Influence of clinical, societal, and treatment variables on racial differences in ER−/PR− breast cancer survival

Roseland, Molly E.; Schwartz, Kendra; Ruterbusch, Julie J.; Lamerato, Lois; Krajenta, Richard; Booza, Jason; Simon, Michael S.

doi:10.1007/s10549-017-4300-y

Cited by 10 publications

(5 citation statements)

References 43 publications

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“…Lower deprivation (better) was categorized as SDI scores 19-52, while higher deprivation (worse) was categorized as SDI scores 53-95. The validity and reliability of SDI has been tested, and it was found that SDI is positively associated with poor access to poor health outcomes, and a multidimensional measure of deprivation is more strongly associated with health outcomes than a measure of poverty alone [11,17].…”

Section: Predictor Variablesmentioning

confidence: 99%

Association between Neighborhood Social Deprivation and Stage at Diagnosis among Breast Cancer Patients in South Carolina

Babatunde

Zahnd

Eberth

et al. 2021

IJERPH

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The purpose of this study was to examine the association between neighborhood social deprivation and individual-level characteristics on breast cancer staging in African American and white breast cancer patients. We established a retrospective cohort of patients with breast cancer diagnosed from 1996 to 2015 using the South Carolina Central Cancer Registry. We abstracted sociodemographic and clinical variables from the registry and linked these data to a county-level composite that captured neighborhood social conditions—the social deprivation index (SDI). Data were analyzed using chi-square tests, Student’s t-test, and multivariable ordinal regression analysis to evaluate associations. The study sample included 52,803 female patients with breast cancer. Results from the multivariable ordinal regression model demonstrate that higher SDI (OR = 1.06, 95% CI: 1.02–1.10), African American race (OR = 1.35, 95% CI: 1.29–1.41), and being unmarried (OR = 1.17, 95% CI: 1.13–1.22) were associated with a distant stage at diagnosis. Higher tumor grade, younger age, and more recent year of diagnosis were also associated with distant-stage diagnosis. As a proxy for neighborhood context, the SDI can be used by cancer registries and related population-based studies to identify geographic areas that could be prioritized for cancer prevention and control efforts.

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Section: Predictor Variablesmentioning

confidence: 99%

Association between Neighborhood Social Deprivation and Stage at Diagnosis among Breast Cancer Patients in South Carolina

Babatunde

Zahnd

Eberth

et al. 2021

IJERPH

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“…A disparity in outcomes for black women with BC has been well-established, but no one factor explains the issue in its entirety. Outcomes for black women are influenced by social determinants of health [100]. Barsevick et al reported that social determinants such as education, unemployment, marital status, age, comorbidity, and medical mistrust were factors in post-treatment burden for survivors [101].…”

Section: Discussionmentioning

confidence: 99%

Symptom Experience, Management, and Outcomes According to Race and Social Determinants Including Genomics, Epigenomics, and Metabolomics (SEMOARS + GEM): an Explanatory Model for Breast Cancer Treatment Disparity

et al. 2019

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Even after controlling for stage, comorbidity, age, and insurance status, black women with breast cancer (BC) in the USA have the lowest 5-year survival as compared with all other races for stage-matched disease. One potential cause of this survival difference is the disparity in cancer treatment, evident in many population clinical trials. Specifically, during BC chemotherapy, black women receive less relative dose intensity with more dose reductions and early chemotherapy cessation compared with white women. Symptom incidence, cancer-related distress, and ineffective communication, including the disparity in patientcenteredness of care surrounding patient symptom reporting and clinician assessment, are important factors contributing to racial disparity in dose reduction and early therapy termination. We present an evidence-based overview and an explanatory model for racial disparity in the symptom experience during BC chemotherapy that may lead to a reduction in dose intensity and a subsequent disparity in outcomes. This explanatory model, the Symptom Experience, Management, Outcomes and Adherence according to Race and Social determinants + Genomics Epigenomics and Metabolomics (SEMOARS + GEM), considers essential factors such as social determinants of health, clinician communication, symptoms and symptom management, genomics, epigenomics, and pharmacologic metabolism as contributory factors.

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“…Across a range of studies using data from single institutions or from the SEER registry, Black compared to White patients were more likely to have a primary residence in census tract areas documented as low SES or in areas where a lower proportion of the population had received higher education or had access to medical insurance ( 15 , 17 , 19 , 40 , 48 , 49 ), or to reside in areas with higher measures of deprivation ( 17 , 40 , 49 ). In addition, as reported in one Detroit Metropolitan area-SEER study, Black breast cancer patients were more likely to reside in an area where hospitals provided more care for Medicare and Medicaid patients ( 13 ).…”

Section: Second-generation Studies: Explaining Disparitiesmentioning

confidence: 99%

“…In a Detroit Metropolitan Area-SEER analysis of colorectal cancer (CRC), Black compared to White patients were less likely to reside in a census tract area categorized as “professional” (16.5% vs. 42.5%, p<0.001) ( 15 ). In a study of women with estrogen and progesterone receptor negative breast cancer at the HFHS, Black compared to White women were ten times more likely to reside in an area with the highest level of deprivation (45.9% vs 4.4%, respectively p< 0.001) ( 49 ).…”

Section: Second-generation Studies: Explaining Disparitiesmentioning

confidence: 99%

“…These included a KCC study which showed no Black-White differences in breast cancer disease-free survival (HR 1.38, 95% CI 0.85-2.26) or overall survival (HR 1.06, 95% CI 0.64-1.75) ( 18 ), and in the HFHS analysis that showed no breast cancer survival differences after adjustment for neighborhood deprivation index (HR 0.97, 95% CI 0.8-1.9) ( 17 ). In a sub-analysis of Black and White women with estrogen and progesterone receptor negative breast cancer at the HFHS, there was also no overall survival disparity after adjustment for deprivation index (HR 1.26, 95% CI 0.84-1.87) ( 49 ).…”

Section: Second-generation Studies: Explaining Disparitiesmentioning

confidence: 99%

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A Review of Research on Disparities in the Care of Black and White Patients With Cancer in Detroit

et al. 2021

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Racial disparities in cancer incidence and outcomes are well-documented in the US, with Black people having higher incidence rates and worse outcomes than White people. In this review, we present a summary of almost 30 years of research conducted by investigators at the Karmanos Cancer Institute’s (KCI’s) Population Studies and Disparities Research (PSDR) Program focusing on Black-White disparities in cancer incidence, care, and outcomes. The studies in the review focus on individuals diagnosed with cancer from the Detroit Metropolitan area, but also includes individuals included in national databases. Using an organizational framework of three generations of studies on racial disparities, this review describes racial disparities by primary cancer site, disparities associated with the presence or absence of comorbid medical conditions, disparities in treatment, and disparities in physician-patient communication, all of which contribute to poorer outcomes for Black cancer patients. While socio-demographic and clinical differences account for some of the noted disparities, further work is needed to unravel the influence of systemic effects of racism against Black people, which is argued to be the major contributor to disparate outcomes between Black and White patients with cancer. This review highlights evidence-based strategies that have the potential to help mitigate disparities, improve care for vulnerable populations, and build an equitable healthcare system. Lessons learned can also inform a more equitable response to other health conditions and crises.

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Influence of clinical, societal, and treatment variables on racial differences in ER−/PR− breast cancer survival

Abstract: Social determinants of health play a large role in explaining racial disparities in breast cancer outcomes, especially among women with aggressive subtypes.

Cited by 10 publications

References 43 publications

Association between Neighborhood Social Deprivation and Stage at Diagnosis among Breast Cancer Patients in South Carolina

Association between Neighborhood Social Deprivation and Stage at Diagnosis among Breast Cancer Patients in South Carolina

Symptom Experience, Management, and Outcomes According to Race and Social Determinants Including Genomics, Epigenomics, and Metabolomics (SEMOARS + GEM): an Explanatory Model for Breast Cancer Treatment Disparity

A Review of Research on Disparities in the Care of Black and White Patients With Cancer in Detroit

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