Breast Cancer Research and Treatment

, Volume 139, Issue 1, pp 207–216

Narrowing racial gaps in breast cancer chemotherapy initiation: the role of the patient–provider relationship

Authors

    • Breast Cancer Program, Lombardi Comprehensive Cancer Center and Department of OncologyGeorgetown University
  • Claudine Isaacs
    • Breast Cancer Program, Lombardi Comprehensive Cancer Center Departments of Medicine and OncologyMedStar Georgetown University Hospital
  • George Luta
    • Breast Cancer Program, Lombardi Comprehensive Cancer Center Departments of Medicine and OncologyMedStar Georgetown University Hospital
    • Department of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer CenterGeorgetown University Medical Center
  • Shawna C. Willey
    • Betty Lou Ourisman Breast Health CenterMedstar Georgetown University Hospital
  • Marc Boisvert
    • Medstar Washington Hospital Center
  • Felicity W. K. Harper
    • Population and Disparities Research Program, Karmanos Cancer Institute, and Department of OncologyWayne State University School of Medicine
  • Karen Smith
    • Medstar Washington Hospital Center
  • Sara Horton
    • Department of OncologyHoward University Hospital
  • Minetta C. Liu
    • Departments of Medical Oncology and Anatomic PathologyThe Mayo Clinic College of Medicine
  • Yvonne Jennings
    • Breast Cancer Program, Lombardi Comprehensive Cancer Center and Department of OncologyGeorgetown University
  • Fikru Hirpa
    • Breast Cancer Program, Lombardi Comprehensive Cancer Center and Department of OncologyGeorgetown University
  • Felicia Snead
    • First Coast Oncology
  • Jeanne S. Mandelblatt
    • Breast Cancer Program, Lombardi Comprehensive Cancer Center Departments of Medicine and OncologyMedStar Georgetown University Hospital
Epidemiology

DOI: 10.1007/s10549-013-2520-3

Cite this article as:
Sheppard, V.B., Isaacs, C., Luta, G. et al. Breast Cancer Res Treat (2013) 139: 207. doi:10.1007/s10549-013-2520-3

Abstract

Chemotherapy improves breast cancer survival but is underused more often in black than in white women. We examined associations between patient–physician relationships and chemotherapy initiation and timeliness of initiation among black and white patients. Women with primary invasive, non-metastatic breast cancer were recruited via hospitals (in Washington, DC and Detroit) and community outreach between July 2006 and April 2011. Data were collected via telephone interviews and medical records. Logistic regression models evaluated associations between chemotherapy initiation and independent variables. Since there were race interactions, analyses were race-stratified. Factors associated with time from surgery to chemotherapy initiation and delay of ≥90 days were evaluated with linear and logistic regressions, respectively. Among eligible women, 82.8 % were interviewed and 359 (90.9 %) of those had complete data. The odds of initiating chemotherapy were 3.26 times (95 % CI: 1.51, 7.06) higher among black women reporting greater communication with physicians (vs. lesser), after considering covariates. In contrast, the odds of starting chemotherapy were lower for white women reporting greater communication (vs. lesser) (adjusted OR 0.22, 95 % CI: 0.07, 0.73). The opposing direction of associations was also seen among the sub-set of black and white women with definitive clinical indications for chemotherapy. Among those initiating treatment, black women had longer mean time to the start of chemotherapy than whites (71.8 vs. 55.0 days, p = 0.005), but race was not significant after considering trust in oncologists, where initiation time decreased as trust increased, controlling for covariates. Black women were also more likely to delay ≥90 days than whites (27 vs. 8.3 %; p = 0.024), but this was not significant after considering religiosity. The patient–physician dyad and sociocultural factors may represent leverage points to improve chemotherapy patterns in black women.

Keywords

Chemotherapy initiationDisparitiesPatient–provider communication

Copyright information

© Springer Science+Business Media New York 2013