Abstract A50: Is there a reverse racial/ethnic disparity in chemotherapy treatment among breast cancer patients?

Author(s):  
Abigail Silva ◽  
Garth H. Rauscher ◽  
Kent Hoskins ◽  
Ruta D. Rao
Author(s):  
C. T. Sánchez-Díaz ◽  
S. Strayhorn ◽  
S. Tejeda ◽  
G. Vijayasiri ◽  
G. H. Rauscher ◽  
...  

Abstract Background Prior studies have observed greater levels of psychosocial stress (PSS) among non-Hispanic (nH) African American and Hispanic women when compared to nH White patients after a breast cancer diagnosis. We aimed to determine the independent and interdependent roles of socioeconomic position (SEP) and unmet support in the racial disparity in PSS among breast cancer patients. Methods Participants were recruited from the Breast Cancer Care in Chicago study (n = 989). For all recently diagnosed breast cancer patients, aged 25–79, income, education, and tract-level disadvantage and affluence were summed to create a standardized socioeconomic position (SEP) score. Three measures of PSS related to loneliness, perceived stress, and psychological consequences of a breast cancer diagnosis were defined based on previously validated scales. Five domains of unmet social support needs (emotional, spiritual, informational, financial, and practical) were defined from interviews. We conducted path models in MPlus to estimate the extent to which PSS disparities were mediated by SEP and unmet social support needs. Results Black and Hispanic patients reported greater PSS compared to white patients and greater unmet social support needs (p = 0.001 for all domains). Virtually all of the disparity in PSS could be explained by SEP. A substantial portion of the mediating influence of SEP was further transmitted by unmet financial and practical needs among Black patients and by unmet emotional needs for Hispanic patients. Conclusions SEP appeared to be a root cause of the racial/ethnic disparities in PSS within our sample. Our findings further suggest that different interventions may be necessary to alleviate the burden of SEP for nH AA (i.e., more financial support) and Hispanic patients (i.e., more emotional support).


2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20713-e20713
Author(s):  
Liliana Moyers-Ruiz ◽  
Tamas Hickish ◽  
Andrew Mayers ◽  
Simon Thompson

e20713 Background: Sleep efficiency might be altered during chemotherapy treatment. Cognitive decline has been associated with sleep disruption, impaired glucose levels, and chemotherapy treatment. We hypothesize that the biological factors considered in this study are playing an important role. Anecdotical reports have shown discrepancy with neuropsychological batteries results, therefore a qualitative interview and memory self-reports will be conducted for the cancer group. Methods: A sample of 32 Breast cancer patients and 29 healthy controls has been recruited in the Dorset area in the UK. The chemotherapy group will be tested three times within de course of their treatment (baseline, mid-treatment, after treatment). The radiotherapy participants will be tested three times within a period of four months, and the healthy control group two times within a four-month period. A subset of chemotherapy participants will be tested six months after chemotherapy. A neuropsychological battery is being used to assess cognitive function, and sleep efficiency is analysed using a sleep monitor and validated self-reports; Furthermore, glucose levels will be analysed for the chemotherapy group, and an online semi-qualitative interview will be conducted for cancer patients for a thematic analysis, along with a Prospective Memory questionnaire. Results: Preliminary data shows that sleep efficiency is disturbed during the course of chemotherapy, although not statistically significant, there is a trend in decreased sleep efficiency percentage when we compared baseline and mid-chemotherapy assessment The strongest tendency is observed on the PSQI self-report, showing an increase in Global PSQI score . Glucose levels show an increase during mid-treatment, although preliminary analyses show no significant effect. Memory data is still under scrutiny and more data will be reported at the poster presentation, along with assessments for times three and four. Conclusions: The inclusion of a semi-qualitative study will add a very important information to this study when test results are compered with anecdotical and self-reports.


2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 273-273
Author(s):  
Steven J. Katz ◽  
Monica Morrow ◽  
Allison W. Kurian

273 Background: Genetic testing is increasingly central to breast and ovarian cancer prevention and treatment. Yet, little is known about trends and disparities in receipt of testing and test results after diagnosis. Methods: We linked all female patients with breast or ovarian cancer diagnosed from 2013-2017 in Georgia and California and reported to SEER registries to genetic testing results from four laboratories (Ambry Genetics, GeneDx, Invitae, Myriad Genetics). We combined test results from all labs with SEER data. We classified a test as a multigene panel (MGP) if it included other genes in addition to BRCA1/2. We grouped pathogenic variants (PVs) by level of evidence that supported clinical testing: BRCA1/2; other genes associated with well-established syndromes (syndromic genes); genes whose cancer association is less certain (emerging genes); and any other tested genes (other genes). We categorized patients with a variant of unknown significance (VUS) in any gene but no PVs as VUS-only. We examined trends in receipt of testing and test results overall and by race/ethnic groups. Results: One quarter (25.5%) of 198,001 breast cancer patients, and 34.5% of 15,461 ovarian cancer patients had genetic tests. Test rates increased by only 2% annually; while the number of genes tested per patient increased by 28%. The mean number of genes tested rose from 10 to 35 during the study period. In early 2013, 18.3% of testers had a PV or VUS result, which increased to 37.2% in late 2017. The upward trend was largely due to increase in VUS-only findings. The proportion of tested breast cancer patients with any PV increased from 9.1% to 9.9%: PVs in BRCA1/2 decreased from 7.5% to 5.0% (p<.001), while PV yield for the two other clinical categories (syndromic and emerging genes) increased from 1.6% to 4.9% (p<.001). PVs in any of the other 61 genes were very rare (<1%). By contrast, the VUS rate in breast cancer patients increased markedly from 9.6% in 2013 to 26.2% in 2017. The VUS rate was higher in racial/ethnic minorities (41.0% Asian, 36.5%% Black, 28.0% Latinas versus 25.6% non-Hispanic Whites diagnosed in 2017; p<.001). We observed similar findings for patients with ovarian cancer. Conclusions: A large gap persists in testing ovarian cancer patients (35% versus 100% recommended). Testing more genes per patient was associated with a substantial racial/ethnic gap in VUS with little difference in yield on clinically relevant PVs. Testing a limited subset of genes may optimize yield-to-noise of genetic testing, particularly for racial/ethnic minorities.


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