Psychosocial Influences on Suboptimal Adjuvant Breast Cancer Treatment Adherence Among African American Women: Implications for Education and Intervention

Abstract

Despite lower incidence, African American women are at increased risk of dying from breast cancer relative to their European American counterparts. Although there are key differences in both screening behavior and tumor characteristics, an additional part of this mortality difference may lie in the fact that African American women receive suboptimal adjuvant chemotherapy and may receive suboptimal hormonal therapy, therapies that are known to increase survival. The authors consider ethnic differences in the psychosocial factors that have been shown to relate to poor screening adherence and consider how they may influence adherence to breast cancer adjuvant treatment, thus the receipt of suboptimal adjuvant chemo or hormonal therapy. To this end, they review ethnic differences in cognitive, emotional, and social network variables. Psychosocial variables should be included in research designed to understand cancer disparities as well interventions that can be tailored to culturally diverse populations to improve treatment adherence.

Association Between Prescription Co-Payment Amount and Compliance With Adjuvant Hormonal Therapy in Women With Early-Stage Breast Cancer

“…6,11,50 For example, similar to other studies, African American race was associated with a 50% reduction in adherence in both age groups. 31,51 In addition, older age, being unmarried, and higher numbers of comorbid conditions were associated with either nonpersistence, nonadherence, or both in our study as well as in others. 6,11,33 This study had several strengths.…”

Predicting Adherence to Tamoxifen for Breast Cancer Adjuvant Therapy and Prevention

“…It is possible that younger women and smokers may be more likely to have an optimistic bias in the perception of their disease risk, and health care professionals may help raise their awareness of the importance of medications and possible clinical consequences as a result of nonadherence (44). In addition, interventions with educational and psychosocial support may show promise for improving adherence to endocrine therapy among African Americans, who are more likely to be at a disadvantage in receiving health-related information and thus may have medical mistrust and lowered estimates of personal risk (45,46). In conclusion, recognizing the adherence predictors in endocrine chemoprevention will assist in the development of effective interventions which optimize women's decision making and promote their adherence to tamoxifen therapy and other treatment modalities, thus holding promise for improving disease outcomes.…”

Disparities in Breast Cancer Treatment and Outcomes: Biological, Social, and Health System Determinants and Opportunities for Research

“…In epidemiological terms, racial and ethnic differences in breast cancer-related morbidity and mortality can be thought of as being produced by multiple complementary causes [9,14], none of which is sufficiently explanatory alone. Possible explanations for enduring racial and ethnic disparities include biological differences in tumor behavior and morphology [6, 26, 28 -30], differences in therapeutic response [31], patient-level psychosocial or behavioral factors [32], socioeconomic status and access to care [9,33,34], and treatment differences [8,11,35]. Determining which of these multifaceted factors can be adjusted to improve outcomes is vital and requires deeper understanding of the complex relationships between biological, behavioral, and social determi- nants of health.…”

“…These include health literacy and personal preferences [62], cognitive and social network correlates [32], trust in the health care system, and health care-seeking behavior [35,63].…”