Underuse of breast cancer adjuvant treatment: Patients' knowledge, beliefs, and medical mistrust

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6521-6521
Author(s):  
N. Bickell ◽  
J. Weidmann ◽  
K. Fei ◽  
H. Leventhal
Keyword(s):  
Breast Cancer ◽  
New York ◽  
New York City ◽  
Adjuvant Treatment ◽  
Physician Communication ◽  
Patient Knowledge ◽  
Medical Mistrust ◽  
Adjuvant Therapies ◽  
Knowledge And Beliefs ◽  
Medical Delivery

6521 Background: We surveyed breast cancer patients in New York City to understand why women did not receive radiotherapy (RT) following lumpectomy, chemotherapy, or hormonal therapy for hormone receptor negative or positive tumors >1 cm, respectively. Methods: 258 New York City women recently surgically treated for a new primary stage I or II breast cancer were surveyed about their experience of care, knowledge and beliefs about breast cancer and its treatment. Adjuvant treatment data were obtained from in and out-patient chart abstraction. Principal components factor analysis was used to create scales of adjuvant treatment beliefs and knowledge, medical mistrust, physician communication about treatment and social support. Scales were scored to 100. Bivariate and multivariate analyses were conducted to determine differences between treated and untreated women; odds ratios were converted to adjusted relative risks. Results: Compared to treated women, untreated women were less likely to know adjuvant therapies increase survival (66 vs 75; p < 0.0001), had greater mistrust (64 vs 53; p = 0.001), and less self efficacy (92 vs 97; p < 0.05); there was no association between physician communication of treatment information and patient knowledge and beliefs about adjuvant treatment (r = 0.8; p = 0.21). Multivariate analysis found that compared to those who were treated, untreated women were more likely to be 70 years or older (OR = 4.46; 95%CI: 1.9–10.7), more likely to have a comorbidity (OR = 3.39;1.5–7.9), more likely to express mistrust in the medical delivery system (OR = 1.03;1.0–1.1), and less likely to believe adjuvant treatments beneficial (OR = 0.91; 0.87–0.96) (model c = 0.84; p =< 0.0001). Conclusions: Patient knowledge and beliefs about treatment and medical mistrust are mutable factors associated with underuse of adjuvant therapies. Despite physicians' discussion of treatment, patients do not have a clear understanding of treatments' benefits and risks. This disconnect between what is said and what is heard may be mediated and addressed by dealing with patients' trust in and concerns about the medical delivery system. No significant financial relationships to disclose.

scholarly journals Underuse of Breast Cancer Adjuvant Treatment: Patient Knowledge, Beliefs, and Medical Mistrust

2009 ◽  
Vol 27 (31) ◽  
pp. 5160-5167 ◽  
Author(s):  
Nina A. Bickell ◽  
Jessica Weidmann ◽  
Kezhen Fei ◽  
Jenny J. Lin ◽  
Howard Leventhal
Keyword(s):  
Breast Cancer ◽  
Adjuvant Treatment ◽  
Early Stage ◽  
Physician Communication ◽  
Patient Knowledge ◽  
Medical Mistrust ◽  
Adjusted Relative Risk ◽  
National Guidelines ◽  
Adjuvant Therapies ◽  
Knowledge And Beliefs

Purpose Little is known about why women with breast cancer who have surgery do not receive proven effective postsurgical adjuvant treatments. Methods We surveyed 258 women who recently underwent surgical treatment at six New York City hospitals for early-stage breast cancer about their care, knowledge, and beliefs about breast cancer and its treatment. As per national guidelines, all women should have received adjuvant treatment. Adjuvant treatment data were obtained from inpatient and outpatient charts. Factor analysis was used to create scales scored to 100 of treatment beliefs and knowledge, medical mistrust, and physician communication about treatment. Bivariate and multivariate analyses assessed differences between treated and untreated women. Results Compared with treated women, untreated women were less likely to know that adjuvant therapies increase survival (on a 100-point scale; 66 v 75; P < .0001), had greater mistrust (64 v 53; P = .001), and had less self-efficacy (92 v 97; P < .05); physician communication about treatment did not affect patient knowledge of treatment benefits (r = 0.8; P = .21). Multivariate analysis found that untreated women were more likely to be 70 years or older (adjusted relative risk [aRR], 1.11; 95% CI, 1.00 to 1.13), to have comorbidities (aRR, 1.10; 95% CI, 1.04 to 1.12), and to express mistrust in the medical delivery system (aRR, 1.003; 95% CI, 1.00 to 1.007), even though they were more likely to believe adjuvant treatments were beneficial (aRR, 0.99; 95% CI, 0.98 to 0.99; model c, 0.84; P ≤ .0001). Conclusion Patient knowledge and beliefs about treatment and medical mistrust are mutable factors associated with underuse of effective adjuvant therapies. Physicians may improve cancer care by ensuring that discussions about adjuvant therapy include a clear presentation of the benefits, not just the risks of treatment, and by addressing patient trust in and concerns about the medical system.

scholarly journals Characteristics and outcomes of patients with breast cancer diagnosed with SARS-Cov-2 infection at an academic center in New York City

2020 ◽  
Vol 182 (1) ◽  
pp. 239-242 ◽  
Author(s):  
Kevin Kalinsky ◽  
Melissa K. Accordino ◽  
Kristina Hosi ◽  
Jessica E. Hawley ◽  
Meghna S. Trivedi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
New York ◽  
New York City ◽  
York City ◽  
Academic Center

A nested case-control study of mammographic patterns, breast volume, and breast cancer (New York City, NY, United States)

1995 ◽  
Vol 6 (5) ◽  
pp. 431-438 ◽  
Author(s):  
Ikuko Kato ◽  
Clifford Beinart ◽  
Alan Bleich ◽  
Shaun Su ◽  
Mimi Kim ◽  
...  
Keyword(s):  
Breast Cancer ◽  
United States ◽  
New York ◽  
New York City ◽  
Case Control Study ◽  
Case Control ◽  
Breast Volume ◽  
Nested Case Control ◽  
Mammographic Patterns ◽  
Control Study

Breast Cancer, Part 1: The Rise Of Activism and The Pesticide Hypothesis

2002 ◽  
Author(s):  
Inge F. Goldstein ◽  
Martin Goldstein
Keyword(s):  
Breast Cancer ◽  
New York ◽  
New York City ◽  
York City ◽  
New York State ◽  
Front Page ◽  
East Side ◽  
Health Authorities ◽  
Waste Dumps ◽  
Breast Cancer Rate

The New York Post, a New York City daily, ran a sensational headline on the front page of its April 12, 2000, issue: “Breast Cancer Hot Spots”. The news story reported that statistics and maps of breast cancer rates just released by New York State health authorities showed unusually high rates of breast cancer on the Upper East Side of Manhattan, as well as on Long Island and several other areas in New York City and upstate. These high rates were described by the state authorities as “not likely due to chance.” The residents of the Upper East Side, one of the most affluent areas of the city, were understandably alarmed. One woman interviewed was considering whether to move elsewhere, but had not yet decided. A second demanded that the two major party candidates for the U.S. Senate state their positions on the high rate. A third noted that there were no obvious sources of pollution in the neighborhood, no pesticide spraying or toxic waste dumps, that could explain why the breast cancer rate was high. Many people believe that breast cancer is caused by toxic agents in the environment. Victims of breast cancer we have met at sessions of support groups have described vividly the pains and discomfort of chemotherapy, radiation, and radical surgery; the nagging anxiety about a possible recurrence, the sense of disfigurement, of mutilation; the ignorance and insensitivity of many of the so-far healthy; the strengthening or weakening of bonds to those close to them: husbands, sons, daughters, parents, who either grow in understanding and compassion or fall short. But there is one common thread that runs through their stories: each of them feels there must be a reason why she, at this particular point in her life, should have gotten this terrible disease. Why me? Lucia D., in her late thirties, remembers that as a child of eight or nine growing up in Panama she and other children used to run after the truck that periodically sprayed DDT in their neighborhood and dance around in the spray. She is convinced that this childhood exposure is the reason she has breast cancer at such an early age.

Adverse consequences of the COVID-19 pandemic on breast cancer stage distribution and breast cancer disparities.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10555-10555
Author(s):  
Genevieve A. Fasano ◽  
Yalei Chen ◽  
Solange Bayard ◽  
Melissa Davis ◽  
Vivian Bea ◽  
...  
Keyword(s):  
Breast Cancer ◽  
New York ◽  
New York City ◽  
Cancer Patients ◽  
York City ◽  
Cancer Stage ◽  
Breast Cancer Patients ◽  
Stage Distribution ◽  
Race Ethnicity ◽  
Racial Ethnic

10555 Background: The COVID-19 surge in March 2020 resulted in a hiatus placed on screening mammography programs in support of shelter-in-place mandates and diversion of medical resources to pandemic management. The COVID-related economic recession and ongoing social distancing policies continued to influence screening practices after the hiatus was lifted. We evaluated the effect of the hiatus on breast cancer stage distribution on the diverse patient population of a health care system in New York City, the first pandemic epicenter in the United States. Methods: Breast cancer patients diagnosed January 1, 2019 to December 31, 2020 were analyzed, with comparisons of stage distribution and mammography screen-detection for three intervals: Pre-Hiatus, During Hiatus (March 15, 2020 to June 15, 2020), and Post-Hiatus. Results were stratified by African American (AA), White American (WA), Asian (As) and Hispanic/Latina (Hisp) self-reported racial/ethnic identity. Results: A total of 894 patients were identified; of these, 549 WA, 100 AA, 104 As, and 93 Hisp comprised the final race/ethnicity-stratified study population. Overall, 588 patients were diagnosed Pre-Hiatus, 61 During-Hiatus, and 245 Post-Hiatus. Nearly two-thirds (65.5%) of the Pre-Hiatus cases were screen-detected versus 49.2% During-Hiatus and 54.7% Post-Hiatus (p = 0.002). Frequency of tumors diagnosed < 1 cm declined from 41.9% Pre-Hiatus to 31.7% Post-Hiatus (p = 0.035). WA patients were more likely to have screen-detected disease compared to AA in the Pre-Hiatus period (69.1% vs. 56.1%; p = 0.05) but non-significantly more likely to have screen-detected disease compared to As and Hisp patients (66.2% vs. 56.9%; p = 0.08). In the Post-Hiatus period, the frequency of screen-detected disease was highest among WA patients (63.0%) compared to all other racial/ethnic groups (AA; 48.1%, As-33.3%, and Hisp-40%; p = 0.007). Similar patterns were observed for frequency of tumors diagnosed ≤1cm Pre-Hiatus (WA-44.3% vs AA-26%, p = 0.02; and vs. As-41.3%, Hisp-48%; p = 0.09), and Post-Hiatus (WA-37.7% vs. AA-18.2%, As-30.8%, Hisp-23.5%; p = 0.25). Conclusions: The 3-month pandemic-related mammography screening hiatus resulted in a more advanced stage distribution for New York City breast cancer patients, and worsened pre-existing race/ethnicity-associated disparities, especially for AA pts.

Breast Cancer Screening Among Homeless Women of New York City Shelter-Based Clinics

2014 ◽  
Vol 24 (5) ◽  
pp. 529-534 ◽  
Author(s):  
Ramin Asgary ◽  
Victoria Garland ◽  
Blanca Sckell
Keyword(s):  
Breast Cancer ◽  
New York ◽  
New York City ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
York City ◽  
Homeless Women
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