Racial and geographic disparities in adherence and discontinuation to adjuvant endocrine therapy in Texas Medicaid-insured patients with breast cancer

Abstract

The purpose of the study is to examine disparities in AET adherence and discontinuation among Texas Medicaid-insured early-stage breast cancer patients. Texas Cancer Registry Medicaid-linked database was used from 2000 to 2007 for breast cancer patients aged 20–64. Multivariable logistic regression was performed to test the association of race/ethnicity and geographic factors with AET adherence and discontinuation. Of the 1240 women with breast cancer, 60.8% of non-Hispanic white vs 46.6% of Black patients were adherent to AET in the first year. After adjusting for confounding, Black patients had lower odds of adherence compared to non-Hispanic white patients (Odds ratio 0.62, 95% CI 0.44–0.87), but they were not more likely to discontinue therapy during the study period. Patients from the Texas/Mexico border had higher odds of adherence compared to other regions (OR 2.32, 95% CI 1.29–4.18). There are substantial racial and geographic disparities in AET adherence and discontinuation among Texas Medicaid-insured women.

Initial outcomes with image‐guided partial breast irradiation delivered with intensity‐modulated radiation therapy

“…This technique represents a patient‐centered approach, reducing treatment duration, and allowing patients with limited access to radiation centers improved convenience in the completion of adjuvant RT while providing value . This is important because growing data have demonstrated noncompliance with adjuvant radiation and endocrine therapy . Finally, it should be noted that this approach is consistent with the updated American Brachytherapy Society guidelines which also support the use of IMRT APBI …”

“…4,10,18 This is important because growing data have demonstrated noncompliance with adjuvant radiation and endocrine therapy. 19,20 Finally, it should be noted that this approach is consistent with the updated American Brachytherapy Society guidelines which also support the use of IMRT APBI. 4 Our analysis is limited by the need for longer follow-up, with only 24 patients available for chronic toxicity assessment and cosmetic assessment.…”

The Impact of the COVID-19 Pandemic on Cancer Care and Health-Related Quality of Life of Non-Hispanic Black/African American, Hispanic/Latina and Non-Hispanic White Women Diagnosed with Breast Cancer in the U.S.: A Mixed-Methods Study Protocol

“…Traditional explanations have included biologic differences in tumor characteristics [ 81 ], late-stage diagnosis due to lack of cancer screening [ 91 , 92 , 93 ], and socioeconomic factors [ 83 , 94 ]. However, a growing body of literature suggests that differences in selection and adherence to recommended treatments may play a major role in the maintenance of disparities in breast cancer outcomes [ 83 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 ]. In the current oncologic practice, where timely engagement with treatment is crucial to prevent recurrence and reduce mortality [ 89 , 90 ], differences in treatment initiation and adherence to treatment have become increasingly relevant given the present recommendations for triage and modified delivery of cancer care [ 75 , 95 , 96 , 97 , 98 , 99 ].…”

“…Minority breast cancer patients are disproportionally characterized by non-initiation, discontinuation, and non-adherence to adjuvant endocrine therapy [ 98 , 99 , 100 , 101 , 102 , 103 , 104 ], which leads to lower survival, shorter time to recurrence, increased medical costs, and lower quality of life [ 87 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 ]. Key determinants of disparities range from proximal factors (socio-demographic variables), to intermediate (social network characteristics), and distal factors (access to resources; healthcare system characteristics, and policy) [ 88 , 89 , 90 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 ]. Although multiple levels of contextual influences affect behavior, currently available interventions to alleviate breast cancer disparities fail to comprehensively address these SDoH, or the interplay between them [ 106 ].…”

Preventing metastatic recurrence in low-risk ER/PR + breast cancer patients—a retrospective clinical study exploring the evolving challenge of persistence with adjuvant endocrine therapy

“…Specifically, 98.6% of the sample population was white and non-Hispanic. Differences in AET adherence by race has been documented, with several reports showing black and Hispanic patients are at higher risk [70]; however, further work is needed to understand this complex issue [64][65][66][67][68][69]. Interventions to address non-adherence and non-persistence should address racial/ethnic differences and aim to eliminate outcome disparities.…”