Lineberger Comprehensive Cancer Center
- Cecil G. Sheps Center for Health Services Research, and
| | - Katherine E. Reeder-Hayes
- Lineberger Comprehensive Cancer Center
- Division of Hematology/Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lisa A. Carey
- Lineberger Comprehensive Cancer Center
- Division of Hematology/Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Akinyemiju TF, Soliman AS, Copeland G, Banerjee M, Schwartz K, Merajver SD. Trends in breast cancer stage and mortality in Michigan (1992-2009) by race, socioeconomic status, and area healthcare resources. PLoS One 2013; 8:e61879. [PMID: 23637921 PMCID: PMC3639257 DOI: 10.1371/journal.pone.0061879] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 03/18/2013] [Indexed: 11/18/2022] Open
Abstract
The long-term effect of socioeconomic status (SES) and healthcare resources availability (HCA) on breast cancer stage of presentation and mortality rates among patients in Michigan is unclear. Using data from the Michigan Department of Community Health (MDCH) between 1992 and 2009, we calculated annual proportions of late-stage diagnosis and age-adjusted breast cancer mortality rates by race and zip code in Michigan. SES and HCA were defined at the zip-code level. Joinpoint regression was used to compare the Average Annual Percent Change (AAPC) in the median zip-code level percent late stage diagnosis and mortality rate for blacks and whites and for each level of SES and HCA. Between 1992 and 2009, the proportion of late stage diagnosis increased among white women [AAPC = 1.0 (0.4, 1.6)], but was statistically unchanged among black women [AAPC = −0.5 (−1.9, 0.8)]. The breast cancer mortality rate declined among whites [AAPC = −1.3% (−1.8,−0.8)], but remained statistically unchanged among blacks [AAPC = −0.3% (−0.3, 1.0)]. In all SES and HCA area types, disparities in percent late stage between blacks and whites appeared to narrow over time, while the differences in breast cancer mortality rates between blacks and whites appeared to increase over time.
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Affiliation(s)
- Tomi F Akinyemiju
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America.
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Livaudais JC, Lacroix A, Chlebowski RT, Li CI, Habel LA, Simon MS, Thompson B, Erwin DO, Hubbell FA, Coronado GD. Racial/ethnic differences in use and duration of adjuvant hormonal therapy for breast cancer in the women's health initiative. Cancer Epidemiol Biomarkers Prev 2013; 22:365-73. [PMID: 23275187 PMCID: PMC3596451 DOI: 10.1158/1055-9965.epi-12-1225] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Five-year breast cancer survival rates are lower among Hispanic and African-American women than among Non-Hispanic White women. Differences in breast cancer treatment likely play a role. Adjuvant hormonal therapies increase overall survival among women with hormone receptor-positive breast cancer. METHODS We examined racial/ethnic differences in use and duration of adjuvant hormonal therapy among 3,588 postmenopausal women enrolled in the Women's Health Initiative (WHI) Extension Study. Women diagnosed with hormone receptor-positive localized or regional stage breast cancer after study enrollment were surveyed between September 2009 and August 2010 and asked to recall prior use and duration of adjuvant hormonal breast cancer therapy. ORs comparing self-reported use and duration with race/ethnicity (Hispanic, African-American, Asian/Pacific Islander vs. Non-Hispanic White) were estimated using multivariable-adjusted logistic regression. RESULTS Of the 3,588 women diagnosed from 1994 to 2009; 3,039 (85%) reported any use of adjuvant hormonal therapy, and 67% of women reporting ever-use who were diagnosed before 2005 reported using adjuvant hormonal therapy for the optimal duration of 5 years or more. In adjusted analysis, no statistically significant differences in use or duration by race/ethnicity were observed. CONCLUSIONS This study did not find significant differences in use or duration of use of adjuvant hormonal therapy by race/ethnicity. IMPACT Findings should be confirmed in other population-based samples, and potential reasons for discontinuation of therapy across all racial/ethnic groups should be explored. Cancer Epidemiol Biomarkers Prev; 22(3); 365-73. ©2012 AACR.
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MESH Headings
- Black or African American/statistics & numerical data
- Aged
- Aged, 80 and over
- Antineoplastic Agents, Hormonal/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/ethnology
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/ethnology
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/ethnology
- Carcinoma, Lobular/pathology
- Chemotherapy, Adjuvant
- Cohort Studies
- Ethnicity/statistics & numerical data
- Female
- Follow-Up Studies
- Hispanic or Latino/statistics & numerical data
- Humans
- Middle Aged
- Neoplasm Grading
- Prognosis
- Racial Groups/statistics & numerical data
- Time Factors
- White People/statistics & numerical data
- Women's Health
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Affiliation(s)
- Jennifer C Livaudais
- Corresponding Author: Jennifer C. Livaudais, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA 98109, USA.
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Griggs JJ, Hawley ST, Graff JJ, Hamilton AS, Jagsi R, Janz NK, Mujahid MS, Friese CR, Salem B, Abrahamse PH, Katz SJ. Factors associated with receipt of breast cancer adjuvant chemotherapy in a diverse population-based sample. J Clin Oncol 2012; 30:3058-64. [PMID: 22869890 DOI: 10.1200/jco.2012.41.9564] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Disparities in receipt of adjuvant chemotherapy may contribute to higher breast cancer fatality rates among black and Hispanic women compared with non-Hispanic whites. We investigated factors associated with receipt of chemotherapy in a diverse population-based sample. PATIENTS AND METHODS Women diagnosed with breast cancer between August 2005 and May 2007 (N = 3,252) and reported to the Detroit, Michigan, or Los Angeles County Surveillance, Epidemiology, and End Results (SEER) registry were recruited to complete a survey. Multivariable analyses examined factors associated with chemotherapy receipt. RESULTS The survey was sent to 3,133 patients; 2,290 completed a survey (73.1%), and 1,403 of these patients were included in the analytic sample. In multivariable models, disease characteristics were significantly associated with the likelihood of receiving chemotherapy. Low-acculturated Hispanics were more likely to receive chemotherapy than non-Hispanic whites (odds ratio [OR], 2.00; 95% CI, 1.31 to 3.04), as were high-acculturated Hispanics (OR, 1.43; 95% CI, 1.03 to 1.98). Black women were less likely to receive chemotherapy than non-Hispanic whites, but the difference was not significant (OR, 0.83; 95% CI, 0.64 to 1.08). Increasing age (even in women age < 50 years) and Medicaid insurance were associated with lower rates of chemotherapy receipt. CONCLUSION In this population-based sample, disease characteristics were strongly associated with receipt of chemotherapy, indicating that clinical benefit guides most treatment decisions. We found no compelling evidence that black women and Hispanics receive chemotherapy at lower rates. Interventions that address chemotherapy use rates according to age and insurance status may improve quality of systemic treatment.
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Affiliation(s)
- Jennifer J Griggs
- University of Michigan, North Campus Research Complex, 2800 Plymouth Rd, Bldg 16, 400S, Ann Arbor, MI 48109-2800, USA.
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The ethnic divide in breast reconstruction: A review of the current literature and directions for future research. Cancer Treat Rev 2012; 38:362-7. [DOI: 10.1016/j.ctrv.2011.12.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 12/27/2011] [Accepted: 12/29/2011] [Indexed: 11/22/2022]
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Livaudais JC, Li C, John EM, Terry MB, Daly M, Buys SS, Habel L, Thompson B, Yanez ND, Coronado GD. Racial and ethnic differences in adjuvant hormonal therapy use. J Womens Health (Larchmt) 2012; 21:950-8. [PMID: 22731764 DOI: 10.1089/jwh.2011.3254] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In the United States, 5-year breast cancer survival is highest among Asian American women, followed by non-Hispanic white, Hispanic, and African American women. Breast cancer treatment disparities may play a role. We examined racial/ethnic differences in adjuvant hormonal therapy use among women aged 18-64 years, diagnosed with hormone receptor-positive breast cancer, using data collected by the Northern California Breast Cancer Family Registry (NC-BCFR), and explored changes in use over time. METHODS Odds ratios (OR) comparing self-reported ever-use by race/ethnicity (African American, Hispanic, non-Hispanic white vs. Asian American) were estimated using multivariable adjusted logistic regression. Analyses were stratified by recruitment phase (phase I, diagnosed January 1995-September 1998, phase II, diagnosed October 1998-April 2003) and genetic susceptibility, as cases with increased genetic susceptibility were oversampled. RESULTS Among 1385 women (731 phase I, 654 phase II), no significant racial/ethnic differences in use were observed among phase I or phase II cases. However, among phase I cases with no susceptibility indicators, African American and non-Hispanic white women were less likely than Asian American women to use hormonal therapy (OR 0.20, 95% confidence interval [CI]0.06-0.60; OR 0.40, CI 0.17-0.94, respectively). No racial/ethnic differences in use were observed among women with 1+ susceptibility indicators from either recruitment phase. CONCLUSIONS Racial/ethnic differences in adjuvant hormonal therapy use were limited to earlier diagnosis years (phase I) and were attenuated over time. Findings should be confirmed in other populations but indicate that in this population, treatment disparities between African American and Asian American women narrowed over time as adjuvant hormonal treatments became more commonly prescribed.
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Affiliation(s)
- Jennifer C Livaudais
- Department of Health Evidence and Policy, Mount Sinai School of Medicine, 1425 Madison Avenue, New York, NY 10029, USA.
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Simon MS, Lamerato L, Krajenta R, Booza JC, Ruterbusch JJ, Kunz S, Schwartz K. Racial differences in the use of adjuvant chemotherapy for breast cancer in a large urban integrated health system. Int J Breast Cancer 2012; 2012:453985. [PMID: 22690339 PMCID: PMC3363414 DOI: 10.1155/2012/453985] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 03/18/2012] [Accepted: 03/19/2012] [Indexed: 11/17/2022] Open
Abstract
Background. Racial differences in breast cancer survival may be in part due to variation in patterns of care. To better understand factors influencing survival disparities, we evaluated patterns of receipt of adjuvant chemotherapy among 2,234 women with invasive, nonmetastatic breast cancer treated at the Henry Ford Health System (HFHS) from 1996 through 2005. Methods. Sociodemographic and clinical information were obtained from linked datasets from the HFHS, Metropolitan Detroit Cancer Surveillance Systems, and U.S. Census. Comorbidity was measured using the Charlson comorbidity index (CCI), and economic deprivation was categorized using a neighborhood deprivation index. Results. African American (AA) women were more likely than whites to have advanced tumors with more aggressive clinical features, to have more comorbidity and to be socioeconomically deprived. While in the unadjusted model, AAs were more likely to receive chemotherapy (odds ratio (OR) 1.22, 95% confidence interval (CI) 1.02-1.46) and to have a delay in receipt of chemotherapy beyond 60 days (OR 1.68, 95% CI, 1.26-1.48), after multivariable adjustment there were no racial differences in receipt (odds ratio (OR) 1.02, 95% confidence interval (CI) 0.73-1.43), or timing of chemotherapy (OR 1.18, 95 CI, 0.8-1.74). Conclusions. Societal factors and not race appear to have an impact on treatment delay among African American women with early breast cancer.
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Affiliation(s)
- Michael S. Simon
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, 4100 John Road, 4221 HWCRC Detroit, MI 48201, USA
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA
| | - Lois Lamerato
- Department of Public Health Sciences, Henry Ford Health Systems, Detroit, MI 48202, USA
| | - Richard Krajenta
- Department of Public Health Sciences, Henry Ford Health Systems, Detroit, MI 48202, USA
| | - Jason C. Booza
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI 48201, USA
| | - Julie J. Ruterbusch
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, 4100 John Road, 4221 HWCRC Detroit, MI 48201, USA
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA
| | - Sara Kunz
- Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Kendra Schwartz
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI 48201, USA
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Structural/organizational characteristics of health services partly explain racial variation in timeliness of radiation therapy among elderly breast cancer patients. Breast Cancer Res Treat 2012; 133:333-45. [PMID: 22270934 DOI: 10.1007/s10549-012-1955-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 01/09/2012] [Indexed: 10/14/2022]
Abstract
Observed racial/ethnic disparities in the process and outcomes of breast cancer care may be explained, in part, by structural/organizational characteristics of health care systems. We examined the role of surgical facility characteristics and distance to care in explaining racial/ethnic variation in timing of initiation of guideline-recommended radiation therapy (RT) after breast conserving surgery (BCS). We used Surveillance Epidemiology and End Results-Medicare data to identify women ages 65 and older diagnosed with stages I-III breast cancer and treated with BCS in 1994-2002. We used stepwise multivariate logistic regression to examine the interactive effects of race/ethnicity and facility profit status, teaching status, size, and institutional affiliations, and distance to nearest RT on timing of RT initiation, controlling for known covariates. Among 38,574 eligible women who received BCS, 39% received RT within 2 months, 52% received RT within 6 months, and 57% received RT within 12 months post-diagnosis, with significant variation by race/ethnicity. In multivariate models, women attending smaller surgical facilities and those with on-site radiation had higher odds of RT at each time interval, and women attending governmental facilities had lower odds of RT at each time interval (P < 0.05). Increasing distance between patients' residence and nearest RT provider was associated with lower overall odds of RT, particularly among Hispanic women (P < 0.05). In fully adjusted models including race-by-distance interaction terms, racial/ethnic disparities disappeared in RT initiation within 6 and 12 months. Racial/ethnic disparities in timing of RT for breast cancer can be partially explained by structural/organizational health system characteristics. Identifying modifiable system-level factors associated with quality cancer care may help us target policy interventions that can reduce disparities in outcomes.
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Chagpar AB, Crutcher CR, Cornwell LB, McMasters KM. Primary tumor size, not race, determines outcomes in women with hormone-responsive breast cancer. Surgery 2011; 150:796-801. [PMID: 22000193 DOI: 10.1016/j.surg.2011.07.066] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 07/18/2011] [Indexed: 01/17/2023]
Abstract
INTRODUCTION We sought to determine if there was a difference in outcomes in African-American compared with Caucasian women with hormone-responsive breast cancer, and whether this was related to race or other tumor and treatment variables. METHODS We included 1,205 patients with hormone-responsive breast cancer were identified in the Kentucky Cancer Registry (1996-2007). The effect of race on survival was evaluated using Kaplan-Meier and Cox regression methodologies. RESULTS In this cohort, 76.9% were Caucasian and 21.7% were African American. Compared with Caucasians, African-American women were older (57 vs 55 years; P = .032) and more likely to have larger tumors (19 vs 17 mm; P = .009). No significant racial differences in grade, operative, or systemic treatment were noted. Univariate analysis found no significant differences in disease-specific overall survival (DSS) or disease-free survival (DFS) between Caucasians and African Americans (5-year actuarial DSS, 93.6% vs 90.7%, respectively; P = .205; 5-year actuarial DFS, 91.5% vs 90.4%, respectively; P = .829). On multivariate analysis, only tumor size remained an independent predictor of DSS (odds ratio [OR], 1.021; 95% confidence interval [CI], 1.013-1.028; P < .001). Controlling for age, tumor size, and insurance status, race did not influence DSS or DFS (P = .913 and P = .857). CONCLUSION African Americans present with larger tumors than Caucasians; treatment is similar. Tumor size, not race, affects disease-specific outcomes in patients with breast cancer.
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Affiliation(s)
- Anees B Chagpar
- Department of Surgery, Yale University, New Haven, CT 06510, USA.
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Racial/ethnic differences in initiation of adjuvant hormonal therapy among women with hormone receptor-positive breast cancer. Breast Cancer Res Treat 2011; 131:607-17. [PMID: 21922245 DOI: 10.1007/s10549-011-1762-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 08/27/2011] [Indexed: 10/17/2022]
Abstract
Mortality after breast cancer diagnosis is known to vary by race/ethnicity even after adjustment for differences in tumor characteristics. As adjuvant hormonal therapy decreases risk of recurrence and increases overall survival among women with hormone receptor-positive tumors, treatment disparities may play a role. We explored racial/ethnic differences in initiation of adjuvant hormonal therapy, defined as two or more prescriptions for tamoxifen or aromatase inhibitor filled within the first year after diagnosis of hormone receptor-positive localized or regional-stage breast cancer. The sample included women diagnosed with breast cancer enrolled in Kaiser Permanente Northern California (KPNC). Odds ratios [OR] and 95% confidence intervals [CI] compared initiation by race/ethnicity (Hispanic, African American, Chinese, Japanese, Filipino, and South Asian vs. non-Hispanic White [NHW]) using logistic regression. Covariates included age and year of diagnosis, area-level socioeconomic status, co-morbidities, tumor stage, histology, grade, breast cancer surgery, radiation and chemotherapy use. Our sample included 13,753 women aged 20-79 years, diagnosed between 1996 and 2007, and 70% initiated adjuvant hormonal therapy. In multivariable analysis, Hispanic and Chinese women were less likely than NHW women to initiate adjuvant hormonal therapy ([OR] = 0.82; [CI] 0.71-0.96 and [OR] = 0.78; [CI] 0.63-0.98, respectively). Within an equal access, insured population, lower levels of initiation of adjuvant hormonal therapy were found for Hispanic and Chinese women. Findings need to be confirmed in other insured populations and the reasons for under-initiation among these groups need to be explored.
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Wheeler SB, Carpenter WR, Peppercorn J, Schenck AP, Weinberger M, Biddle AK. Predictors of timing of adjuvant chemotherapy in older women with hormone receptor-negative, stages II-III breast cancer. Breast Cancer Res Treat 2011; 131:207-16. [PMID: 21842244 DOI: 10.1007/s10549-011-1717-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 08/01/2011] [Indexed: 10/17/2022]
Abstract
Adherence to consensus guidelines for cancer care may vary widely across health care settings and contribute to differences in cancer outcomes. For some women with breast cancer, omission of adjuvant chemotherapy or delays in its initiation may contribute to differences in cancer recurrence and mortality. We studied adjuvant chemotherapy use among women with stage II or stage III, hormone receptor-negative breast cancer to understand health system and socio-demographic correlates of underuse and delayed adjuvant chemotherapy. We used Surveillance Epidemiology and End Results (SEER)-Medicare linked data to examine the patterns of care for 6,678 women aged 65 and older diagnosed with stage II or stage III hormone receptor-negative breast cancer in 1994-2002, with claims data through 2007. Age-stratified logistic regression was employed to examine the potential role of socio-demographic and structural/organizational health services characteristics in explaining differences in adjuvant chemotherapy initiation. Overall utilization of guideline-recommended adjuvant chemotherapy peaked at 43% in this population. Increasing age, higher co-morbidity burden, and low-income status were associated with lower odds of chemotherapy initiation within 4 months, whereas having positive lymph nodes, more advanced disease, and being married were associated with higher odds (P < 0.05). Health system-related structural/organizational characteristics and race/ethnicity offered little explanatory insight. Timely initiation of guideline-recommended adjuvant chemotherapy was low, with significant variation by age, income, and co-morbidity status. Based on these findings, future studies should seek to explore the more nuanced reasons why older women do not receive chemotherapy and why delays in care occur.
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Affiliation(s)
- Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB 7411, Chapel Hill, NC 27599-7411, USA.
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Enewold L, Zhou J, McGlynn KA, Anderson WF, Shriver CD, Potter JF, Zahm SH, Zhu K. Racial variation in breast cancer treatment among Department of Defense beneficiaries. Cancer 2011; 118:812-20. [PMID: 21766298 DOI: 10.1002/cncr.26346] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 04/20/2011] [Accepted: 05/16/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although the overall age-adjusted incidence rates for female breast cancer are higher among whites than blacks, mortality rates are higher among blacks. Many attribute this discrepancy to disparities in health care access and to blacks presenting with later stage disease. Within the Department of Defense (DoD) Military Health System, all beneficiaries have equal access to health care. The aim of this study was to determine whether female breast cancer treatment varied between white and black patients in the DoD system. METHODS The study data were drawn from the DoD cancer registry and medical claims databases. Study subjects included 2308 white and 391 black women diagnosed with breast cancer between 1998 and 2000. Multivariate logistic regression analyses that controlled for demographic factors, tumor characteristics, and comorbidities were used to assess racial differences in the receipt of surgery, chemotherapy, and hormonal therapy. RESULTS There was no significant difference in surgery type, particularly when mastectomy was compared with breast-conserving surgery plus radiation (blacks vs whites: odds ratio [OR], 1.1; 95% confidence interval [CI], 0.8-1.5). Among those with local stage tumors, blacks were as likely as whites to receive chemotherapy (OR, 1.2; 95% CI, 0.9-1.7) and hormonal therapy (OR, 1.0; 95% CI, 0.6-1.4). Among those with regional stage tumors, blacks were significantly less likely than whites to receive chemotherapy (OR, 0.4; 95% CI, 0.2-0.7) and hormonal therapy (OR, 0.5; 95% CI, 0.3-0.8). CONCLUSIONS Even within an equal access health care system, stage-related racial variations in breast cancer treatment are evident. Studies that identify driving factors behind these within-stage racial disparities are warranted.
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Affiliation(s)
- Lindsey Enewold
- United States Military Cancer Institute, Walter Reed Army Medical Center, Washington, DC, USA.
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Nsouli-Maktabi HH, Henson DE, Younes N, Young HA, Cleary SD. Second primary breast, endometrial, and ovarian cancers in Black and White breast cancer survivors over a 35-year time span: effect of age. Breast Cancer Res Treat 2011; 129:963-9. [DOI: 10.1007/s10549-011-1560-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 04/26/2011] [Indexed: 12/01/2022]
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Leung AM, Vu HN, Nguyen KA, Thacker LR, Bear HD. Effects of Surgical Excision on Survival of Patients with Stage IV Breast Cancer. J Surg Res 2010; 161:83-8. [DOI: 10.1016/j.jss.2008.12.030] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Revised: 12/09/2008] [Accepted: 12/19/2008] [Indexed: 01/21/2023]
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Sharma C, Harris L, Haffty BG, Yang Q, Moran MS. Does Compliance with Radiation Therapy Differ in African-American Patients with Early-Stage Breast Cancer? Breast J 2010; 16:193-6. [DOI: 10.1111/j.1524-4741.2009.00874.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sprehn GC, Chambers JE, Saykin AJ, Konski A, Johnstone PAS. Decreased cancer survival in individuals separated at time of diagnosis: critical period for cancer pathophysiology? Cancer 2009; 115:5108-16. [PMID: 19705348 DOI: 10.1002/cncr.24547] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND : It long has been recognized that married patients have improved cancer survival when compared with unmarried patients. This has been postulated as being due to increased support, potentially leading to better compliance with therapy. Conversely, some data exist pointing to a relationship between marital discord and decreased immunity. We examined whether unmarried patients have a different prognosis by whether they are 1) never married, 2) divorced, 3) widowed, or 4) separated at time of diagnosis. METHODS : The public access data of the Surveillance, Epidemiology and End Results (SEER) registry were queried for cancer survival across all 17 registries between 1973 and 2004. SEER last updated data in April 2007. Records of 3.79 million patients were included in the analysis. We specifically analyzed 5-year and 10-year relative survival (RS; 5yRS, 10yRS), defined as observed survival divided by observed survival of an age-matched, race-matched, and gender-matched population without disease, for all cancer patients by marital status, with specific subset analyses as indicated. RESULTS : Among unmarried patients, those separated at time of diagnosis had the lowest survival, followed by widowed, divorced, and never married patients. 5-year and 10-year RS of separated patients was 72% and 64% than that of married patients, respectively. This relationship persists when data are analyzed by gender. CONCLUSIONS : Separated marital status is associated with a significant decrement in cancer survival, even in comparison with other unmarried groups. While other socioeconomic variables could contribute to this phenomenon, further research into the immunologic correlates of the acutely stressful condition of marital separation should be conducted. Cancer 2009. (c) 2009 American Cancer Society.
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Affiliation(s)
- Gwen C Sprehn
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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Abstract
BACKGROUND Black Americans have higher mortality from breast cancer than white Americans. This study explores the influence of socioeconomic factors and black race on treatment and mortality for early-stage breast cancer. METHODS A cohort of 21,848 female black and white, non-Hispanic subjects from the Massachusetts Cancer Registry diagnosed with stage I or II breast cancer between 1999-2004 was studied. Subjects with tumors larger than 5 cm were excluded. We used mixed modeling methods to assess the impact of race on guideline concordant care (GCC), defined as receipt of mastectomy or breast conserving surgery plus radiation. Cox proportional hazard regression was used to assess disease-specific mortality. RESULTS Blacks were less likely to receive GCC after adjusting for age and clinical variables (OR: 0.75; 95% CI: 0.61, 0.92). Marital status and insurance were predictors of receipt of GCC. After adjustment for all covariates, there were no longer significant differences between black and white women regarding the receipt of GCC. Nevertheless, black women were more likely to die of early-stage breast cancer than white women after adjusting for clinical, treatment, socioeconomic variables, and reporting hospital (HR: 1.6; 95% CI: 1.1-2.1). CONCLUSIONS Socioeconomic factors are mediators of racial differences in treatment outcomes. Significant racial differences exist in disease-specific mortality for women with early-stage breast cancer. Attention to reducing socioeconomic barriers to care may influence racial differences in breast cancer treatment and mortality.
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Marks LB, Cirrincione C, Fitzgerald TJ, Laurie F, Glicksman AS, Vredenburgh J, Prosnitz LR, Shpall EJ, Crump M, Richardson PG, Schuster MW, Ma J, Peterson BL, Norton L, Seagren S, Henderson IC, Hurd DD, Peters WP. Impact of high-dose chemotherapy on the ability to deliver subsequent local-regional radiotherapy for breast cancer: analysis of Cancer and Leukemia Group B Protocol 9082. Int J Radiat Oncol Biol Phys 2009; 76:1305-13. [PMID: 19747781 DOI: 10.1016/j.ijrobp.2009.04.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 03/03/2009] [Accepted: 04/04/2009] [Indexed: 01/18/2023]
Abstract
PURPOSE To report, from Cancer and Leukemia Group B Protocol 9082, the impact of high-dose cyclophosphamide, cisplatin, and BCNU (HD-CPB) vs. intermediate-dose CPB (ID-CPB) on the ability to start and complete the planned course of local-regional radiotherapy (RT) for women with breast cancer involving >or=10 axillary nodes. METHODS AND MATERIALS From 1991 to 1998, 785 patients were randomized. The HD-CPB and ID-CPB arms were balanced regarding patient characteristics. The HD-CPB and ID-CPB arms were compared on the probability of RT initiation, interruption, modification, or incompleteness. The impact of clinical variables and interactions between variables were also assessed. RESULTS Radiotherapy was initiated in 82% (325 of 394) of HD-CPB vs. 92% (360 of 391) of ID-CPB patients (p = 0.001). On multivariate analyses, RT was less likely given to patients who were randomized to HD treatment (odds ratio [OR] = 0 .38, p < 0.001), older (p = 0.005), African American (p = 0.003), postmastectomy (p = 0.02), or estrogen receptor positive (p = 0.03). High-dose treatment had a higher rate of RT interruption (21% vs. 12%, p = 0.001, OR = 2.05), modification (29% vs. 14%, p = 0.001, OR = 2.46), and early termination of RT (9% vs. 2%, p = 0.0001, OR = 5.35), compared with ID. CONCLUSION Treatment arm significantly related to initiation, interruption, modification, and early termination of RT. Patients randomized to HD-CPB were less likely to initiate RT, and of those who did, they were more likely to have RT interrupted, modified, and terminated earlier than those randomized to ID-CPB. The observed lower incidence of RT usage in African Americans vs. non-African Americans warrants further study.
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Affiliation(s)
- Lawrence B Marks
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7512, USA.
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Bhargava A, Du XL. Racial and socioeconomic disparities in adjuvant chemotherapy for older women with lymph node-positive, operable breast cancer. Cancer 2009; 115:2999-3008. [PMID: 19452539 DOI: 10.1002/cncr.24363] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Consistent with findings from clinical trials, a recent population-based study indicated that adjuvant chemotherapy for lymph node-positive, operable breast cancer is effective at improving survival in older women, specifically those ages 65 years to 69 years; however, to the authors' knowledge, no conclusion has been reached about the relative benefit of chemotherapy for women aged > or =70 years, probably because of small number of patients. However, little is known about racial and socioeconomic disparities in adjuvant chemotherapy for breast cancer among older women. METHODS This study included 14,177 white women and 1277 black women aged > or =65 years who were diagnosed with operable breast cancer (stage II-IIIA) and positive lymph nodes between 1991 and 2002. These women were identified from the Surveillance, Epidemiology, and End Results and Medicare-linked database. Multivariate logistic regression was used to compute the odds ratios of receiving chemotherapy among black women compared with white women, and the causal step approach was used to test whether census tract-level poverty mediated racial disparities. RESULTS Interaction terms analyses indicated that regressions should be stratified by age group. In the group ages 65 years to 69 years, the adjusted odds ratio of receiving chemotherapy were lower for black women than for white women (odds ratio, 0.85; 95% confidence interval, 0.57-0.97). Poverty mediated the association between chemotherapy and race in this age group. No racial or socioeconomic disparities were observed among women aged > or =70 years. CONCLUSIONS This study documented racial disparities in adjuvant chemotherapy that were mediated by poverty in women ages 65 years to 69 years, an age group for which there is clear evidence for the efficacy of chemotherapy, but no disparities were observed among women aged > or =70 years. The authors concluded that it is important to work toward reducing treatment disparities among older women.
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Affiliation(s)
- Alessia Bhargava
- Department of Economics, Yale University, New Haven, Connecticut, USA
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Harper S, Lynch J, Meersman SC, Breen N, Davis WW, Reichman MC. Trends in area-socioeconomic and race-ethnic disparities in breast cancer incidence, stage at diagnosis, screening, mortality, and survival among women ages 50 years and over (1987-2005). Cancer Epidemiol Biomarkers Prev 2009; 18:121-31. [PMID: 19124489 DOI: 10.1158/1055-9965.epi-08-0679] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among women in the United States and varies systematically by race-ethnicity and socioeconomic status. Previous research has often focused on disparities between particular groups, but few studies have summarized disparities across multiple subgroups defined by race-ethnic and socioeconomic position. METHODS Data on breast cancer incidence, stage, mortality, and 5-year cause-specific probability of death (100 - survival) were obtained from the Surveillance, Epidemiology, and End Results program and data on mammography screening from the National Health Interview Survey from 1987 to 2005. We used four area-socioeconomic groups based on the percentage of poverty in the county of residence (<10, 10-15, 15-20, +20%) and five race-ethnic groups (White, Black, Asian, American Indian, and Hispanic). We used summary measures of disparity based on both rate differences and rate ratios. RESULTS From 1987 to 2004, area-socioeconomic disparities declined by 20% to 30% for incidence, stage at diagnosis, and 5-year cause-specific probability of death, and by roughly 100% for mortality, whether measured on the absolute or relative scale. In contrast, relative area-socioeconomic disparities in mammography use increased by 161%. Absolute race-ethnic disparities declined across all outcomes, with the largest reduction for mammography (56% decline). Relative race-ethnic disparities for mortality and 5-year cause-specific probability of death increased by 24% and 17%, respectively. CONCLUSIONS Our analysis suggests progress towards race-ethnic and area-socioeconomic disparity goals for breast cancer, especially when measured on the absolute scale. However, greater progress is needed to address increasing relative socioeconomic disparities in mammography and race-ethnic disparities in mortality and 5-year cause-specific probability of death.
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Affiliation(s)
- Sam Harper
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Room 34, Montreal, Quebec, Canada H3A 1A2.
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Yang R, Cheung MC, Franceschi D, Hurley J, Huang Y, Livingstone AS, Koniaris LG. African-American and low-socioeconomic status patients have a worse prognosis for invasive ductal and lobular breast carcinoma: do screening criteria need to change? J Am Coll Surg 2009; 208:853-68; discussion 869-70. [PMID: 19476849 DOI: 10.1016/j.jamcollsurg.2008.10.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2008] [Accepted: 10/07/2008] [Indexed: 12/15/2022]
Abstract
BACKGROUND Determine the effect of race, socioeconomic status (SES) and other demographic variables on outcomes of patients with invasive ductal and lobular breast cancer. STUDY DESIGN Florida cancer registry and inpatient hospital data were queried for patients diagnosed with invasive breast cancer from 1998 to 2002. RESULTS A total of 63,472 patients with breast cancer were identified. Overall, 90.5% of patients were Caucasian, 7.6% African American, and 8.7% Hispanic. African-American patients presented at a younger age and with more-advanced disease, 10.5% presented with breast cancer before the age of 40 years, and 22.4% before 45 years of age. African-American patients were less likely to undergo operations. Similarly, low-SES patients were less likely to have operations and presented more often with larger tumors. Stepwise multivariate analysis revealed a substantial drop in the hazard ratio for African-American patients once correction for stage of presentation was made, suggesting that disparities in breast cancer outcomes are, in part, a result of advanced stage at presentation. Race and low SES were independent predictors of worse prognosis when controlling for patient comorbidities and treatment. CONCLUSIONS Dramatic disparities by patient race and SES exist in breast cancer. Our study integrates previous smaller studies, providing comprehensive insight into African-American patients and their outcomes for breast cancer. Earlier screening programs and greater access to cancer care for the poor and African Americans are needed. Successful institution of such programs will not completely erase disparities in outcomes for breast cancer in African-American patients.
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MESH Headings
- Adult
- Black or African American/statistics & numerical data
- Aged
- Aged, 80 and over
- Breast Neoplasms/epidemiology
- Breast Neoplasms/ethnology
- Breast Neoplasms/mortality
- Breast Neoplasms/prevention & control
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/ethnology
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/prevention & control
- Carcinoma, Lobular/epidemiology
- Carcinoma, Lobular/ethnology
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/prevention & control
- Female
- Hispanic or Latino/statistics & numerical data
- Humans
- Male
- Mass Screening
- Middle Aged
- Multivariate Analysis
- Prognosis
- Social Class
- Survival Analysis
- White People/statistics & numerical data
- Young Adult
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Affiliation(s)
- Relin Yang
- DeWitt Daughtry Family Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
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