The association of race/ethnicity, insurance status, and socioeconomic factors with breast cancer care

Freedman, Rachel A.; Virgo, Katherine S.; He, Yulei; Pavluck, Alexandre L.; Winer, Eric P.; Ward, Elizabeth; Keating, Nancy L.

doi:10.1002/cncr.25542

Cited by 181 publications

(159 citation statements)

References 30 publications

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“…This may be because of the relatively small numbers of patients in the treatment-eligible subgroups or because of our focus on a single geographic area. Nevertheless, many other studies have documented persistent disparities in treatment receipt, [30][31][32][33][34][35][36][37][38] and understanding how differences in knowledge may affect disparities among larger and broader cohorts is essential. We did observe differences in treatment by stage and age, consistent with other studies.…”

Section: Discussionmentioning

confidence: 99%

Association of Breast Cancer Knowledge With Receipt of Guideline-Recommended Breast Cancer Treatment

Freedman

Kouri

West

et al. 2016

JOP

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QUESTION ASKED: Is knowledge about one's cancer associated with treatment receipt for women with breast cancer?SUMMARY ANSWER: Knowledge about one's tumor characteristics was strongly associated with receipt of guideline-recommended therapies, suggesting the potential importance of knowledge about one's disease. METHODS:We surveyed women with stage I-III breast cancer diagnosed during 2010-2011. We assessed if reporting correct information about one's tumor, including stage, grade, estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) status, was associated with guideline-recommended chemotherapy, radiation, and hormonal therapy using the California Cancer Registry for confirmation of tumor information. RESULTS (OR WHAT WE FOUND):Among 414 women eligible for adjuvant therapies, patients who reported correct stage and HER2 status were more likely to receive chemotherapy than those reporting incorrect information. Those correctly reporting ER status were more likely than others to receive hormonal therapy and those reporting correct stage were also more likely to receive radiation (Fig). BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: Although our observations are provocative, our results are limited by a lack of detailed information on treatment discussions, information on trastuzumab receipt, treatment adherence, patient preferences, and if/how information was conveyed to patients. Our definitions for correct information also relied on the accuracy of registry data. Finally, although knowledge about one's tumor was associated with receipt of therapy, whether a woman received treatment as a result of that knowledge or knew her tumor characteristics because she received treatment is uncertain. REAL-LIFE IMPLICATIONS:Our findings underscore the major knowledge deficits women had about their own cancers and suggest that this knowledge may be important in receipt of guidelinerecommended treatments. Our observations highlight the need for further study of the clinical, emotional, and social consequences of poor knowledge and how we can improve information delivery to patients. Interventions to improve patients' knowledge and understanding of their cancers should be tested as a strategy for improving cancer care. Abstract PurposeKnowledge about one's breast cancer characteristics is poor, but whether this knowledge affects treatment is uncertain. Among women with breast cancer, we examined whether tumor knowledge was associated with adjuvant treatment receipt. MethodsWe surveyed a population-based sample of women in Northern California with stage 0 to III breast cancer diagnosed during 2010 to 2011 (participation rate, 68.5%). Interviews were conducted between 4 months and 3 years after diagnosis. Among 414 respondents with stage I to III disease, we examined receipt of guideline-recommended chemotherapy, radiation, and hormonal therapy by reporting correct information about one's tumor, including stage, estrogen receptor, human epidermal growth factor receptor 2 (HER2), and grade (using registry data fo...

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Section: Discussionmentioning

confidence: 99%

Association of Breast Cancer Knowledge With Receipt of Guideline-Recommended Breast Cancer Treatment

Freedman

Kouri

West

et al. 2016

JOP

Self Cite

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“…As introduced earlier, a limited number of studies have explored racial/ ethnic differences in the use of adjuvant hormonal therapies for the treatment of hormone receptor-positive breast cancer. 5,9,10,16,17 Unlike our analysis, prior studies have compared use of adjuvant hormonal therapy among racial/ethnic groups using non-Hispanic white women as the referent category, making direct comparisons with our study difficult. Similar to our study, however, three of the prior studies documented that African American women had the lowest frequency of adjuvant hormonal therapy use.…”

Section: Discussionmentioning

confidence: 99%

“…Similar to our study, however, three of the prior studies documented that African American women had the lowest frequency of adjuvant hormonal therapy use. 5,9,17 Specifically, two of these studies 5,17 reported that non-Hispanic white women were more likely to use adjuvant hormonal therapy than African American women (OR 4.59 and OR = 2.09, respectively), and the third study 9 reported a lower likelihood of adjuvant hormonal therapy use among both African American and Hispanic women compared to non-Hispanic white women (OR 0.91 and OR 0.95, respectively).…”

Section: Discussionmentioning

confidence: 99%

“…5,9 We were unable to control for this factor in our analysis, as the original study did not collect information on health insurance status. However, other research indicates that even after adjustment for insurance status and SES, African American women are less likely than non-Hispanic white women to use adjuvant hormonal therapy.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6] Adjuvant hormonal therapies improve disease-free and overall survival among women with hormone receptor-positive breast cancer, irrespective of patient age, menopausal status, lymph node status, or chemotherapy use. 7,8 A small number of studies to date have documented racial/ethnic differences in the use of adjuvant hormonal therapy, indicating that compared to non-Hispanic white women, African American, 5,[9][10][11] Hispanic, 9 and Chinese 10 women are significantly less likely to use adjuvant hormonal therapy. However, none of these studies have explored how patterns of use by racial/ethnic groups have changed over time.…”

Section: Introductionmentioning

confidence: 99%

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Racial and Ethnic Differences in Adjuvant Hormonal Therapy Use

Livaudais

John

et al. 2012

Journal of Women's Health

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Background: In the United States, 5-year breast cancer survival is highest among Asian American women, followed by non-Hispanic white, Hispanic, and African American women. Breast cancer treatment disparities may play a role. We examined racial/ethnic differences in adjuvant hormonal therapy use among women aged 18-64 years, diagnosed with hormone receptor-positive breast cancer, using data collected by the Northern California Breast Cancer Family Registry (NC-BCFR), and explored changes in use over time. Methods: Odds ratios (OR) comparing self-reported ever-use by race/ethnicity (African American, Hispanic, non-Hispanic white vs. Asian American) were estimated using multivariable adjusted logistic regression. Analyses were stratified by recruitment phase (phase I, diagnosed January 1995-September 1998, phase II, diagnosed October 1998-April 2003) and genetic susceptibility, as cases with increased genetic susceptibility were oversampled. Results: Among 1385 women (731 phase I, 654 phase II), no significant racial/ethnic differences in use were observed among phase I or phase II cases. However, among phase I cases with no susceptibility indicators, African American and non-Hispanic white women were less likely than Asian American women to use hormonal therapy (OR 0.20, 95% confidence interval [CI]0.06-0.60; OR 0.40, CI 0.17-0.94, respectively). No racial/ ethnic differences in use were observed among women with 1 + susceptibility indicators from either recruitment phase. Conclusions: Racial/ethnic differences in adjuvant hormonal therapy use were limited to earlier diagnosis years (phase I) and were attenuated over time. Findings should be confirmed in other populations but indicate that in this population, treatment disparities between African American and Asian American women narrowed over time as adjuvant hormonal treatments became more commonly prescribed.

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Treatment Disparities in Radiation and Hormone Therapy Among Women Covered by Medicaid vs Private Insurance in Cancer Registry and Claims Data

et al. 2023

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ImportancePrior research has reported undertreatment among patients with cancer who are insured by Medicaid, but this finding may be due, in part, to incomplete data in cancer registries.ObjectiveTo compare disparities in radiation and hormone therapy between women with breast cancer covered by Medicaid and those with private insurance using the Colorado Central Cancer Registry (CCCR) and CCCR data supplemented with All Payer Claims Data (APCD).Design, Setting, and ParticipantsThis observational cohort study included women aged 21 to 63 years who received breast cancer surgery. We linked the CCCR and Colorado APCD to identify Medicaid and privately insured women who were newly diagnosed with invasive, nonmetastatic breast cancer between January 1, 2012, and December 31, 2017. In the radiation treatment analysis, we narrowed the sample to women who received breast-conserving surgery (Medicaid, n = 1408; private, n = 1984) and in the hormone therapy analysis, we selected women who were hormone-receptor positive (Medicaid, n = 1156; private, n = 1667).Main Outcomes and MeasuresWe used logistic regression to estimate the likelihood of treatment within 12 months to assess whether the results varied between data sources.ResultsThere were 3392 and 2823 participants in the radiation and hormone therapy cohorts, respectively. The mean (SD) age was 51.71 (8.30) years in the radiation therapy cohort, and 52.00 (8.16) years in the hormone therapy cohort. Among the participants, there were 140 (4%) and 105 (4%) who were Black non-Hispanic, 499 (15%) and 406 (14%) who were Hispanic, 2602 (77%) and 2190 (78%) were White, and 151 (4%) and 122 (4%) were other/unknown in the radiation and hormone therapy cohorts, respectively. A higher percentage of women were aged 50 years or younger in the Medicaid samples (40% vs 34% in the privately insured sample) and identified as non-Hispanic Black (about 7%) or Hispanic (approximately 24%). Treatment was underreported in both sources, but to a lesser extent in the APCD (2.5% and 2.0% for Medicaid and private insurance, respectively) compared with CCCR (19.5% and 13.3% for Medicaid and private insurance, respectively). Using CCCR data, Women with Medicaid insurance were 4 (95% CI, −8 to −1; P = .02) and 10 (95% CI, −14 to −6; P &lt; .001) percentage points less likely to have a record of radiation and hormone therapy compared with privately insured women, respectively. Using combined CCCR and APCD, no statistically significant disparity was observed in radiation or hormone therapy between Medicaid-insured and privately insured women.Conclusions and RelevanceAmong women with breast cancer covered by Medicaid vs private insurance, cancer treatment disparities may be overestimated if based solely on cancer registry data.

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The association of race/ethnicity, insurance status, and socioeconomic factors with breast cancer care

Cited by 181 publications

References 30 publications

Association of Breast Cancer Knowledge With Receipt of Guideline-Recommended Breast Cancer Treatment

Association of Breast Cancer Knowledge With Receipt of Guideline-Recommended Breast Cancer Treatment

Racial and Ethnic Differences in Adjuvant Hormonal Therapy Use

Treatment Disparities in Radiation and Hormone Therapy Among Women Covered by Medicaid vs Private Insurance in Cancer Registry and Claims Data

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