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Narrowing the Gap in Breast Adjuvant Therapy for African American Women
Black women have higher breast cancer mortality than White women, despite lower age-adjusted incidence rates and steady improvements in screening. Moreover, stage for stage they have significantly worse breast cancer survival than Whites and disparities have widened in recent decades. Some of the disparity may be accounted for by differences in breast cancer biology. However, even after controlling for these factors, outcome disparities persist. Many Black women may have failed to benefit to the same extent as Whites from the dissemination of adjuvant systemic therapy. It is estimated that this therapy should be considered for ~80% of patients with invasive breast cancer, yet ~50% of Black women eligible for this therapy are estimated to be receiving it. When Blacks receive definitive breast cancer treatment their survival outcomes are similar to Whites. Thus, disparities in survival may be explained, in part, by low adherence to adjuvant systemic therapy. We hypothesize that factors relating to the provision of care are associated with Black women's adherence to adjuvant therapy. We further hypothesize that cultural and subjective norms, health beliefs, and attitudes are associated with adherence. Aims: 1) examine the role of patient-provider communication on adherence to an oncology referral and receipt of adjuvant therapy; 2) identify cultural and subjective norms that are associated with adherence to initiating and completing adjuvant therapy, controlling for other factors; and 3) identify associations between health beliefs, attitudes and adherence. We will conduct a prospective observational cohort study of adjuvant treatment determinants among 400 newly diagnosed Black women. We will recruit women with invasive, non-metastatic breast cancer who have indications for systemic adjuvant treatment over a 36-month period. Women will participate in a structured telephone interview within 4-12 weeks of definitive breast surgery. Medical records will be abstracted to assess tumor factors, comorbid conditions, and patterns of care. Primary outcomes: referral to a medical oncologist and initiation of definitive systemic adjuvant hormonal and/or hormonal treatment, based on the woman's cancer stage, ER status, and risk of recurrence. Secondary outcomes: completion of definitive systemic treatment and satisfaction with care. This study will improve understanding of factors that promote adherence to clinically indicated systemic adjuvant therapy.
Compared to White women, Black women have a lower incidence of breast cancer but significantly worse survival. These disparities are well documented, but t he complex pathways whereby race influences breast cancer outcomes is poorly understood. Few studies have examined treatment disparities or have identified unique socio-cultural factors that may impact adherence among Black women. To fill this gap, we will talk to 400 Black women recently completing surgery for breast cancer to identify factors that are associated with adherence to chemotherapy and hormonal therapy after breast cancer surgery. We will examine whether women are referred to a medical oncology specialist, and if they are, examine whether adjuvant treatment is recommended. If treatment is recommended, we will determine factors that help women start and complete the full course of adjuvant treatment. The aims of this study are: 1) To examine the role of Black women’s rating of patient-provider communication in keeping an oncology medical appointment and starting adjuvant systemic therapy; 2) To identify cultural and subjective norms (e.g., fatalism) that are associated with the adherence of Black women to initiating and completing systemic adjuvant therapy, controlling for other factors; 3) To identify associations between Black women’s health beliefs and attitudes (e.g., perceived benefits, susceptibility to recurrence) and adherence to adjuvant systemic therapy. We plan to use results from this study to develop interventions that will improve use of adjuvant systemic therapy among Black women and reduce the Black-White survival gap.