Breast Cancer Treatment in Black Women

Abstract Background: Black women diagnosed with breast cancer in the U.S. tend to experience significantly longer waits to begin treatment than do their white counterparts, and such treatment delay has been associated with poorer survival. We sought to identify the factors driving or mitigating treatment delay among Black women in an urban community where treatment delay is common.Methods: Applying the SaTScan method to data from Ohio’s state cancer registry, we identified the community within Cuyahoga County, Ohio (home to Cleveland) with the highest degree of breast cancer treatment delay from 2010 through 2015. We then recruited breast cancer survivors living in the target community, their family caregivers, and professionals serving breast cancer patients in this community. Participants completed semi-structured interviews focused on identifying barriers to and facilitators of timely breast cancer treatment initiation after diagnosis.Results: Factors reported to impact timely treatment fell into three primary themes: informational, intrapersonal, and logistical. Informational barriers included erroneous beliefs and lack of information about processes of care; intrapersonal barriers centered on mistrust, fear, and denial; while logistical barriers involved transportation and financial access, as well as patients’ own caregiving obligations. An informational facilitator was the provision of objective and understandable disease information, and a common intrapersonal facilitator was faith. Logistical facilitators included financial counseling and mechanisms to assist with Medicaid enrollment. Crosscutting these themes, and mentioned frequently, was the centrality of both patient navigators and support networks (formal and, especially, informal) as critical lifelines for overcoming barriers and leveraging facilitating factors.Conclusions: The present study describes the numerous hurdles to timely breast cancer treatment faced by Black women in a high-risk urban community. These hurdles, as well as corresponding facilitators, can be classified as informational, intrapersonal, and logistical. Observing similar results on a larger scale could inform the design of interventions and policies to reduce race-based disparities in processes of cancer care.

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Racial differences in impact of geography on breast cancer treatment delay.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.81 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 81-81

Author(s):

Katherine Elizabeth Reeder-Hayes ◽

Christopher Baggett ◽

Bradford E. Jackson ◽

Tzy-Mey Kuo ◽

Jacquelyne Janean Gaddy ◽

...

Keyword(s):

Breast Cancer ◽

North Carolina ◽

Black Women ◽

Health System ◽

Cancer Treatment ◽

Racial Disparities ◽

Treatment Delay ◽

Breast Cancer Treatment ◽

Black Patients ◽

Region Of Residence

81 Background: Delays in breast cancer treatment > 60 days have been linked to decrements in outcome and constitute poor quality care. Black compared to non-Black patients are at greater risk of treatment delays across the cancer care delivery spectrum. The extent to which racial disparities in breast cancer timeliness are linked to the geographic areas where Black patients receive care is unclear. Methods: We assembled a cohort of 26,482 patients diagnosed with stage I-III breast cancer in North Carolina from 2004 to 2015 from the Cancer Information and Population Health Resource (CIPHR), a multi-payer linkage of insurance claims to cancer registry data, and enrolled for 1 year after diagnosis. We defined time to treatment (TTx) as days between diagnosis and the first claim for cancer-directed therapy (surgery or chemotherapy); patients receiving radiation before other treatments and those who did not receive cancer-directed surgery by 12 months were excluded. The main exposure was the patient’s Area Health Education Center (AHEC) region of residence. The outcome of clinically significant delay was dichotomized at 60 days. Modified Poisson regression was used to generate risk ratios for bivariate, race and age-adjusted, and fully-adjusted multivariable models including clinical characteristic. The interaction of race and AHEC region was significant; therefore all subsequent analyses were stratified by Black versus non-Black race. Results: Overall, 12.3% of Blacks were delayed > 60 days, compared to 6.8% of non-Blacks. Among non-Black patients, AHEC region of residence did not predict delay. Among Black patients, likelihood of delay varied significantly across the state’s nine AHEC regions, with a risk ratio of 1.91 (95% CI 1.30-2.79) for the lowest-performing region compared to the highest-performing region. The two highest-performing regions had the largest proportions of Black patients (25-38%), and did not contain any of the state’s five largest cities. Adjustment for age, disease stage, hormone receptor status and type of first treatment did not significantly attenuate regional differences in delay among Black patients. Conclusions: Significant racial disparities exist in timely breast cancer treatment among Black women in North Carolina. AHEC region of residence had a disproportionate impact on the likelihood of treatment delay among Black women, with higher-minority regions without large cities delivering more timely care to Black patients. Our findings suggest that local health system characteristics of AHEC regions, rather than patient-level factors, may be key determinants of care disparities among Black breast cancer patients in this context. Ongoing work includes additional multi-level modeling including AHEC-level health system factors, and stakeholder interviews in high and low performing areas to enhance understanding of patterns of care and identify intervention targets.

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