Racial/Ethnic and Socioeconomic Disparities in Endocrine Therapy Adherence in Breast Cancer: A Systematic Review

Abstract

We examined the current literature to understand factors that influence endocrine therapy (ET) adherence among racial/ethnic and socioeconomic subpopulations of breast cancer patients. We searched PubMed and PsycINFO databases for studies from January 1, 1978, to June 20, 2014, and January 1, 1991, to June 20, 2014, respectively, and hand-searched articles from relevant literature reviews. We abstracted and synthesized results within a social ecological framework. Fourteen articles met all inclusion criteria. The majority of included articles reported significant underuse of ET among minority and low-income women. Modifiable intrapersonal, interpersonal, and community-level factors are associated with ET use, and these factors vary across subgroups. Both race/ethnicity and socioeconomic status are associated with ET use in most settings. Variation in factors associated with ET use across subgroups indicates the need for more nuanced research and targeted interventions among breast cancer patients.

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

“…This is lower than previous reports using similar claims-based methodology among non-elderly privately insured women, which reported 72–81% 12-month adherence to AET [37–41]. However, unlike our study, they did not include a large proportion of low-income minority women which are factors that are associated with lower likelihood of adherence [11, 16, 17]. Studies using state cancer registry and Medicaid-linked data in North Carolina [17] and New York [42] corroborate our adherence rates and find that adherence ranges from 59 to 60% within the first year of initiation.…”

“…Despite the effectiveness of AET to improve survival and decrease cancer recurrence, between 55–75% of breast cancer patients are not adherent to AET during 1-year period [14] and the proportion of being not adherent is even higher for minority women [15, 16]. Previous studies have examined that black patients had 24% lower odds of adherence to AET compared to non-Hispanic white women [11].…”

“…Because the known risk factors of adherence to AET, such as low socioeconomic status [11, 16], and being a minority [11, 16, 24], are predominately prevalent among the Medicaid population, studying these factors in this population is critical. Texas Medicaid provides comprehensive medical care to breast and cervical cancer patients, and mothers and children in low-income households [25].…”

Impact of socioeconomic status on disease phenotype, genomic landscape and outcomes in myelodysplastic syndromes

“…Based on the established SES-dependent variation in clinicopathological characteristics and outcomes in many diseases (Barker, 1981;Gomez et al, 2015;Stringhini et al, 2013) including cancer (DeSantis et al, 2011;Kolahdooz et al, 2014;Lyratzopoulos et al, 2012;Roberts et al, 2015;Rutherford et al, 2013), we hypothesised a role for SES in influencing the biological and clinical heterogeneity in patients with MDS. In previous studies, Wang et al (2009) investigated the prognostic role of neighbourhood SES in MDS using data from the Surveillance, Epidemiology and End Results (SEER) cancer registries linked to the national insurance programme Medicare in the USA and identified poorer survival in patients belonging to lower SES groups.…”

“…In patients with solid organ and other haematological neoplasia differences in time to diagnosis, access to clinical care or trials and comorbidity between patients that are SES-dependent are known to affect survival (Kolahdooz et al, 2014;Munro, 2005;Roberts et al, 2015;Rutherford et al, 2013). For example, the lower incidence of childhood acute lymphoblastic leukaemia across levels of increasing relative deprivation could reflect under-diagnosis in lower socioeconomic communities (Kroll et al, 2012;Lightfoot et al, 2012), and the mortality in AML and myeloma appears to be reduced in higher SES groups in some studies (Kristinsson et al, 2009).…”