ASPO Abstracts
Patient Factors that Contribute to Racial Disparities in Early-Stage Breast Cancer Treatment
Category: Cancer Health Disparities, Cancer Health Disparities
Conference Year: 2018
Abstract Body:
Purpose: Differential quality of treatment has been proposed as a cause for racial disparity in breast cancer (BrCa) mortality. We examined: (1) racial disparity in physicians’ recommendation of treatment based on standard National Comprehensive Cancer Network (NCCN) treatment decision trees; (2) racial differences in patients’ receipt of physician-recommended treatment; and (3) factors that are associated with undertreatment by race. Methods: This study included African American (AA) and white women who participated in a population-based prospective BrCa cohort study. Participants were identified through rapid case ascertainment by the New Jersey State Cancer Registry. Eligibility for this analysis included 849 AA and 347 white women newly diagnosed with stage I, II, and T3N1M0 BrCa (2005-2015). Medical records were collected and abstracted for medical history, diagnostic work-up, and treatment information. We used NCCN guidelines to determine the type of treatments patients should have received based on clinical factors. Chi-square test was used to compare proportions by race. Using binomial regression, the likelihood of physicians not recommending therapy and patients not receiving physician-recommended treatment were compared by race after adjusting for age, income, insurance, and comorbidities. We used a generalized estimating equation procedure with a compound symmetry working correlation to account for within-physician correlation. Results: Physicians were less likely to recommend endocrine therapy to AA women compared to white women when NCCN guidelines indicated its use (94% versus 98%, p=0.01). Income and insurance status were associated with physicians not recommending endocrine therapy (p=0.013 and p=0.024). Racial disparity of physicians’ recommendation of endocrine therapy was attenuated when adjusted for income and insurance status. There were no racial differences for patients’ receipt of surgery, radiation, and systemic therapy when recommended by their physician. Conclusions: We observed racial disparity in physicians’ recommendation of endocrine therapy when indicated by NCCN guidelines. Identifying patient factors that contribute to physicians’ not recommending endocrine therapy is the first step to address inequities in BrCa care.
Keywords: breast cancer, cancer health disparities, treatment guidelines