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Yanguela J, Jackson BE, Reeder-Hayes KE, Roberson ML, Rocque GB, Kuo TM, LeBlanc MR, Baggett CD, Green L, Laurie-Zehr E, Wheeler SB. Simulating the population impact of interventions to reduce racial gaps in breast cancer treatment. J Natl Cancer Inst 2024; 116:902-910. [PMID: 38281076 PMCID: PMC11160503 DOI: 10.1093/jnci/djae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/16/2024] [Accepted: 01/21/2024] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND Inequities in guideline-concordant treatment receipt contribute to worse survival in Black patients with breast cancer. Inequity-reduction interventions (eg, navigation, bias training, tracking dashboards) can close such treatment gaps. We simulated the population-level impact of statewide implementation of inequity-reduction interventions on racial breast cancer inequities in North Carolina. METHODS Using registry-linked multipayer claims data, we calculated inequities between Black and White patients receiving endocrine therapy (n = 12 033) and chemotherapy (n = 1819). We then built cohort-stratified (endocrine therapy and chemotherapy) and race-stratified Markov models to simulate the potential increase in the proportion of patients receiving endocrine therapy or chemotherapy and subsequent improvements in breast cancer outcomes if inequity-reducing intervention were implemented statewide. We report uncertainty bounds representing 95% of simulation results. RESULTS In total, 75.6% and 72.1% of Black patients received endocrine therapy and chemotherapy, respectively, over the 2006-2015 and 2004-2015 periods (vs 79.3% and 78.9% of White patients, respectively). Inequity-reduction interventions could increase endocrine therapy and chemotherapy receipt among Black patients to 89.9% (85.3%, 94.6%) and 85.7% (80.7%, 90.9%). Such interventions could also decrease 5-year and 10-year breast cancer mortality gaps from 3.4 to 3.2 (3.0, 3.3) and from 6.7 to 6.1 (5.9, 6.4) percentage points in the endocrine therapy cohorts and from 8.6 to 8.1 (7.7, 8.4) and from 8.2 to 7.8 (7.3, 8.1) percentage points in the chemotherapy cohorts. CONCLUSIONS Inequity-focused interventions could improve cancer outcomes for Black patients, but they would not fully close the racial breast cancer mortality gap. Addressing other inequities along the cancer continuum (eg, screening, pre- and postdiagnosis risk factors) is required to achieve full equity in breast cancer outcomes.
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Affiliation(s)
- Juan Yanguela
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Bradford E Jackson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katherine E Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mya L Roberson
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gabrielle B Rocque
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tzy-Mey Kuo
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Matthew R LeBlanc
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Nursing, 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, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Laura Green
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Erin Laurie-Zehr
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie B Wheeler
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Halpern MT, McNeel TS, Kozono D, Mollica MA. Association of Patient Experience of Care and Radiation Therapy Initiation Among Women With Early-Stage Breast Cancer. Pract Radiat Oncol 2023; 13:434-443. [PMID: 37150319 PMCID: PMC10524855 DOI: 10.1016/j.prro.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/11/2023] [Accepted: 04/21/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE For women diagnosed with early-stage breast cancer, lumpectomy followed by radiation therapy (RT) has been a guideline-recommended treatment. However, lumpectomy followed by hormonal therapy is also an approved treatment for certain women. It is unclear what patient-driven factors are related to decisions to receive RT. This study examined relationships between patient-reported experience of care, an important dimension of health care quality, and receipt of RT after lumpectomy. METHODS AND MATERIALS We used National Cancer Institute Surveillance, Epidemiology, and End Results data linked to the CMS Medicare Consumer Assessment of Healthcare Providers and Systems patient surveys (SEER-CAHPS) to examine experiences of care among women diagnosed with local/regional stage breast cancer 2000 to 2017 who received lumpectomy, were enrolled in fee-for-service Medicare, completed a CAHPS survey ≤18 months after diagnosis, and survived for this study period. Experience of care was assessed by patient-provided scores for physicians, doctor communication, care coordination, and other aspects of care. Multivariable logistic regression models assessed associations of receipt of external beam RT with care experience and patient sociodemographic and clinical characteristics. RESULTS The study population included 824 women; 655 (79%) received RT. Women with higher experience of care scores for their personal doctor were significantly more likely to have received any RT (odds ratio [OR], 1.18; P = .033). Nonsignificant trends were observed for associations of increased RT with higher CAHPS measures of doctor communications (OR, 1.15; P = .055) and care coordination (OR, 1.24; P = .051). In contrast, women reporting higher scores for Part D prescription drug plans were significantly less likely to have received RT (OR, 0.78; P = .030). CONCLUSIONS Patient experience of care was significantly associated with receipt of RT after lumpectomy among women with breast cancer. Health care organization leaders may want to consider incorporating experience of care into quality improvement initiatives and other activities that aim to improve patient decision-making, care, and outcomes.
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Affiliation(s)
- Michael T Halpern
- Division of Cancer Control and Populations Sciences, National Cancer Institute, Bethesda, Maryland.
| | | | - David Kozono
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Michelle A Mollica
- Division of Cancer Control and Populations Sciences, National Cancer Institute, Bethesda, Maryland
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Mantz CA, Thaker NG, Deville C, Hubbard A, Pendyala P, Mohideen N, Kavadi V, Winkfield KM. A Medicare Claims Analysis of Racial and Ethnic Disparities in the Access to Radiation Therapy Services. J Racial Ethn Health Disparities 2023; 10:501-508. [PMID: 35064522 DOI: 10.1007/s40615-022-01239-0] [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: 09/01/2021] [Revised: 12/20/2021] [Accepted: 01/12/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Reduced access and utilization of radiation therapy (RT) is a well-documented healthcare disparity observed among racial and ethnic minority groups in the USA and a contributor to the inferior health outcomes observed among Black, Hispanic, and Native American patient groups. What is less understood are the points during the process of care following RT consultation at which patients either fail to complete their prescribed treatment or encounter delays. Identification of those points where significant differences exist among different patient groups may help identify opportunities to close gaps in the access of clinically indicated RT. METHODS AND MATERIALS This analysis examines 261,559 RT episodes abstracted from Medicare claims and beneficiary data between 2016 and 2018 to determine rates of treatment initiation following planning and timeliness of treatment completion for different racial groups. RESULTS Failure to initiate treatment was observed to be 29.3% relatively greater for Black, Hispanic, and Native American patients than for White and Asian patients. Among episodes for which treatment was initiated, Black and Hispanic patients were observed to require a significantly greater number of calendar days (when adjusted for fraction number) for completion than for White, Asian, and Native American patients. CONCLUSIONS There appears to be a patient cohort for which RT disparities may be more marginal in their effects-allowing for access to consultation and treatment prescription but not for treatment initiation or timely completion of treatment-and may therefore permit effective solutions to help address current differences in cancer outcomes.
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Affiliation(s)
| | | | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Anne Hubbard
- American Society for Radiation Oncology, Fairfax, VA, USA
| | - Praveen Pendyala
- Rutgers Cancer Institute of New Jersey, North Brunswick, NJ, USA
| | | | | | - Karen M Winkfield
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
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Sutton AL, He J, Edmonds MC, Sheppard VB. Medical Mistrust in Black Breast Cancer Patients: Acknowledging the Roles of the Trustor and the Trustee. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:600-607. [PMID: 29552705 PMCID: PMC7061268 DOI: 10.1007/s13187-018-1347-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Studies indicate that Black patients report higher medical mistrust compared to their White counterparts. However, little is known about factors associated with higher medical mistrust among Black breast cancer patients. We examined predictors of medical mistrust and relationships between medical mistrust, subscales of mistrust, and process of care factors to identify opportunities to promote positive healthcare interactions between the trustees (e.g., providers) and Black breast cancer patients, or the trustors. A secondary analysis was conducted of survey data from 210 Black women with confirmed diagnosis of invasive breast cancer. Participants completed telephone surveys consisting of questions pertaining to sociodemographics, attitudes, and beliefs about medical care and breast cancer treatments. Multiple linear regression determined factors associated with medical mistrust and mistrust subscales. Most participants (61%) were over the age of 50 and currently single (64.8%). Women with greater medical mistrust reported less satisfaction with the trustee's technical ability (p < 0.0001) and greater satisfaction with their own propensity to access care (p < 0.05). Additionally, women with public insurance demonstrated greater mistrust (p < 0.01) and suspicion (p < 0.05) than women with private insurance, and women with less education reported greater perceived discrimination than women who have at least a bachelor's degree. Findings from this study may inform future endeavors to educate providers on ways to effectively interact with and treat Black breast cancer patients. Opportunities to develop interventions that address and tackle issues of mistrust as reported by Black patients may contribute to ongoing efforts to reduce health disparities.
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Affiliation(s)
- Arnethea L Sutton
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, 9th Floor, Suite 919, Richmond, VA, 23219, USA.
| | - Jun He
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, 9th Floor, Suite 919, Richmond, VA, 23219, USA
| | - Megan C Edmonds
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, 9th Floor, Suite 919, Richmond, VA, 23219, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, 9th Floor, Suite 919, Richmond, VA, 23219, USA
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McClelland S, Kaleem T, Bernard ME, Ahmed HZ, Sio TT, Miller RC. The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States-Part 4: Appalachian patients. Adv Radiat Oncol 2018; 3:471-477. [PMID: 30370344 PMCID: PMC6200890 DOI: 10.1016/j.adro.2018.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 12/17/2022] Open
Abstract
Purpose Compared with the rest of the United States, the population of Appalachia has lower education levels, higher rates of poverty, and limited access to health care. The presence of disparities in radiation therapy (RT) access for Appalachian patients with cancer has rarely been examined. Methods and materials The National Cancer Institute initiatives toward addressing disparities in treatment access for rural populations were examined. An extensive literature search was undertaken for studies investigating RT access disparities in Appalachian patients, beginning with the most common cancers in these patients (lung, colorectal, and cervical). Results Although the literature investigating RT access disparities in Appalachia is relatively sparse, studies examining lung, colorectal, cervical, prostate, head and neck, breast, and esophageal cancer, as well as lymphoma, indicate an unfortunate commonality in barriers to optimal RT access for Appalachian patients with cancer. These barriers are predominantly socioeconomic in nature (low income and lack of private insurance) but are exacerbated by paucities in both the number and quality of radiation centers that are accessible to this patient population. Conclusions Regardless of organ system, there are significant barriers for Appalachian patients with cancer to receive RT. Such diminished access is alarming and warrants resources devoted to addressing these disparities, which often go overlooked because of the assumption that the overall wealth of the United States is tangibly applicable to all of its citizens. Without intelligently targeted investments of time and finances in this arena, there is great risk of exacerbating rather than alleviating the already heavy burden facing Appalachian patients with cancer.
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Affiliation(s)
- Shearwood McClelland
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
| | - Tasneem Kaleem
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Mark E Bernard
- Department of Radiation Oncology, University of Kentucky, Lexington, Kentucky
| | - Hiba Z Ahmed
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Robert C Miller
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
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Regional diagnostic rates, treatments, and outcomes among patients with invasive ductal carcinoma. J Surg Res 2018; 229:114-121. [PMID: 29936977 DOI: 10.1016/j.jss.2018.03.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/12/2018] [Accepted: 03/28/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND The association between regional breast cancer diagnostic rates, treatments, and outcomes is unclear. We sought to investigate the management and survival of women with invasive ductal carcinoma (IDC) from geographic regions with variable rates of diagnosis. METHODS Data on women diagnosed with IDC years 2009-2010 were obtained from the Surveillance, Epidemiology, and End Results database. Patients were divided into quartiles based on the IDC diagnostic rate within their county of residence. Chi-square and one-way analysis of variance (ANOVA) analyses tested the association between patient and clinical characteristics and the diagnostic rate quartiles. Cox regression analyses compared survival between the quartiles. RESULTS Among the 83,375 patients included, the mean age was 60.8 y and 70.9% were white. Patients residing in counties with the highest diagnostic rates were more frequently white, employed, educated, and wealthier and more often received adjuvant radiation following both partial mastectomy for localized disease and complete mastectomy for advanced disease compared to patients in counties with the lowest diagnostic rates. The highest diagnostic rate quartile had 10% decreased odds of death compared to the lower quartile (hazard ratio: 0.897; 95% confidence interval: 0.832-0.966). However, after adjustment for socioeconomic variables, survival was comparable (hazard ratio: 0.916; 95% confidence interval: 0.835-1.003). CONCLUSIONS Regional variation in IDC diagnostic rates is associated with differences in socioeconomic status, grade, stage, and treatment. Patients from regions with the highest rates of diagnosis may have improved access to evidence-based care and resultant superior survival. Enhancing access to care may improve outcomes of patients residing in regions where breast cancer is diagnosed less frequently.
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Kong AL, Nattinger AB, McGinley E, Pezzin LE. The relationship between patient and tumor characteristics, patterns of breast cancer care, and 5-year survival among elderly women with incident breast cancer. Breast Cancer Res Treat 2018; 171:477-488. [DOI: 10.1007/s10549-018-4837-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/25/2018] [Indexed: 11/29/2022]
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Treatment Patterns Among Women Diagnosed With Stage I-III Triple-negative Breast Cancer. Am J Clin Oncol 2017; 41:997-1007. [PMID: 29278527 DOI: 10.1097/coc.0000000000000418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine contemporary treatment patterns for women diagnosed with stage I-III triple-negative breast cancer (TNBC) in the United States. METHODS We identified 48,961 patients diagnosed with stage I-III TNBC from 2010 to 2013 in the National Cancer Data Base and created 3 treatment subcohorts (definitive locoregional therapy [appropriate local therapy, including surgery/radiation], adjuvant chemotherapy [stage II-III disease or stage I tumors with tumor size ≥1 cm], and adjuvant chemotherapy for small tumors [stage I tumors with tumor size <1 cm and node negative]). We performed descriptive analyses, calculated percentages for treatment receipt, and used multivariable modified Poisson regression models to estimate risk ratios (RRs) with 95% confidence intervals (CIs) predicting receipt of treatments. RESULTS Older age, larger tumor size, positive nodal status, and Southern/Pacific US regions, but not race/ethnicity, were strongly associated with a lower probability of receiving definitive locoregional therapy. Older age was also strongly associated with lower likelihood of adjuvant chemotherapy receipt, as were grade, negative nodal status, and higher comorbidity. For example, compared with women aged 18 to 39 years, those aged 75 to 90 years were 17% less likely to receive definitive locoregional therapy (RR, 0.83; 95% CI, 0.73-0.88), and 62% less likely to receive adjuvant chemotherapy (RR, 0.38; 95% CI, 0.35-0.41). Age, tumor grade, tumor size, and comorbidity score were also independently associated with receipt of chemotherapy for women with small TNBC. CONCLUSIONS Advancing age but not race/ethnicity was associated with lower likelihood of recommended treatment receipt among women with TNBC. Although omission of therapy among older patients with breast cancer may be appropriate in the case of smaller and lower risk TNBC, some were likely undertreated.
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McClelland S, Page BR, Jaboin JJ, Chapman CH, Deville C, Thomas CR. The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States, part 1: African-American patients. Adv Radiat Oncol 2017; 2:523-531. [PMID: 29204518 PMCID: PMC5707425 DOI: 10.1016/j.adro.2017.07.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/03/2017] [Accepted: 07/11/2017] [Indexed: 01/05/2023] Open
Abstract
Introduction African Americans experience the highest burden of cancer incidence and mortality in the United States and have been persistently less likely to receive interventional care, even when such care has been proven superior to conservative management by randomized controlled trials. The presence of disparities in access to radiation therapy (RT) for African American cancer patients has rarely been examined in an expansive fashion. Methods and materials An extensive literature search was performed using the PubMed database to examine studies investigating disparities in RT access for African Americans. Results A total of 55 studies were found, spanning 11 organ systems. Disparities in access to RT for African Americans were most prominently study in cancers of the breast (23 studies), prostate (7 studies), gynecologic system (5 studies), and hematologic system (5 studies). Disparities in RT access for African Americans were prevalent regardless of organ system studied and often occurred independently of socioeconomic status. Fifty of 55 studies (91%) involved analysis of a population-based database such as Surveillance, Epidemiology and End Result (SEER; 26 studies), SEER-Medicare (5 studies), National Cancer Database (3 studies), or a state tumor registry (13 studies). Conclusions African Americans in the United States have diminished access to RT compared with Caucasian patients, independent of but often in concert with low socioeconomic status. These findings underscore the importance of finding systemic and systematic solutions to address these inequalities to reduce the barriers that patient race provides in receipt of optimal cancer care.
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Affiliation(s)
- Shearwood McClelland
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
| | - Brandi R Page
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Jerry J Jaboin
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
| | - Christina H Chapman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
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Reeder-Hayes KE, Anderson BO. Breast Cancer Disparities at Home and Abroad: A Review of the Challenges and Opportunities for System-Level Change. Clin Cancer Res 2017; 23:2655-2664. [PMID: 28572260 PMCID: PMC5499686 DOI: 10.1158/1078-0432.ccr-16-2630] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/03/2017] [Accepted: 04/06/2017] [Indexed: 01/06/2023]
Abstract
Sizeable disparities exist in breast cancer outcomes, both between Black and White patients in the United States, and between patients in the United States and other high-income countries compared with low- and middle-income countries (LMIC). In both settings, health system factors are key drivers of disparities. In the United States, Black women are more likely to die of breast cancer than Whites and have poorer outcomes, even among patients with similar stage and tumor subtype. Over-representation of higher risk "triple-negative" breast cancers contributes to breast cancer mortality in Black women; however, the greatest survival disparities occur within the good-prognosis hormone receptor-positive (HR+) subtypes. Disparities in access to treatment within the complex U.S. health system may be responsible for a substantial portion of these differences in survival. In LMICs, breast cancer mortality rates are substantially higher than in the United States, whereas incidence continues to rise. This mortality burden is largely attributable to health system factors, including late-stage presentation at diagnosis and lack of availability of systemic therapy. This article will review the existing evidence for how health system factors in the United States contribute to breast cancer disparities, discuss methods for studying the relationship of health system factors to racial disparities, and provide examples of health system interventions that show promise for mitigating breast cancer disparities. We will then review evidence of global breast cancer disparities in LMICs, the treatment factors that contribute to these disparities, and actions being taken to combat breast cancer disparities around the world. Clin Cancer Res; 23(11); 2655-64. ©2017 AACRSee all articles in this CCR Focus section, "Breast Cancer Research: From Base Pairs to Populations."
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Affiliation(s)
- Katherine E Reeder-Hayes
- Division of Hematology and Oncology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
- The University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Benjamin O Anderson
- Departments of Surgery and Global Health Medicine, School of Medicine, University of Washington, Seattle, Washington
- Program in Epidemiology, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Campbell JE, Janitz AE, Vesely SK, Lloyd D, Pate A. Patterns of Care for Localized Breast Cancer in Oklahoma, 2003-2006. Women Health 2015; 55:975-95. [PMID: 26133913 DOI: 10.1080/03630242.2015.1061095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Despite well-established clinical guidelines for breast cancer treatment, Standard of Care (SOC) is not universal in the U.S. The purpose of this study was to describe the extent to which patients receive guideline-based, stage-specific treatments for localized female breast cancer in Oklahoma. Data were obtained from the Oklahoma Central Cancer Registry for the period 2003-2006. We included localized, invasive female breast cancers and analyzed both treatment and demographic factors. We used the National Comprehensive Cancer Network (NCCN) treatment guidelines to determine SOC. Among women who received breast conserving surgery (BCS), we used logistic regression to evaluate factors related to SOC. In Oklahoma, 92 percent of the 4,177 localized breast cancer patients were treated with recognized SOC. In women aged ≥65 years with BCS, those ≥75 years had a lower adjusted odds of meeting SOC than did those without insurance, with comorbid conditions, or whose comorbid status was unknown. Among women aged <65 years, those with Medicare/Medicaid, Medicare only, or without insurance, along with comorbid conditions, had a lower adjusted odds of meeting SOC. Overall, 92 percent of women met SOC. Factors such as age, insurance type, and comorbid conditions were associated with meeting SOC.
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Affiliation(s)
- Janis E Campbell
- a Department of Biostatistics and Epidemiology , College of Public Health, University of Oklahoma Health Sciences Center , Oklahoma City , Oklahoma , USA
| | - Amanda E Janitz
- a Department of Biostatistics and Epidemiology , College of Public Health, University of Oklahoma Health Sciences Center , Oklahoma City , Oklahoma , USA
| | - Sara K Vesely
- a Department of Biostatistics and Epidemiology , College of Public Health, University of Oklahoma Health Sciences Center , Oklahoma City , Oklahoma , USA
| | - Dana Lloyd
- b Department of Health Information Management , Southwestern Oklahoma State University , Weatherford , Oklahoma , USA
| | - Anne Pate
- c School of Nursing and Allied Health Sciences , Southwestern Oklahoma State University , Weatherford , Oklahoma , USA
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Camacho-Rivera M, Ragin C, Roach V, Kalwar T, Taioli E. Breast Cancer Clinical Characteristics and Outcomes in Trinidad and Tobago. J Immigr Minor Health 2013; 17:765-72. [DOI: 10.1007/s10903-013-9930-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Luu C, Goldstein L, Goldner B, Schoellhammer HF, Chen SL. Trends in Radiotherapy After Breast-Conserving Surgery in Elderly Patients with Early-Stage Breast Cancer. Ann Surg Oncol 2013; 20:3266-73. [DOI: 10.1245/s10434-013-3150-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Indexed: 01/20/2023]
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Peipins LA, Graham S, Young R, Lewis B, Flanagan B. Racial disparities in travel time to radiotherapy facilities in the Atlanta metropolitan area. Soc Sci Med 2013; 89:32-8. [PMID: 23726213 PMCID: PMC5836478 DOI: 10.1016/j.socscimed.2013.04.018] [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] [Received: 07/26/2012] [Revised: 02/19/2013] [Accepted: 04/18/2013] [Indexed: 10/26/2022]
Abstract
Low-income women with breast cancer who rely on public transportation may have difficulty in completing recommended radiation therapy due to inadequate access to radiation facilities. Using a geographic information system (GIS) and network analysis we quantified spatial accessibility to radiation treatment facilities in the Atlanta, Georgia metropolitan area. We built a transportation network model that included all bus and rail routes and stops, system transfers and walk and wait times experienced by public transportation system travelers. We also built a private transportation network to model travel times by automobile. We calculated travel times to radiation therapy facilities via public and private transportation from a population-weighted center of each census tract located within the study area. We broadly grouped the tracts by low, medium and high household access to a private vehicle and by race. Facility service areas were created using the network model to map the extent of areal coverage at specified travel times (30, 45 and 60 min) for both public and private modes of transportation. The median public transportation travel time to the nearest radiotherapy facility was 56 min vs. approximately 8 min by private vehicle. We found that majority black census tracts had longer public transportation travel times than white tracts across all categories of vehicle access and that 39% of women in the study area had longer than 1 h of public transportation travel time to the nearest facility. In addition, service area analyses identified locations where the travel time barriers are the greatest. Spatial inaccessibility, especially for women who must use public transportation, is one of the barriers they face in receiving optimal treatment.
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Affiliation(s)
- Lucy A Peipins
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, Atlanta, GA 30341, USA.
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Gorey KM, Luginaah IN, Holowaty EJ, Zou G, Hamm C, Balagurusamy MK. Mediation of the effects of living in extremely poor neighborhoods by health insurance: breast cancer care and survival in California, 1996 to 2011. Int J Equity Health 2013; 12:6. [PMID: 23311824 PMCID: PMC3599601 DOI: 10.1186/1475-9276-12-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 01/07/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We examined the mediating effect of health insurance on poverty-breast cancer care and survival relationships and the moderating effect of poverty on health insurance-breast cancer care and survival relationships in California. METHODS Registry data for 6,300 women with breast cancer diagnosed between 1996 and 2000 and followed until 2011 on stage at diagnosis, surgeries, adjuvant treatments and survival were analyzed. Socioeconomic data were obtained for residences from the 2000 census to categorize neighborhoods: high poverty (30% or more poor), middle poverty (5%-29% poor) and low poverty (less than 5% poor). Primary payers or health insurers were Medicaid, Medicare, private or uninsured. RESULTS Evidence of survival mediation was observed for women with node negative breast cancer. The apparent effect of poverty disappeared in the presence of Medicare or private health insurance. Women who were so insured were advantaged on 8-year survival compared to the uninsured or those insured by Medicaid (OR = 1.89). Evidence of payer moderation by poverty was also observed for women with node negative breast cancer. The survival advantaging effect of Medicare or private insurance was stronger in low poverty (OR = 1.81) than it was in middle poverty (OR = 1.57) or in high poverty neighborhoods (OR = 1.16). This same pattern of mediated and moderated effects was also observed for early stage at diagnosis, shorter waits for adjuvant radiation therapy and for the receipt of sentinel lymph node biopsies. These findings are consistent with the theory that more facilitative social and economic capital is available in low poverty neighborhoods, where women with breast cancer may be better able to absorb the indirect and direct, but uncovered, costs of care. As for treatments, main protective effects as well as moderator effects indicative of protection, particularly in high poverty neighborhoods were observed for women with private health insurance. CONCLUSIONS America's multi-tiered health insurance system mediates the quality of breast cancer care. The system is inequitable and unjust as it advantages the well insured and the well to do. Recent health care reforms ought to be enacted in ways that are consistent with their federal legislative intent, that high quality health care be truly available to all.
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Affiliation(s)
- Kevin M Gorey
- School of Social Work, University of Windsor, 401 Sunset Avenue, Windsor, Ontario, N9B 3P4, Canada
| | - Isaac N Luginaah
- Department of Geography, University of Western Ontario, London, Ontario, Canada
| | - Eric J Holowaty
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Guangyong Zou
- Department of Epidemiology and Biostatistics, University of Western Ontario and Scientist, Robarts Research Institute, London, Ontario, Canada
| | - Caroline Hamm
- Medical Oncologist, Windsor Regional Cancer Center, School of Medicine and Dentistry, Department of Medicine, Division of General Internal Medicine, University of Western Ontario, London, Ontario, Canada
| | - Madhan K Balagurusamy
- Statistician and Research Associate, School of Social Work, University of Windsor, Windsor, Ontario, Canada
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