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James SE, Riggan KA, Halyard M, Kelly M, Cobran E, Allyse MA. The "Strong Black Woman" Paradox: Insights from a Cohort of Black Breast and Ovarian Cancer Patients and Family Members. J Racial Ethn Health Disparities 2024:10.1007/s40615-023-01905-x. [PMID: 38191790 PMCID: PMC11288339 DOI: 10.1007/s40615-023-01905-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND The strong Black woman (SBW) stereotype can be seen as a positive view of Black women and even a standard to uphold. SBW internalization is a coping mechanism for dealing with racism and sexism. However, multiple recent studies have indicated that Black women in the modern era experience the paradox of SBW internalization having negative generational health effects. We interviewed Black women with a personal or relation diagnosis of breast or ovarian cancer to understand their views and experiences, including how the perception of the SBW stereotype influenced their care. METHODS Qualitative semi-structured interviews were conducted via telephone or video conference and transcribed verbatim. Transcripts were qualitatively analyzed for iterative themes related to cancer care and psychosocial support. RESULTS Sixty-one Black women completed an interview. Responses in multiple transcripts expressed experiences and sentiments consistent with the SBW stereotype, including the importance of maintaining the appearance of strength during their cancer journey. This resulted in some patients declining assistance during their cancer journeys. Participants shared a hope that there would be more willingness to show vulnerability so that future generations of cancer patients receive adequate support. Key aspects of the SBW stereotype were also cited as potential contributors to ongoing racial disparities in breast and ovarian cancer outcomes. CONCLUSION(S) Participants described a paradox of the SBW stereotype that is ultimately detrimental to health and wellbeing. Healthcare professionals and cancer researchers should be aware of this phenomenon to address cancer care more appropriately in Black women.
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Affiliation(s)
- Sarah E James
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA.
- Coalition of Blacks Against Breast Cancer, Phoenix, AZ, USA.
| | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Michele Halyard
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
- Coalition of Blacks Against Breast Cancer, Phoenix, AZ, USA
| | - Marion Kelly
- Coalition of Blacks Against Breast Cancer, Phoenix, AZ, USA
- Department of Community Engagement, Mayo Clinic, Scottsdale, AZ, USA
| | - Ewan Cobran
- Department of Quantitative Health Science, Mayo Clinic, Scottsdale, AZ, USA
| | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA
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Higgason N, Soroka O, Goyal P, Mahmood SS, Pinheiro LC. Suboptimal Cardiology Follow-Up Among Patients With and Without Cancer Hospitalized for Heart Failure. Am J Cardiol 2023; 196:79-86. [PMID: 37019746 PMCID: PMC10297727 DOI: 10.1016/j.amjcard.2023.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/19/2023] [Accepted: 02/25/2023] [Indexed: 04/07/2023]
Abstract
Many patients hospitalized for heart failure (HF) do not receive recommended follow-up cardiology care, and non-White patients are less likely to receive follow-up than White patients. Poor HF management may be particularly problematic in patients with cancer because cardiovascular co-morbidity can delay cancer treatments. Therefore, we sought to describe outpatient cardiology care patterns in patients with cancer hospitalized for HF and to determine if receipt of follow-up varied by race/ethnicity. SEER (Surveillance, Epidemiology, and End Results) data from 2007 to 2013 linked to Medicare claims from 2006 to 2014 were used. We included patients aged 66+ years with breast, prostate, or colorectal cancer, and preexisting HF. Patients with cancer were matched to patients in a noncancer cohort that included individuals with HF and no cancer. The primary outcome was receipt of an outpatient, face-to-face cardiologist visit within 30 days of HF hospitalization. We compared follow-up rates between cancer and noncancer cohorts, and stratified analyses by race/ethnicity. A total of 2,356 patients with cancer and 2,362 patients without cancer were included. Overall, 43% of patients with cancer and 42% of patients without cancer received cardiologist follow-up (p = 0.30). After multivariable adjustment, White patients were 15% more likely to receive cardiology follow-up than Black patients (95% confidence interval [CI] 1.02 to 1.30). Black patients with cancer were 41% (95% CI 1.11 to 1.78) and Asian patients with cancer were 66% (95% CI 1.11 to 2.49) more likely to visit a cardiologist than their noncancer counterparts. In conclusion, less than half of patients with cancer hospitalized for HF received recommended follow-up with a cardiologist, and significant race-related differences in cardiology follow-up exist. Future studies should investigate the reasons for these differences.
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Affiliation(s)
- Noel Higgason
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas.
| | - Orysya Soroka
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Parag Goyal
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York; Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Syed S Mahmood
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Laura C Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York; Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
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Doose M, Verhoeven D, Sanchez JI, McGee-Avila JK, Chollette V, Weaver SJ. Clinical Multiteam System Composition and Complexity Among Newly Diagnosed Early-Stage Breast, Colorectal, and Lung Cancer Patients With Multiple Chronic Conditions: A SEER-Medicare Analysis. JCO Oncol Pract 2023; 19:e33-e42. [PMID: 36473151 PMCID: PMC10166428 DOI: 10.1200/op.22.00304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/23/2022] [Accepted: 09/30/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Sixty percent of adults have multiple chronic conditions at cancer diagnosis. These patients may require a multidisciplinary clinical team-of-teams, or a multiteam system (MTS), of high-complexity involving multiple specialists and primary care, who, ideally, coordinate clinical responsibilities, share information, and align clinical decisions to ensure comprehensive care needs are managed. However, insights examining MTS composition and complexity among individuals with cancer and comorbidities at diagnosis using US population-level data are limited. METHODS Using SEER-Medicare data (2006-2016), we identified newly diagnosed patients with breast, colorectal, or lung cancer who had a codiagnosis of cardiopulmonary disease and/or diabetes (n = 75,201). Zaccaro's theory-based classification of MTSs was used to categorize clinical MTS complexity in the 4 months following cancer diagnosis: high-complexity (≥ 4 clinicians from ≥ 2 specialties) and low-complexity (1-3 clinicians from 1-2 specialties). We describe the proportions of patients with different MTS compositions and quantify the incidence of high-complexity MTS care by patient groups. RESULTS The most common MTS composition was oncology with primary care (37%). Half (50.3%) received high-complexity MTS care. The incidence of high-complexity MTS care for non-Hispanic Black and Hispanic patients with cancer was 6.7% (95% CI, -8.0 to -5.3) and 4.7% (95% CI, -6.3 to -3.0) lower than non-Hispanic White patients with cancer; 13.1% (95% CI, -14.1 to -12.2) lower for rural residents compared with urban; 10.4% (95% CI, -11.2 to -9.5) lower for dual Medicaid-Medicare beneficiaries compared with Medicare-only; and 16.6% (95% CI, -17.5 to -15.8) lower for colorectal compared with breast cancer. CONCLUSION Incidence differences of high-complexity MTS care were observed among cancer patients with multiple chronic conditions from underserved populations. The results highlight the need to further understand the effects of and mechanisms through which care team composition, complexity, and functioning affect care quality and outcomes.
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Affiliation(s)
- Michelle Doose
- Division of Clinical and Health Services Research, National Institute on Minority Health and Health Disparities, Bethesda, MD
| | - Dana Verhoeven
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Janeth I Sanchez
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Jennifer K McGee-Avila
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Veronica Chollette
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Sallie J Weaver
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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Doose M, Sanchez JI, Cantor JC, Plascak JJ, Steinberg MB, Hong CC, Demissie K, Bandera EV, Tsui J. Fragmentation of Care Among Black Women With Breast Cancer and Comorbidities: The Role of Health Systems. JCO Oncol Pract 2021; 17:e637-e644. [PMID: 33974834 DOI: 10.1200/op.20.01089] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Black women are disproportionately burdened by comorbidities and breast cancer. The complexities of coordinating care for multiple health conditions can lead to adverse consequences. Care coordination may be exacerbated when care is received outside the same health system, defined as care fragmentation. We examine types of practice setting for primary and breast cancer care to assess care fragmentation. MATERIALS AND METHODS We analyzed data from a prospective cohort of Black women diagnosed with breast cancer in New Jersey who also had a prior diagnosis of diabetes and/or hypertension (N = 228). Following breast cancer diagnosis, we examined types of practice setting for first primary care visit and primary breast surgery, through medical chart abstraction, and identified whether care was used within or outside the same health system. We used multivariable logistic regression to explore sociodemographic and clinical factors associated with care fragmentation. RESULTS Diverse primary care settings were used: medical groups (32.0%), health systems (29.4%), solo practices (23.7%), Federally Qualified Health Centers (8.3%), and independent hospitals (6.1%). Surgical care predominately occurred in health systems (79.8%), with most hospitals being Commission on Cancer-accredited. Care fragmentation was experienced by 78.5% of Black women, and individual-level factors (age, health insurance, cancer stage, and comorbidity count) were not associated with care fragmentation (P > .05). CONCLUSION The majority of Black breast cancer survivors with comorbidities received primary care and surgical care in different health systems, illustrating care fragmentation. Strategies for care coordination and health care delivery across health systems and practice settings are needed for health equity.
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Affiliation(s)
- Michelle Doose
- Helthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD.,Rutgers School of Public Health, Piscataway, NJ.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Janeth I Sanchez
- Helthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Joel C Cantor
- Rutgers Center for State Health Policy, New Brunswick, NJ.,Rutgers Edward J. Bloustein School of Planning and Public Policy, New Brunswick, NJ
| | | | | | - Chi-Chen Hong
- University at Buffalo, Buffalo, NY.,Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | - Elisa V Bandera
- Rutgers School of Public Health, Piscataway, NJ.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Jennifer Tsui
- Rutgers Center for State Health Policy, New Brunswick, NJ.,Keck School of Medicine, University of Southern California, Los Angeles, CA
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