The introduction of generic medications attenuated the decline in adherence to AIs over three years of treatment among breast cancer survivors not receiving low-income subsidies for Medicare D coverage.
Background The United States Preventive Services Task Force (USPSTF) endorses routine screening for genetic risk for breast/ovarian cancer as a component of primary healthcare. Implementation of this recommendation may prove challenging, especially in clinics serving disadvantaged communities. Methods We tested the feasibility of implementing the USPSTF mandate at a Federally Qualified Health Center (FQHC) in order to identify women eligible for genetic counseling (GC). A 12-month usual care phase was followed by a 12-month enrollment phase, during which cancer genetic risk assessment (CGRA) was systematically performed for all women age 25–69 years presenting for an annual exam. Women eligible for GC were recruited to participate in the study. Results After initiating CGRA, 112 women eligible for GC consented to study participation, and 56% of them received a referral for counseling from their PCP. A subgroup of 50 participants were seen by the same PCP during both the usual care and the enrollment phases. None of them were referred for counseling during usual care, compared to 64% after initiation of CGRA (p< 0.001). Only 16% of referred participants attended a GC session. Conclusion Implementing USPSTF recommendations for CGRA as a standard component of primary healthcare is feasible in FQHCs and improves referral of minority women for genetic counseling, but more work is needed to understand the beliefs and barriers that prevent many underserved women from accessing cancer genetic services.
To investigate the role of out-of-pocket cost supports through the Medicare Part D Low-Income Subsidy on disparities in breast cancer hormonal therapy persistence and adherence by race or ethnicity. MethodsA nationwide cohort of women age $ 65 years with a breast cancer operation between 2006 and 2007 and at least one prescription filled for oral breast cancer hormonal therapy was identified from all Medicare D enrollees. The association of race or ethnicity with nonpersistence (90 consecutive days with no claims for a hormonal therapy prescription) and nonadherence (medication possession rate , 80%) was examined. Survival analyses were used to account for potential differences in age, comorbidity, or intensity of other treatments. ResultsAmong the 25,111 women in the study sample, 77% of the Hispanic and 70% of the black women received a subsidy compared with 21% of the white women. By 2 years, 69% of black and 70% of Hispanic patients were persistent compared with 61% of white patients. In adjusted analyses, patients in all three unsubsidized race or ethnicity groups had greater discontinuation than subsidized groups (white patients: hazard ratio [HR], 1.83; 95% CI, 1.70 to 1.95; black patients: HR, 2.09; 95% CI, 1.73 to 2.51; Hispanic patients: HR, 3.00; 95% CI, 2.37 to 3.89). Racial or ethnic persistence disparities that were present for unsubsidized patients were not present or reversed among subsidized patients. All three subsidized race or ethnicity groups also had higher adherence than all three unsubsidized groups, although with the smallest difference occurring in black women. ConclusionReceipt of a prescription subsidy was associated with substantially improved persistence to breast cancer hormonal therapy among white, black, and Hispanic women and lack of racial or ethnic disparities in persistence. Given high subsidy enrollment among black and Hispanic women, policies targeted at low-income patients have the potential to also substantially reduce racial and ethnic disparities.
African Americans report higher rates of chronic stress compared to non-Hispanic Whites. Consequently, chronic stress contributes to disproportionately higher rates of poor health outcomes among African Americans. Mindfulness meditation is a well-established and studied strategy to reduce stress and potentially improve health outcomes. However, the practice of mindfulness meditation is largely underutilized in African American communities despite its potential health benefits. In this commentary, we will discuss the relevance of mindfulness interventions, limited research available, reasons for low representation, and cultural adaptations for mindfulness meditation in African American communities. We also provide additional strategies to guide future mindfulness research that target African Americans.
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