Epidemiology

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

  • Vanessa B. SheppardAffiliated withBreast Cancer Program, Lombardi Comprehensive Cancer Center and Department of Oncology, Georgetown University Email author 
  • , Claudine IsaacsAffiliated withBreast Cancer Program, Lombardi Comprehensive Cancer Center Departments of Medicine and Oncology, MedStar Georgetown University Hospital
  • , George LutaAffiliated withBreast Cancer Program, Lombardi Comprehensive Cancer Center Departments of Medicine and Oncology, MedStar Georgetown University HospitalDepartment of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center
  • , Shawna C. WilleyAffiliated withBetty Lou Ourisman Breast Health Center, Medstar Georgetown University Hospital
  • , Marc BoisvertAffiliated withMedstar Washington Hospital Center
  • , Felicity W. K. HarperAffiliated withPopulation and Disparities Research Program, Karmanos Cancer Institute, and Department of Oncology, Wayne State University School of Medicine
  • , Karen SmithAffiliated withMedstar Washington Hospital Center
  • , Sara HortonAffiliated withDepartment of Oncology, Howard University Hospital
  • , Minetta C. LiuAffiliated withDepartments of Medical Oncology and Anatomic Pathology, The Mayo Clinic College of Medicine
    • , Yvonne JenningsAffiliated withBreast Cancer Program, Lombardi Comprehensive Cancer Center and Department of Oncology, Georgetown University
    • , Fikru HirpaAffiliated withBreast Cancer Program, Lombardi Comprehensive Cancer Center and Department of Oncology, Georgetown University
    • , Felicia SneadAffiliated withFirst Coast Oncology
    • , Jeanne S. MandelblattAffiliated withBreast Cancer Program, Lombardi Comprehensive Cancer Center Departments of Medicine and Oncology, MedStar Georgetown University Hospital

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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 initiation Disparities Patient–provider communication