Comprehensive Analysis of Breast Cancer Survival Outcomes in a Public Safety-Net Hospital Compared with an Adjacent Academic Cancer Center

1088 Background: The Black population in the US constitutes of 4 million immigrants, with 50% from the Caribbean. It has been shown that breast cancer is responsible for 14%-30% of cancer deaths in the Caribbean; this is up to two times higher than the USA. Methods: Retrospective cohort of 1369 self-identified Black women with breast cancer. Data was obtained from Jackson Memorial Health Systems and University of Miami Health System Tumor Registry. Individual-level data from 1132 cases was used to estimate hazard rations (HRs) of women born in the Caribbean (CB) or in the USA (USB) using Cox proportional hazards regression analysis for overall survival. Median follow-up was 115 months (interquartile range, 91.9-138.1 months) per participant. Results: Data from 622 (54.9%) USB women and 507 (45%) CB women diagnosed with breast cancer between 2006-2017. 90% (n = 1232) of the cohort is of non-Hispanic ethnicity. Caribbean immigrants from Haiti (18.3%), Jamaica (6.5%), Bahamas (3.1%), Cuba and Dominica Republic (2.8% each), Trinidad and Tobago (1%) and other nationalities from the Organization of Eastern Caribbean States were included, mean age 55.7 [95% CI, 54.7-56.8]; USB mean age 57.6 [95% CI, 56.4-58.7] (P = 0.02). Compared to USB, CB had lower BMI at diagnosis 29.6 [95% CI, 28.9-30.3] versus 30.9 [95% CI, 30.1-31.7, P = 0.015]. Compared to CB patients, USB patients had more ER- [31.4% vs 39.1 %, P = 0.018] and triple negative breast cancers [19.6% vs 27.9%, P = 0.003]. Compared to USB patients, CB presented at more advanced stage, III and IV [44.2% vs 35.2%], p = 0.016. In spite of higher advanced stage at diagnoses, CB patients had a better breast cancer overall survival [HR = 0.75; 95%CI, 0.59-0.96; P = 0.024]. Black Hispanic patients had a better overall survival [HR = 0.51; 95%CI, 0.28-0.93; p = 0.028] compared to non-Hispanic Blacks. Compared to Hispanic Caribbean, non-Hispanic Caribbean had a worse overall survival [HR = 1.98; 95%CI, 1.00-3.94; P = 0.048]. The distribution of patients treated at the private cancer center and the safety net hospital were the same, differences in outcomes observed are due to intrinsic differences. Conclusions: This is the largest analysis to date of self-identified Black breast cancer patients in the context of nativity, race, ethnic identity and overall survival with clinico-pathologic characteristics. CB immigrants diagnosed with breast cancer have a better overall survival than US born Black patients. This finding suggests that within the African diaspora in the USA, additional factors beyond race contribute to the outcomes.

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43 Effect of Nodal Status in Triple Negative Breast Cancer – Survival Outcomes From a Tertiary Center

European Journal of Cancer ◽

10.1016/s0959-8049(12)70111-9 ◽

2012 ◽

Vol 48 ◽

pp. S53

Author(s):

E. Elias ◽

D. Mukherji ◽

W. Faraj ◽

R. Alameddine ◽

A. Saleh ◽

...

Keyword(s):

Breast Cancer ◽

Triple Negative Breast Cancer ◽

Triple Negative ◽

Cancer Survival ◽

Breast Cancer Survival ◽

Nodal Status ◽

Survival Outcomes ◽

Tertiary Center

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Multiple mediation analysis with survival outcomes: With an application to explore racial disparity in breast cancer survival

Statistics in Medicine ◽

10.1002/sim.7977 ◽

2018 ◽

Vol 38 (3) ◽

pp. 398-412 ◽

Cited By ~ 7

Author(s):

Qingzhao Yu ◽

Xiaocheng Wu ◽

Bin Li ◽

Richard A. Scribner

Keyword(s):

Breast Cancer ◽

Mediation Analysis ◽

Racial Disparity ◽

Cancer Survival ◽

Breast Cancer Survival ◽

Survival Outcomes ◽

Multiple Mediation ◽

Multiple Mediation Analysis

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Breast cancer diagnosis and treatment in a safety net setting: Differences between insured and uninsured patients

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.6566 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 6566-6566

Author(s):

N. J. Farrell ◽

C. J. Bradley ◽

L. M. Schickle

Keyword(s):

Breast Cancer ◽

Health Care ◽

Health Insurance ◽

Adjuvant Chemotherapy ◽

Breast Cancer Diagnosis ◽

Safety Net ◽

Cancer Center ◽

Hospital System ◽

Safety Net Hospital ◽

Chemotherapy Initiation

6566 Background: Despite the safety net system and many other means of providing free or low cost care to women with breast cancer, disparities in health outcomes between uninsured and insured women with breast cancer exist. In this study, we evaluate the role of health insurance on breast cancer treatments at a large safety net hospital system. Methods: From the patient population at the Massey Cancer Center at Virginia Commonwealth University Health Care System (a large regional safety net provider), we selected women ages 21 to 64 diagnosed with breast cancer between January 1999 and March 2006 (n=1,381). We used billing records to identify health insurance status of these patients. First, we compared the stage of disease and tumor size at diagnosis for women with and without insurance. Next, we compared the number of days between diagnosis and surgery and the number of days between surgery and chemotherapy initiation. Finally, we estimated the number of days it took these groups of women to complete a common adjuvant chemotherapy regimen of doxorubicin plus cyclophosphamide (AC) or doxorubicin plus cyclophosphamide followed by paclitaxel (ACT). Results: Our analysis shows that women without insurance were more likely to have more advanced cancers and correspondingly larger tumors. Uninsured women experienced considerable delays from the date of diagnosis to surgery and from surgery to chemotherapy initiation compared with insured women (21.5 and 22 days longer, respectively). Uninsured women also took significantly longer to complete adjuvant chemotherapy regimens relative to insured women (4 and 26 days for AC and ACT, respectively). Conclusions: To understand the disparities that exist in breast cancer outcomes among women with and without health insurance, we must understand the different experiences these groups of women have with treatment. In this study, uninsured women had more advanced cancers, and experienced considerable delays receiving and completing treatment relative to insured women. Our study demonstrates the value of health insurance in the timely provision of health care even in a safety net setting where care is guaranteed. No significant financial relationships to disclose.

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Overcoming Disparities: Multidisciplinary Breast Cancer Care at a Public Safety-Net Hospital

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2019.08.351 ◽

2019 ◽

Vol 229 (4) ◽

pp. S159

Author(s):

Kristin N. Kelly ◽

Emily Ryon ◽

Ahkeel Allen ◽

Dido Franceschi ◽

Mecker Moller ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Care ◽

Public Safety ◽

Safety Net ◽

Breast Cancer Care ◽

Safety Net Hospital

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Comparison of Cancer Care and Outcomes between a Public Safety-Net Hospital and a Private Cancer Center

Journal of Health Care for the Poor and Underserved ◽

10.1353/hpu.2013.0145 ◽

2013 ◽

Vol 24 (3) ◽

pp. 1136-1149 ◽

Cited By ~ 4

Author(s):

Ulas Darda Bayraktar ◽

Sean Warsch ◽

Emerson Chen ◽

Caio Max Rocha Lima ◽

Denise Pereira

Keyword(s):

Cancer Care ◽

Public Safety ◽

Safety Net ◽

Cancer Center ◽

Safety Net Hospital

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Estimating Breast Cancer Survival by Molecular Subtype in the Absence of Screening and Adjuvant Treatment

Medical Decision Making ◽

10.1177/0272989x17743236 ◽

2018 ◽

Vol 38 (1_suppl) ◽

pp. 32S-43S ◽

Cited By ~ 9

Author(s):

Diego F. Munoz ◽

Sylvia K. Plevritis

Keyword(s):

Breast Cancer ◽

Adjuvant Treatment ◽

Cancer Survival ◽

Molecular Subtype ◽

Breast Cancer Survival ◽

Her2 Status ◽

Survival Outcomes ◽

Treatment Interventions ◽

Molecular Subtyping ◽

Incidence And Mortality

Background. As molecular subtyping of breast cancer influences clinical management, the evaluation of screening and adjuvant treatment interventions at the population level needs to account for molecular subtyping. Performing such analyses are challenging because molecular subtype-specific, long-term outcomes are not readily accessible; these markers were not historically recorded in tumor registries. We present a modeling approach to estimate historical survival outcomes by estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) status. Method. Our approach leverages a simulation model of breast cancer outcomes and integrates data from two sources: the Surveillance Epidemiology and End Results (SEER) databases and the Breast Cancer Surveillance Consortium (BCSC). We not only produce ER- and HER2-specific estimates of breast cancer survival in the absence of screening and adjuvant treatment but we also estimate mean tumor volume doubling time (TVDT) and mean mammographic detection threshold by ER/HER2-status. Results. In general, we found that tumors with ER-negative and HER2-positive status are associated with more aggressive growth, have lower TVDTs, are harder to detect by mammography, and have worse survival outcomes in the absence of screening and adjuvant treatment. Our estimates have been used as inputs into model-based analyses that evaluate the effects of screening and adjuvant treatment interventions on population outcomes by ER and HER2 status developed by the Cancer Intervention and Surveillance Modeling Network (CISNET) Breast Cancer Working Group. In addition, our estimates enable a re-assessment of historical trends in breast cancer incidence and mortality in terms of contemporary molecular tumor characteristics. Conclusion. Our approach can be generalized beyond breast cancer and to more complex molecular profiles.

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Hospital Characteristics and Breast Cancer Survival in the California Breast Cancer Survivorship Consortium

JCO Oncology Practice ◽

10.1200/op.20.00064 ◽

2020 ◽

Vol 16 (6) ◽

pp. e517-e528

Author(s):

Salma Shariff-Marco ◽

Libby Ellis ◽

Juan Yang ◽

Jocelyn Koo ◽

Esther M. John ◽

...

Keyword(s):

Breast Cancer ◽

African American ◽

African American Women ◽

Cancer Survival ◽

Breast Cancer Survival ◽

Cancer Center ◽

American Women ◽

Initial Care ◽

Race Ethnicity ◽

Hospital Characteristics

INTRODUCTION: Racial/ethnic disparities in breast cancer survival are well documented, but the influence of health care institutions is unclear. We therefore examined the effect of hospital characteristics on survival. METHODS: Harmonized data pooled from 5 case-control and prospective cohort studies within the California Breast Cancer Survivorship Consortium were linked to the California Cancer Registry and the California Neighborhoods Data System. The study included 9,701 patients with breast cancer who were diagnosed between 1993 and 2007. First reporting hospitals were classified by hospital type—National Cancer Institute (NCI) –designated cancer center, American College of Surgeons (ACS) Cancer Program, other—and hospital composition of the neighborhood socioeconomic status and race/ethnicity of patients with cancer. Multivariable Cox proportional hazards models adjusted for clinical and patient-level prognostic factors were used to examine the influence of hospital characteristics on survival. RESULTS: Fewer than one half of women received their initial care at an NCI-designated cancer center (5%) or ACS program (38%) hospital. Receipt of initial care in ACS program hospitals varied by race/ethnicity—highest among non-Latina White patients (45%), and lowest among African Americans (21%). African-American women had superior breast cancer survival when receiving initial care in ACS hospitals versus other hospitals (non-ACS program and non–NCI-designated cancer center; hazard ratio, 0.67; 95% CI, 0.55 to 0.83). Other hospital characteristics were not associated with survival. CONCLUSION: African American women may benefit significantly from breast cancer care in ACS program hospitals; however, most did not receive initial care at such facilities. Future research should identify the aspects of ACS program hospitals that are associated with higher survival and evaluate strategies by which to enhance access to and use of high-quality hospitals, particularly among African American women.

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