Examining racial variation in antiemetic use and post-chemotherapy health care utilization for nausea and vomiting among breast cancer patients

Abstract

Purpose Racial minority cancer patients may experience underuse of antiemetic medications to prevent chemotherapy-induced nausea and vomiting (CINV). In addition to its adverse implications for quality of life, antiemetic underuse may contribute to observed disparities in acute illness during chemotherapy. To understand the potential contribution of CINV prophylaxis to breast cancer disparities, we assessed racial variation in potent antiemetic use and post-chemotherapy utilization related to CINV, and the relationship between the two. Methods We used SEER-Medicare data to evaluate health care utilization in the 14 days following chemotherapy initiation among black and white women receiving highly emetogenic chemotherapy for breast cancer. We used modified Poisson regression to assess the relationship between: 1) race and CINV-related utilization; and 2) NK1 use and CINV-related utilization, overall and stratified by race. We report adjusted risk ratios (aRR) and 95% confidence intervals (CI). Results The study included 1,130 women. Black women were 11% less likely than white women to use neurokinin-1 receptor antagonists (NK1s) for CINV prophylaxis (p=0.02); however, they experienced fewer CINV-related encounters following chemotherapy (unadjusted RR:0.63, 95%CI:0.40–0.99; p=0.05). After adjustment for clinical covariates, estimates were similar but no longer statistically significant (p=0.07). Among white women NK1 use was associated with increased CINV-related utilization (aRR NK1 users vs. non-users: 1.35, 95%CI: 1.07–1.69, p=0.01), likely resulting from unmeasured confounders. Conclusion Black women were less likely to use NK1s and CINV-related services. Racial variation in CINV-related services use may be partly explained by differential symptom reporting or access to care.

Guideline concordant care for prevention of acute chemotherapy-induced nausea and vomiting in children, adolescents, and young adults

“…A previous study of adult breast cancer patients described disparities in receipt of guideline recommended antiemetics related to race, reporting that black (vs. white) women were 11% less likely to be prescribed NK1RAs. 27 It is notable that over 70% of patients in our study received chemotherapy in the inpatient setting where medications are not charged individually, but rather are bundled. It is possible, therefore, that the difference in CINV care based on insurance is a proxy for other sociodemographic disparities not identified in this single-institution study.…”

“…clinical, system-level, and sociodemographic) were abstracted from the EHR as potential factors associated with receiving guideline-recommended CINV prophylaxis. 4,6,22,27 Clinical factors included: primary oncologic diagnosis (i.e. leukemia, lymphoma, solid tumor, central nervous system tumor), cancer recurrence, chemotherapy regimen, emetogenicity of chemotherapy regimen, and co-morbidities at the time of chemotherapy initiation (e.g.…”

Adherence to Endocrine Therapy and Racial Outcome Disparities in Breast Cancer

“…First, better systems are needed to uniformly and equitably screen for ET side effects at visits or even between visits. Because communication quality between physicians and Black patients with breast cancer about symptom experiences is known to be problematic [26,31], and given the earlier findings that ET side effect burden is higher in these women, we are unlikely to fully appreciate and address the ET-associated symptoms of Black breast cancer survivors without systematic and uniform symptom capture. However, data from survivor survey © 2021 AlphaMed Press.…”

The relationship between household income and patient‐reported symptom distress and quality of life in children with advanced cancer: A report from the PediQUEST study

“…Prior studies in adults with cancer have demonstrated that patients who are racial or ethnic minorities and those living in poverty experience higher symptom distress than their counterparts. 6–8 Provider symptom management differs based on race and income, 6,9 as does patient-perceived unmet need for supportive care in adult patients with cancer. 10 Furthermore, well-documented differences in the quality of communication between physicians and adult patients who are economically disadvantaged or of minority race 11 suggest that uncontrolled symptoms may go unrecognized and unaddressed.…”