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Moore JX, Andrzejak SE, Jones S, Han Y. Exploring the intersectionality of race/ethnicity with rurality on breast cancer outcomes: SEER analysis, 2000-2016. Breast Cancer Res Treat 2023; 197:633-645. [PMID: 36520228 PMCID: PMC9883364 DOI: 10.1007/s10549-022-06830-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/30/2022] [Indexed: 12/16/2022]
Abstract
PURPOSE Disparities in breast cancer survival have been observed within marginalized racial/ethnic groups and within the rural-urban continuum for decades. We examined whether there were differences among the intersectionality of race/ethnicity and rural residence on breast cancer outcomes. METHODS We performed a retrospective analysis among 739,448 breast cancer patients using Surveillance Epidemiology and End Results (SEER) 18 registries years 2000 through 2016. We conducted multilevel logistic-regression and Cox proportional hazards models to estimate adjusted odds ratios (AORs) and hazard ratios (AHRs), respectively, for breast cancer outcomes including surgical treatment, radiation therapy, chemotherapy, late-stage disease, and risk of breast cancer death. Rural was defined as 2013 Rural-Urban Continuum Codes (RUCC) of 4 or greater. RESULTS Compared with non-Hispanic white-urban (NH-white-U) women, NH-black-U, NH-black-rural (R), Hispanic-U, and Hispanic-R women, respectively, were at increased odds of no receipt of surgical treatment (NH-black-U, AOR = 1.98, 95% CI 1.91-2.05; NH-black-R, AOR = 1.72, 95% CI 1.52-1.94; Hispanic-U, AOR = 1.58, 95% CI 1.52-1.65; and Hispanic-R, AOR = 1.40, 95% CI 1.18-1.67), late-stage diagnosis (NH-black-U, AOR = 1.32, 95% CI 1.29-1.34; NH-black-R, AOR = 1.29, 95% CI 1.22-1.36; Hispanic-U, AOR = 1.25, 95% CI 1.23-1.27; and Hispanic-R, AOR = 1.17, 95% CI 1.08-1.27), and increased risks for breast cancer death (NH-black-U, AHR = 1.46, 95% CI 1.43-1.50; NH-black-R, AHR = 1.42, 95% CI 1.32-1.53; and Hispanic-U, AHR = 1.10, 95% CI 1.07-1.13). CONCLUSION Regardless of rurality, NH-black and Hispanic women had significantly increased odds of late-stage diagnosis, no receipt of treatment, and risk of breast cancer death.
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Affiliation(s)
- Justin Xavier Moore
- Cancer Prevention, Control, & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, GA USA ,Institute of Preventive and Public Health, Medical College of Georgia, Augusta University, Augusta, GA USA ,Cancer Prevention, Control, & Population Health Program, Department of Medicine, Institute of Public and Preventive Health, Medical College of Georgia at Augusta University, 1410 Laney Walker Blvd. CN-2135, Augusta, GA 30912 USA
| | - Sydney Elizabeth Andrzejak
- Cancer Prevention, Control, & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, GA USA
| | - Samantha Jones
- Cancer Prevention, Control, & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, GA USA
| | - Yunan Han
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110 USA
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Choi L, Ku K, Chen W, Shahait AD, Kim S. Axillary Needle Biopsy in the Era of American College of Surgeons Oncology Group (ACOSOG) Z0011: Institutional Experience With a Largely Urban Minority Population and Review of the Literature. Cureus 2022; 14:e24317. [PMID: 35607532 PMCID: PMC9122337 DOI: 10.7759/cureus.24317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background: The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial demonstrated that sentinel lymph node biopsy (SLNB) alone is adequate for axillary control in patients with one to two positive axillary lymph nodes. However, axillary lymph node dissection (ALND) is required in patients with N1 disease diagnosed with a preoperative needle biopsy. In this report, we determined how many patients could potentially have had SNB alone based on finding only one to two positive nodes in the axilla. Methods: A retrospective review of patients with positive preoperative axillary needle biopsy undergoing ALND was used to identify rates of high volume axillary disease (>2 positive nodes). Wilcoxon’s rank-sum and Fisher’s exact test were used for statistical analysis. A review of the literature is included for comparison. Results: 73% of 51 total patients with a positive needle biopsy had >2 positive nodes on axillary dissection. The high-volume axillary disease was significantly more likely with the presence of lymphovascular invasion and extranodal extension. Conclusions: Patients with positive preoperative axillary needle biopsies have a significantly higher rate of high volume axillary disease. However, at least one-quarter of these patients will have <3 positive nodes and potentially could have been treated with SNB alone.
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3
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Dinis J, Allam O, Junn A, Park KE, Mozaffari MA, Shah R, Avraham T, Alperovich M. Predictors for Prolonged Drain Use Following Autologous Breast Reconstruction. J Reconstr Microsurg 2021; 38:160-167. [PMID: 34284504 DOI: 10.1055/s-0041-1731765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Surgical drains are routinely used following autologous reconstruction, but are often cited as the leading cause of peri-operative discomfort. This study defined routine drain use duration and assessed the risk factors for prolonged breast and abdominal drain use during microvascular breast reconstruction, measures which have never previously been defined. METHODS Patients who underwent an abdominal microvascular free flap were included. Demographics, comorbidities, and operation-related characteristics were retrospectively collected in a prospectively maintained database. Statistical analysis utilized chi-square independent t-test, and linear regression analyses. RESULTS One hundred forty-nine patients comprising 233 breast flaps were included. Average breast and abdominal drain duration were 12.9 ± 3.9 and 17.7 ± 8.2 days, respectively. Prolonged breast and abdominal drain duration were defined as drain use beyond the 75th percentile at 14 and 19 days, respectively. Multivariable regression revealed hypertension was associated with an increased breast drain duration by 1.4 days (p = 0.024), axillary dissection with 1.7 days (p = 0.026), African-American race with 3.1 days (p < 0.001), Hispanic race with 1.6 days (p = 0.029), return to the OR with 3.2 days (p = 0.004), and each point increase in BMI with 0.1 days (p = 0.028). For abdominal drains, each point increase in BMI was associated with an increased abdominal drain duration by 0.3 days (p = 0.011), infection with 14.4 days (p < 0.001), and return to the OR with 5.7 days (p = 0.007). CONCLUSION Elevated BMI, hypertension, and axillary dissection increase risk for prolonged breast drain requirement in autologous reconstruction. African-American and Hispanic populations experience prolonged breast drain requirement after controlling for other factors, warranting further study.
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Affiliation(s)
- Jacob Dinis
- Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Omar Allam
- Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Alexandra Junn
- Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Kitae Eric Park
- Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Mohammad Ali Mozaffari
- Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Rema Shah
- Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Tomer Avraham
- Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Michael Alperovich
- Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Connecticut
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4
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Husain M, Nolan TS, Foy K, Reinbolt R, Grenade C, Lustberg M. An overview of the unique challenges facing African-American breast cancer survivors. Support Care Cancer 2018; 27:729-743. [PMID: 30460398 DOI: 10.1007/s00520-018-4545-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 11/07/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE The existence of cancer disparities is well known. Focus on alleviating such disparities centers on diagnosis, treatment, and mortality. This review surveyed current knowledge of health disparities that exist in the acute survivorship period (immediately following diagnosis and treatment) and their contributors, particularly for African-American breast cancer survivors (AA-BCS). METHODS Utilizing the ASCO four components of survivorship care, we explore disparities in surveillance and effects of cancer and therapies that AA-BCS face within the acute survivorship period (the years immediately following diagnosis). A literature review of PUBMED, Scopus, and Cochrane databases was conducted to identify articles related to AA-BCS acute survivorship. The search yielded 97 articles. Of the 97 articles, 38 articles met inclusion criteria. RESULTS AA-BCS experience disparate survivorship care, which negatively impacts quality of life and health outcomes. Challenges exist in surveillance, interventions for late effects (e.g., quality-of-life outcomes, cardiotoxicity, and cognitive changes), preventing recurrence with promotion of healthy living, and coordinating care among the healthcare team. CONCLUSIONS This overview identified current knowledge on the challenges in survivorship among AA-BCS. Barriers to optimal survivorship care inhibit progress in eliminating breast cancer disparities. Research addressing best practices for survivorship care is needed for this population. Implementation of culturally tailored care may reduce breast cancer disparities among AA-BCS.
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Affiliation(s)
- Marium Husain
- The Ohio State University, 320 W. 10th Ave, Suite A455, Columbus, OH, 43210, USA.
| | - Timiya S Nolan
- The Ohio State University, 320 W. 10th Ave, Suite A455, Columbus, OH, 43210, USA
| | - Kevin Foy
- The Ohio State University, 320 W. 10th Ave, Suite A455, Columbus, OH, 43210, USA
| | - Raquel Reinbolt
- Medical Oncology, The Ohio State University, 320 W. 10th Ave, Suite A455, Columbus, OH, 43210, USA
| | - Cassandra Grenade
- Medical Oncology, The Ohio State University, 320 W. 10th Ave, Suite A455, Columbus, OH, 43210, USA
| | - Maryam Lustberg
- Medical Oncology, The Ohio State University, 320 W. 10th Ave, Suite A455, Columbus, OH, 43210, USA
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5
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Moore JX, Akinyemiju T, Bartolucci A, Wang HE, Waterbor J, Griffin R. Mediating Effects of Frailty Indicators on the Risk of Sepsis After Cancer. J Intensive Care Med 2018; 35:708-719. [PMID: 29862879 DOI: 10.1177/0885066618779941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cancer survivors are at increased risk of sepsis, possibly attributed to weakened physiologic conditions. The aims of this study were to examine the mediation effect of indicators of frailty on the association between cancer survivorship and sepsis incidence and whether these differences varied by race. METHODS We performed a prospective analysis using data from the REasons for Geographic and Racial Differences in Stroke cohort from years 2003 to 2012. We categorized frailty as the presence of ≥2 frailty components (weakness, exhaustion, and low physical activity). We categorized participants as "cancer survivors" or "no cancer history" derived from self-reported responses of being diagnosed with any cancer. We examined the mediation effect of frailty on the association between cancer survivorship and sepsis incidence using Cox regression. We repeated analysis stratified by race. RESULTS Among 28 062 eligible participants, 2773 (9.88%) were cancer survivors and 25 289 (90.03%) were no cancer history participants. Among a total 1315 sepsis cases, cancer survivors were more likely to develop sepsis (12.66% vs 3.81%, P < .01) when compared to participants with no cancer history (hazard ratios: 2.62, 95% confidence interval: 2.31-2.98, P < .01). The mediation effects of frailty on the log-hazard scale were very small: weakness (0.57%), exhaustion (0.31%), low physical activity (0.20%), frailty (0.75%), and total number of frailty indicators (0.69%). Similar results were observed when stratified by race. CONCLUSION Cancer survivors had more than a 2-fold increased risk of sepsis, and indicators of frailty contributed to less than 1% of this disparity.
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Affiliation(s)
- Justin Xavier Moore
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Tomi Akinyemiju
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Epidemiology, University of Kentucky, Lexington, KY, USA
| | - Alfred Bartolucci
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Henry E Wang
- Department of Emergency Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - John Waterbor
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Russell Griffin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
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6
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Moore JX, Akinyemiju T, Bartolucci A, Wang HE, Waterbor J, Griffin R. A prospective study of cancer survivors and risk of sepsis within the REGARDS cohort. Cancer Epidemiol 2018; 55:30-38. [PMID: 29763753 DOI: 10.1016/j.canep.2018.05.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/30/2018] [Accepted: 05/03/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Hospitalized cancer patients are nearly 10 times more likely to develop sepsis when compared to patients with no cancer history. We compared the risk of sepsis between cancer survivors and no cancer history participants, and examined whether race was an effect modifier. METHODS We performed a prospective analysis of data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We categorized participants as "cancer survivors" or "no cancer history" derived from self-reported responses of being diagnosed with any cancer, excluding non-melanoma skin cancer. We defined sepsis as hospitalization for a serious infection with ≥2 systemic inflammatory response syndrome criteria. We performed Cox proportional hazard models to examine the risk of sepsis after cancer (adjusted for sociodemographics, health behaviors, and comorbidities), and stratified by race. RESULTS Among 29,693 eligible participants, 2959 (9.97%) were cancer survivors, and 26,734 (90.03%) were no cancer history participants. Among 1393 sepsis events, the risk of sepsis was higher for cancer survivors (adjusted HR: 2.61, 95% CI: 2.29-2.98) when compared to no cancer history participants. Risk of sepsis after cancer survivorship was similar for Black and White participants (p value for race and cancer interaction = 0.63). CONCLUSION In this prospective cohort of community-dwelling adults we observed that cancer survivors had more than a 2.5-fold increased risk of sepsis. Public health efforts should attempt to mitigate sepsis risk by awareness and appropriate treatment (e.g., antibiotic administration) to cancer survivors with suspected infection regardless of the number of years since cancer remission.
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Affiliation(s)
- Justin Xavier Moore
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States; Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis School of Medicine, St Louis, MO, United States.
| | - Tomi Akinyemiju
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States; Department of Epidemiology, University of Kentucky, Lexington, KY, United States
| | - Alfred Bartolucci
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Henry E Wang
- Department of Emergency Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - John Waterbor
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Russell Griffin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
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Prieto D, Soto-Ferrari M, Tija R, Peña L, Burke L, Miller L, Berndt K, Hill B, Haghsenas J, Maltz E, White E, Atwood M, Norman E. Literature review of data-based models for identification of factors associated with racial disparities in breast cancer mortality. Health Syst (Basingstoke) 2018; 8:75-98. [PMID: 31275571 PMCID: PMC6598506 DOI: 10.1080/20476965.2018.1440925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 01/29/2018] [Accepted: 02/08/2018] [Indexed: 01/03/2023] Open
Abstract
In the United States, early detection methods have contributed to the reduction of overall breast cancer mortality but this pattern has not been observed uniformly across all racial groups. A vast body of research literature shows a set of health care, socio-economic, biological, physical, and behavioural factors influencing the mortality disparity. In this paper, we review the modelling frameworks, statistical tests, and databases used in understanding influential factors, and we discuss the factors documented in the modelling literature. Our findings suggest that disparities research relies on conventional modelling and statistical tools for quantitative analysis, and there exist opportunities to implement data-based modelling frameworks for (1) exploring mechanisms triggering disparities, (2) increasing the collection of behavioural data, and (3) monitoring factors associated with the mortality disparity across time.
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Affiliation(s)
- Diana Prieto
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
- Johns Hopkins Carey Business School, Baltimore, MD, USA
| | - Milton Soto-Ferrari
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
- Department of Marketing and Operations, Scott College of Business, Terre Haute, IN, USA
| | - Rindy Tija
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
| | - Lorena Peña
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
| | - Leandra Burke
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Lisa Miller
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Kelsey Berndt
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Brian Hill
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Jafar Haghsenas
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Ethan Maltz
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Evan White
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Maggie Atwood
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Earl Norman
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
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8
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Marcinkowski EF, Ottesen R, Niland J, Vito C. Acceptance of adjuvant chemotherapy recommendations in early-stage hormone-positive breast cancer. J Surg Res 2017. [DOI: 10.1016/j.jss.2017.02.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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Yee MK, Sereika SM, Bender CM, Brufsky AM, Connolly MC, Rosenzweig MQ. Symptom incidence, distress, cancer-related distress, and adherence to chemotherapy among African American women with breast cancer. Cancer 2017; 123:2061-2069. [PMID: 28199006 DOI: 10.1002/cncr.30575] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/20/2016] [Accepted: 01/03/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND There is a persistent racial survival disparity between African American (AA) and white women with breast cancer. There is evidence that symptom incidence, associated distress, and overall cancer-related distress may be unexplored, important contributing factors. The purpose of the current study was to: 1) describe and compare the number of chemotherapy-related symptoms and associated distress among AA women with breast cancer over the course of chemotherapy at 3 time points (at baseline before initiating chemotherapy, midpoint, and at the completion of chemotherapy); and 2) to describe the relationship between the number of chemotherapy-related symptoms and overall cancer distress compared with the ability to receive at least 85% of the prescribed chemotherapy within the prescribed timeframe. METHODS Descriptive, comparative, and correlational analyses of symptom incidence, symptom distress, cancer-related distress, and prescribed chemotherapy dose received among a cohort of AA women receiving chemotherapy for breast cancer were performed. RESULTS AA women (121 women) experienced worsening symptoms from baseline to midpoint in chemotherapy and then stabilized for the duration of therapy. The inability to receive 85% of the prescribed chemotherapy within a prescribed time point was found to be significantly correlated with midpoint symptom distress. CONCLUSIONS The main findings of the current study were that AA women experience a deterioration in symptom distress over the course of chemotherapy from baseline (before chemotherapy) to the midpoint, which was found to be associated with less adherence to chemotherapy overall. Thus, the incidence and management of physical and emotional symptoms, as measured through a multidimensional symptom measurement tool, may be contributing to breast cancer dose disparity and should be explored further. Cancer 2017;123:2061-2069. © 2017 American Cancer Society.
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Affiliation(s)
- Melissa K Yee
- Department of Medical Oncology at Dana-Farber/Brigham and Women's Cancer Center in clinical affiliation with South Shore Hospital, Harvard University, Cambridge, Massachusetts
| | - Susan M Sereika
- Department of Epidemiology, School of Nursing and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Adam M Brufsky
- Department of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mary C Connolly
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Margaret Q Rosenzweig
- Acute and Tertiary Care Department, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
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10
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Breast cancer survival in African-American women by hormone receptor subtypes. Breast Cancer Res Treat 2015; 153:211-8. [PMID: 26250393 DOI: 10.1007/s10549-015-3528-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 08/01/2015] [Indexed: 12/31/2022]
Abstract
Breast cancer accounts for over 200,000 annual cases among women in the United States, and is the second leading cause of cancer-related deaths. However, few studies have investigated the association between breast cancer subtype and survival among African-American women. We analyzed cancer-related deaths among African-American women using data obtained from the SEER database linked to the 2000 U.S. census data. We examined distribution of baseline socio-demographic and clinical characteristics by breast cancer subtypes and used Cox proportional hazard models to determine associations between breast cancer subtypes and cancer-related mortality, adjusting for age, socio-economic status, stage at diagnosis, and treatment. Among 19,836 female breast cancer cases, 54.4% were diagnosed with the HER2-/HR+ subtype, with the majority of those cases occurring among women ages 55 and older. However, after adjusting for age, stage, and treatment type (surgery, radiation, or no radiation and/or cancer-directed surgery), TNBC (HR 2.34; 95% CI 1.95-2.81) and HER2+/HR- (HR 1.39, 95% CI 1.08-1.79) cases had significantly higher hazards of cancer-related deaths compared with HER2+/HR+ cases. Adjusting for socio-economic status did not significantly alter these associations. African-American women with TNBC were more likely to have a cancer-related death than African-American women with other breast cancer subtypes. This association remained after adjustments for age, stage, treatment, and socio-economic status. Further studies are needed to identify subtype-specific risk and prognostic factors aimed at better informing prevention efforts for all women.
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11
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Bustami RT, Shulkin DB, O'Donnell N, Whitman ED. Variations in time to receiving first surgical treatment for breast cancer as a function of racial/ethnic background: a cohort study. JRSM Open 2014; 5:2042533313515863. [PMID: 25057404 PMCID: PMC4100229 DOI: 10.1177/2042533313515863] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective To evaluate surgical treatment delay disparities by race/ethnic group in a group of breast cancer patients treated in the New York region. Design Cohort study. Setting Two affiliated hospitals in the New York region. Participants Patients admitted at two affiliated hospitals in the New York region for breast cancer treatment during 2007–2011. Main outcome measure Time to receiving first surgery for breast cancer, defined as the time in days between initial diagnosis (biopsy) and definitive surgical treatment (lumpectomy or mastectomy). Predicted time to first surgery by race group was also analysed using a multivariate linear regression model with adjustments made for several demographic and clinical factors. Results Totally, 3071 patients who were first treated with surgery were identified. Racial background was classified as White, African American or Asian/other. Overall median time to surgery was 28 days: 28 days in whites, and 34 and 29 days in African Americans and Asian/others, respectively (p = 0.032). Multivariate analyses showed that only African Americans, not Asian/others, had significantly increased surgical delay compared to whites (p = 0.019). Conclusions This study demonstrates significant racial differences in surgical delay in a group of breast cancer patients treated in the New York region. These differences may reflect tacit attitudes of medical providers or processes insensitive to patient educational needs. Additional studies may improve our understanding of this delay.
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Affiliation(s)
- Rami T Bustami
- Atlantic Center for Research, Atlantic Health System, Morristown, NJ 07962-1905, USA
| | - Daniel B Shulkin
- New York University Robert F. Wagner Graduate School of Public Service, New York, NY 10012, USA
| | - Nancy O'Donnell
- Cancer Registry, Morristown Medical Center, Atlantic Health System, Morristown, NJ 07962-1905, USA
| | - Eric D Whitman
- Atlantic Center for Research, Atlantic Health System, Morristown, NJ 07962-1905, USA ; Carol Simon Cancer Center, Atlantic Health System, Morristown, NJ 07962-1905, USA
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12
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Racial disparities in survival and age-related outcome in postsurgery breast cancer patients in a new york city community hospital. ISRN ONCOLOGY 2014; 2014:694591. [PMID: 24693452 PMCID: PMC3945176 DOI: 10.1155/2014/694591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 12/23/2013] [Indexed: 01/25/2023]
Abstract
Breast cancer survival has significantly improved over the past two decades. However, the diagnosis of breast cancer is lower and the mortality rate remains higher, in African American women (AA) compared to Caucasian-American women. The purpose of this investigation is to analyze postoperative events that may affect breast cancer survival. This is a retrospective analysis of prospectively collected data from The Brooklyn Hospital Center cancer registry from 1997 to 2010. Of the 1538 patients in the registry, 1226 are AA and 269 are Caucasian. The study was divided into two time periods, 1997-2004 (period A) and 2005-2010 (period B), in order to assess the effect of treatment outcomes on survival. During period A, 5-year survival probabilities of 75.37%, 74.53%, and 78.70% were seen among all patients, AA women and Caucasian women, respectively. These probabilities increased to 87.62%, 87.15% and 89.99% in period B. Improved survival in AA women may be attributed to the use of adjuvant chemotherapy, radiation, and hormonal therapy. Improved survival in Caucasian patients was attributed to the use of radiation therapy, as well as earlier detection resulting in more favorable tumor grades and pathological stages.
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13
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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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Bhatta SS, Hou N, Moton ZN, Polite BN, Fleming GF, Olopade OI, Huo D, Hong S. Factors associated with compliance to adjuvant hormone therapy in Black and White women with breast cancer. SPRINGERPLUS 2013; 2:356. [PMID: 23961419 PMCID: PMC3736077 DOI: 10.1186/2193-1801-2-356] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 07/18/2013] [Indexed: 01/13/2023]
Abstract
Background Studies have demonstrated lower rates of breast cancer survival for Black versus White women. Factors implicated include later stages at diagnosis, differences in tumor biology, and lower compliance rates to adjuvant hormone therapy (AHT) among Black women with hormone sensitive breast cancer. We examined factors associated with compliance to AHT among Black and White women with invasive breast cancer. Methods Women with estrogen receptor positive (ER+), non-metastatic breast cancer were identified by the cancer registry at the University of Chicago Hospital and asked to complete a mail-in survey. Compliance was defined by self-reported adherence to AHT ≥80% at the time of the survey plus medical record verification of persistence (completion of 5 years of AHT). Logistic regression was used to determine factors associated with compliance to AHT. Results 197 (135 White and 62 Black) women were included in the analysis. 97.4% of patients reported adherence to therapy. 87.4% were found to be persistent to therapy. Overall compliance was 87.7% with no statistically significant racial difference seen (87.9% in White and 87.0% in Black, P = 0.87). For both Black and White women, compliance was strongly associated with both perceived importance of AHT (OR =2.1, 95% CI:1.21-3.68,P = 0.009) and the value placed on their doctor’s opinion about the importance of AHT (OR = 4.80, 95% CI: 2.03-11.4, P < 0.001). Conclusions In our cohort of Black and White women, perceived importance of AHT and the degree to which they valued their doctor’s opinion correlated with overall compliance. This suggests that Black and White women consider similar factors in their decision to take AHT.
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Affiliation(s)
- Sumita S Bhatta
- Department of Medicine, University of Chicago, 5841 S. Maryland Avenue MC 3051, Chicago, IL 60637 USA
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15
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Gany F, Ramirez J, Nierodzick ML, McNish T, Lobach I, Leng J. Cancer portal project: a multidisciplinary approach to cancer care among Hispanic patients. J Oncol Pract 2013; 7:31-8. [PMID: 21532808 DOI: 10.1200/jop.2010.000036] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2010] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This study investigates the impact of a multilingual, multidisciplinary team targeting social and economic determinants of cancer treatment adherence among at-risk Hispanic immigrants. METHODS Patients were recruited at 10 hospital-based cancer clinics in New York City between December 2008 and November 2009. This is a nested cohort study of Hispanic patients and their sociodemographic characteristics, areas of needed assistance, and reported impact of meeting service needs on keeping appointments. At the core of the intervention is the trained, bilingual Portal Access Facilitator, who assesses needs and synchronizes an individualized set of transdisciplinary services for each patient. RESULTS A total of 328 Hispanic patients participated in the study. Of these, 89% preferred to speak Spanish in the health care setting, and 17% had no health insurance. The most common cancer diagnosis among participants was breast cancer (35%) followed by GI (17%) and gynecologic (16%) cancers. Patients most commonly requested financial support (59%), food support (37%), transportation assistance (21%), social work services (14%), psychosocial support (6%), help with health insurance issues (5%), and legal services (5%). In a follow-up assessment of high-need patients in urgent need of financial support, 86% reported that portal services helped them attend cancer care and treatment appointments, and 72% reported that portal services decreased worry about their care. CONCLUSION Most patients reported that financial, social, and logistical support would help them attend their appointments for cancer care and treatment. Further multidisciplinary interventions should be implemented and evaluated to address social and economic determinants in cancer care for this population.
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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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Individual and neighborhood socioeconomic status and healthcare resources in relation to black-white breast cancer survival disparities. J Cancer Epidemiol 2013; 2013:490472. [PMID: 23509460 PMCID: PMC3590635 DOI: 10.1155/2013/490472] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 12/20/2012] [Accepted: 01/07/2013] [Indexed: 01/25/2023] Open
Abstract
Background. Breast cancer survival has improved significantly in the US in the past 10–15 years. However, disparities exist in breast cancer survival between black and white women. Purpose. To investigate the effect of county healthcare resources and SES as well as individual SES status on breast cancer survival disparities between black and white women. Methods. Data from 1,796 breast cancer cases were obtained from the Surveillance Epidemiology and End Results and the National Longitudinal Mortality Study dataset. Cox Proportional Hazards models were constructed accounting for clustering within counties. Three sequential Cox models were fit for each outcome including demographic variables; demographic and clinical variables; and finally demographic, clinical, and county-level variables. Results. In unadjusted analysis, black women had a 53% higher likelihood of dying of breast cancer and 32% higher likelihood of dying of any cause (P < 0.05) compared with white women. Adjusting for demographic variables explained away the effect of race on breast cancer survival (HR, 1.40; 95% CI, 0.99–1.97), but not on all-cause mortality. The racial difference in all-cause survival disappeared only after adjusting for county-level variables (HR, 1.27; CI, 0.95–1.71). Conclusions. Improving equitable access to healthcare for all women in the US may help eliminate survival disparities between racial and socioeconomic groups.
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Meredith SM. Disparities in Breast Cancer and the Role of Patient Navigator Programs. Clin J Oncol Nurs 2013; 17:54-9. [DOI: 10.1188/13.cjon.54-59] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tamaki K, Tamaki N, Kamada Y, Uehara K, Zaha H, Onomura M, Gushimiyagi M, Kurashita K, Miyazato K, Tengan H, Miyara K, Ishida T, Tamaki K, Tamaki N, Kamada Y, Uehara K, Zaha H, Onomura M, Gushimiyagi M, Ueda M, Kurashita K, Miyazato K, Tengan H, Miyara K, Miyaguni T, Nagamine S, Miyagi J, Nomura H, Sunagawa K, Higa J, Sato C, Ishida T. The Challenge to Reduce Breast Cancer Mortality in Okinawa: Consensus of the First Okinawa Breast Oncology Meeting. Jpn J Clin Oncol 2013; 43:208-13. [DOI: 10.1093/jjco/hys217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Racial disparities in Medicaid patients after brain tumor surgery. J Clin Neurosci 2012; 20:57-61. [PMID: 23084348 DOI: 10.1016/j.jocn.2012.05.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 05/06/2012] [Indexed: 11/24/2022]
Abstract
The presence of healthcare-related disparities is an ongoing, widespread, and well-documented societal and health policy issue. We investigated the presence of racial disparities among post-operative patients either with meningioma or malignant, benign, or metastatic brain tumors. We used the Medicaid component of the Thomson Reuter's MarketScan database from 2000 to 2009. Univariate and multivariate analysis assessed death, 30-day post-operative risk of complications, length of stay, and total charges. We identified 2321 patients, 73.7% were Caucasian, 57.8% were women; with Charlson comorbidity scores of <3 (56.2%) and treated at low-volume centers (73.4%). Among all, 26.3% of patients were of African-American ethnicity and 22.1% had meningiomas. Mortality was 2.0%, mean length of stay (LOS) was 9 days, mean total charges were US$42,422, an adverse discharge occurred in 22.5% of patients, and overall 30-day complication rate was 23.4%. In a multivariate analysis, African-American patients with meningiomas had higher odds of developing a 30-day complication (p=0.05) and were significantly more likely to have longer LOS (p<0.001) and greater total charges (p<0.001) relative to Caucasian counterparts. The presence of one post-operative complication doubled LOS and nearly doubled total charges, while the presence of two post-operative complications tripled these outcomes. Patients of African-American ethnicity had significantly higher post-operative complications than those of Caucasian ethnicity. This higher rate of complications seems to have driven greater healthcare utilization, including greater LOS and total charges, among African-American patients. Interventions aimed at reducing complications among African-American patients with brain tumor may help reduce post-operative disparities.
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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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Korber SF, Padula C, Gray J, Powell M. A breast navigator program: barriers, enhancers, and nursing interventions. Oncol Nurs Forum 2011; 38:44-50. [PMID: 21186159 DOI: 10.1188/11.onf.44-50] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES to identify barriers to and enhancers of completion of breast cancer treatment from the perspective of participants in a breast health navigator program. RESEARCH APPROACH qualitative, using focus group methodology and telephone interview. SETTING two teaching hospital ambulatory cancer centers. PARTICIPANTS women enrolled in the breast navigator program, including patients who completed (n = 13) and did not complete (n = 1) breast cancer treatment. METHODOLOGIC APPROACH researchers used semistructured, open-ended questioning to guide the interviews and elicit identification of barriers to and enhancers of treatment. A flexible approach was used and the interviews were recorded. Content analysis was used to identify themes. MAIN RESEARCH VARIABLES perceived barriers and enhancers of breast cancer treatment. FINDINGS the most common theme was the value of the education and information received from the navigator. Several participants saw this as the essence of the role. Assistance with managing symptoms, access to financial and community resources, and the team approach were completion enhancers. CONCLUSIONS completion of breast cancer therapy and care can be improved by recognizing the value the nurse navigator role brings to the patient experience and enhancing that role. INTERPRETATION the intentional presence of the oncology nurse and the nursing emphasis on culturally appropriate education and care can be seen as key competencies of the navigator. As the concept of the navigation process is expanded to other cancers, oncology nurses are particularly well positioned to advocate for the navigator role as a nursing domain.
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Gany F, Ramirez J, Chen S, Leng JCF. Targeting social and economic correlates of cancer treatment appointment keeping among immigrant Chinese patients. J Urban Health 2011; 88:98-103. [PMID: 21246300 PMCID: PMC3042088 DOI: 10.1007/s11524-010-9512-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Chinese immigrants have high rates of a variety of cancers and face numerous social and economic barriers to cancer treatment appointment keeping. This study is a nested cohort of 82 Chinese patients participating in the Immigrant Cancer Portal Project. Twenty-two percent reported having missed appointments for oncology follow-up, radiation therapy, and/or chemotherapy. Patients most commonly reported needing assistance with financial support to enable appointment keeping. Efforts to further address social and economic correlates in cancer care should be developed for this population.
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Affiliation(s)
- Francesca Gany
- Center for Immigrant Health Department of Medicine, New York University School of Medicine, 550 First Avenue, OBV, CD-401, New York, NY 10016, USA.
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Treatment disparities following the diagnosis of an astrocytoma. J Neurooncol 2010; 101:67-74. [PMID: 20495849 DOI: 10.1007/s11060-010-0223-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2009] [Accepted: 05/04/2010] [Indexed: 10/19/2022]
Abstract
Post-operative radiation and chemotherapy following diagnosis of astrocytoma are standard care. No research has examined racial or insurance-based disparities in treatment receipt. The purpose of this study was to evaluate whether African Americans and patients with dual eligibility in Medicare and Medicaid (DE), compared to Caucasians and patients with Medicare alone, experienced differences in (1) seeing a radiation oncologist, (2) receiving radiation or chemotherapy, and (3) overall survival. Using a retrospective descriptive design, statewide Medicaid and Medicare data were merged with the Michigan Tumor Registry to extract a sample of patients (n = 604) ≥ 65 years old with a first primary astrocytoma diagnosis in Michigan between 1996 and 2000. There were no racial or insurance-based differences in reporting a claim for a radiation oncologist. Controlling for age, income, surgical intervention, residence population, comorbidities, gender, and stage, African Americans were less likely to report radiation claims than Caucasians (OR = 0.20; 95% CI = 0.07-0.54). DE patients were less likely to report radiation claims (OR = 0.50; 95% CI = 0.26-0.94) than those with Medicare only. These differences were not seen with chemotherapy. When only those with a glioblastoma multiforme were examined, DE patients (OR = 0.47; 95% CI = 0.24-0.92) and African Americans (OR = 0.13; 95% CI = 0.04-0.44) were much less likely to report radiation claims. Race and insurance status did not significantly affect survival, although income did. Data suggest disparities in race and insurance status may exist in receiving standard of care for astrocytomas. Further research is warranted to replicate the data and determine potential sources for these disparities.
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Lobb R, Allen JD, Emmons KM, Ayanian JZ. Timely care after an abnormal mammogram among low-income women in a public breast cancer screening program. ACTA ACUST UNITED AC 2010; 170:521-8. [PMID: 20233801 DOI: 10.1001/archinternmed.2010.22] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Since 1990, the National Breast and Cervical Cancer Early Detection Program (BCCEDP) has funded breast cancer screening and diagnostic services for low-income, underinsured women. Case management was implemented in 2001 to address barriers to follow-up after an abnormal mammogram, and free treatment was introduced in 2004. However, the effect of these policies on timeliness of care has not been empirically evaluated. METHODS Among 2252 BCCEDP participants in Massachusetts during 1998 through 2007, we conducted a time-to-event analysis with prepolicy-postpolicy comparisons to examine associations of case management and free treatment with diagnostic and treatment delays (>60 days and >90 days, respectively) after an abnormal mammogram. RESULTS The proportion of women experiencing a diagnostic delay decreased from 33% to 23% after the introduction of case management (P < .001), with a significant reduction in the adjusted risk of diagnostic delay (relative risk [RR], 0.65; 95% confidence interval [CI], 0.53-0.79) that did not differ by race and ethnicity. However, case management was not associated with changes in treatment delay (RR, 0.93; 95% CI, 0.80-1.10). Free treatment was not associated with changes in the adjusted risk of diagnostic delay (RR, 0.61; 95% CI, 0.33-1.14) or treatment delay (RR, 0.77; 95% CI, 0.43-1.38) beyond improvements associated with case management. CONCLUSIONS Case management to assist women in overcoming logistic and psychosocial barriers to care may improve time to diagnosis among low-income women who receive free breast cancer screening and diagnostic services. Programs that provide services to coordinate care, in addition to free screening and diagnostic tests, may improve population health.
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Affiliation(s)
- Rebecca Lobb
- Harvard School of Public Health, Boston, Massachusetts, USA.
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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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Yu XQ. Socioeconomic disparities in breast cancer survival: relation to stage at diagnosis, treatment and race. BMC Cancer 2009; 9:364. [PMID: 19828016 PMCID: PMC2770567 DOI: 10.1186/1471-2407-9-364] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Accepted: 10/14/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies have documented lower breast cancer survival among women with lower socioeconomic status (SES) in the United States. In this study, I examined the extent to which socioeconomic disparity in breast cancer survival was explained by stage at diagnosis, treatment, race and rural/urban residence using the Surveillance, Epidemiology, and End Results (SEER) data. METHODS Women diagnosed with breast cancer during 1998-2002 in the 13 SEER cancer registry areas were followed-up to the end of 2005. The association between an area-based measure of SES and cause-specific five-year survival was estimated using Cox regression models. Six models were used to assess the extent to which SES differences in survival were explained by clinical and demographical factors. The base model estimated the hazard ratio (HR) by SES only and then additional adjustments were made sequentially for: 1) age and year of diagnosis; 2) stage at diagnosis; 3) first course treatment; 4) race; and 5) rural/urban residence. RESULTS An inverse association was found between SES and risk of dying from breast cancer (p < 0.0001). As area-level SES falls, HR rises (1.00 --> 1.05 --> 1.23 --> 1.31) with the two lowest SES groups having statistically higher HRs. This SES differential completely disappeared after full adjustment for clinical and demographical factors (p = 0.20). CONCLUSION Stage at diagnosis, first course treatment and race explained most of the socioeconomic disparity in breast cancer survival. Targeted interventions to increase breast cancer screening and treatment coverage in patients with lower SES could reduce much of socioeconomic disparity.
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Affiliation(s)
- Xue Qin Yu
- Cancer Epidemiology Research Unit, Cancer Council New South Wales, PO Box 572, Kings Cross, NSW 1340, Australia.
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Ell K, Vourlekis B, Xie B, Nedjat-Haiem FR, Lee PJ, Muderspach L, Russell C, Palinkas LA. Cancer treatment adherence among low-income women with breast or gynecologic cancer: a randomized controlled trial of patient navigation. Cancer 2009; 115:4606-15. [PMID: 19551881 PMCID: PMC2749894 DOI: 10.1002/cncr.24500] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The authors implemented a controlled, randomized trial that compared 2 interventions: the provision of written resource navigation information (enhanced usual care [EUC]) versus written information plus patient navigation (TPN) aimed at improving adjuvant treatment adherence and follow-up among 487 low-income, predominantly Hispanic women with breast cancer or gynecologic cancer. METHODS Women were randomized to receive either TPN or EUC; and chemotherapy, radiation therapy, hormone therapy, and follow-up were assessed over 12 months. Patients with breast cancer were analyzed separately from patients with gynecologic cancer. RESULTS Overall adherence rates ranged from 87% to 94%, and there were no significant differences between the TPN group and the EUC group. Among women with breast cancer, 90% of the EUC group and 88% of the TPN group completed chemotherapy (14% of the EUC group and 26% of the TPN group delayed the completion of chemotherapy), 2% of the EUC group and 4% of the TPN group failed to complete chemotherapy, and 8% of the EUC group and 7% of the TPN group refused chemotherapy. Radiation treatment adherence was similar between the groups: Ninety percent of patients completed radiation (40% of the EUC group and 42% of the TPN group delayed the completion of radiation); in both groups, 2% failed to complete radiation, and 8% refused radiation. Among gynecologic patients, 87% of the EUC group and 94% of the TPN group completed chemotherapy (41% of the EUC group and 31% of the TPN group completed it with delays), 7% of the EUC group and 6% of the TPN group failed to complete chemotherapy, 6% of the EUC refused chemotherapy, 87% of the EUC group and 84% of the TPN group completed radiation (51% of the EUC group and 42% of the TPN with delays), 5% of the EUC group and 8% of the TPN group failed to complete radiation, and 8% of the EUC group and 5% of the TPN group refused radiation. CONCLUSIONS Treatment adherence across randomized groups was notably higher than reported in previous studies, suggesting that active telephone patient navigation or written resource informational materials may facilitate adherence among low-income, predominantly Hispanic women. Adherence also may have be facilitated by federal-state breast and cervical cancer treatment funding.
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Affiliation(s)
- Kathleen Ell
- School of Social Work, University of Southern California, Los Angeles, California, USA.
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