Investigating racial disparities in use of NK1 receptor antagonists to prevent chemotherapy-induced nausea and vomiting among women with breast cancer

Abstract

Purpose Chemotherapy-induced nausea and vomiting (CINV) is a major concern for cancer patients and, if uncontrolled, can seriously compromise quality of life (QOL) and other treatment outcomes. Because of the expense of antiemetic medications used to prevent CINV (particularly oral medications filled through Medicare Part D), disparities in their use may exist. Methods We used 2006–2012 SEER-Medicare data to evaluate the use of neuroknin-1 receptor antagonists (NK1s), a potent class of antiemetics, among black and white women initiating highly emetogenic chemotherapy for the treatment of early-stage breast cancer. We used modified Poisson regression to assess the relationship between race and (1) any NK1 use, (2) oral NK1 (aprepitant) use, and (3) intravenous NK1 (fosaprepitant) use. We report adjusted risk ratios (aRR) and 95% confidence intervals (CI). Results The study included 1,130 women. We observed racial disparities in use of any NK1 (aRR: 0.68, 95% CI: 0.51–0.91) and in use of oral aprepitant specifically (aRR: 0.54, 95% CI: 0.35–0.83). We did not observe disparities in intravenous fosaprepitant use. After controlling for variables related to socioeconomic status, disparities in NK1 and aprepitant use were reduced but not eliminated. Conclusions We found racial disparities in women’s use of oral NK1s for the prevention of CINV. These disparities may be partly explained by racial differences in socioeconomic status, which may translate into differential ability to afford the medication.

Race and delays in breast cancer treatment across the care continuum in the Carolina Breast Cancer Study

“…40 Other sources suggest that toxicities of radiation and chemotherapy, which could potentially prolong therapy, are more common among black women. [41][42][43][44] Thus, there are several barriers not measured in this study that warrant future investigation.…”

Data Quality of Chemotherapy-Induced Nausea and Vomiting Documentation

“…Second, 26 years is the cutoff age for young adults to be on parental insurance, and disparities in high-quality care delivery have previously been documented by socioeconomic factors, such as insurance status. 25,26 In fact, we recently reported that patients receiving emetogenic chemotherapy with commercial insurance were significantly more likely to receive guidelineconcordant antiemetic prophylaxis compared with those with Medicaid (odds ratio [OR]: 2.4; 95% confidence interval [95% CI]: 1.0-4.8). 19 All available EHR data from the first clinical encounter for HEC were included for each eligible patient.…”

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

“…[14] More recently, we documented disparities in use of neurokinin-1 receptor antagonists (NK1s), a newer and more potent class of antiemetics recommended for use with highly emetogenic chemotherapy regimens, among women with early-stage breast cancer, a population that frequently receives highly emetogenic chemotherapy. [15]…”