Supportive Care in Cancer

, Volume 23, Issue 11, pp 3201–3209 | Cite as

Disparities in barriers to follow-up care between African American and White breast cancer survivors

  • Nynikka R. A. Palmer
  • Kathryn E. Weaver
  • Sally P. Hauser
  • Julia A. Lawrence
  • Jennifer Talton
  • L. Douglas Case
  • Ann M. Geiger
Original Article



Despite recommendations for breast cancer survivorship care, African American women are less likely to receive appropriate follow-up care, which is concerning due to their higher mortality rates. This study describes differences in barriers to follow-up care between African American and White breast cancer survivors.


We conducted a mailed survey of women treated for non-metastatic breast cancer in 2009–2011, 6–24 months post-treatment (N = 203). Survivors were asked about 14 potential barriers to follow-up care. We used logistic regression to explore associations between barriers and race, adjusting for covariates.


Our participants included 31 African American and 160 White survivors. At least one barrier to follow-up care was reported by 62 %. Compared to White survivors, African Americans were more likely to identify barriers related to out-of-pocket costs (28 vs. 51.6 %, p = 0.01), other health care costs (21.3 vs. 45.2 %, p = 0.01), anxiety/worry (29.4 vs. 51.6 %, p = 0.02), and transportation (4.4 vs. 16.1 %, p = 0.03). After adjustment for covariates, African Americans were three times as likely to report at least one barrier to care (odds ratio (OR) = 3.3, 95 % confidence interval (CI) = 1.1–10.1).


Barriers to care are common among breast cancer survivors, especially African American women. Financial barriers to care may prevent minority and underserved survivors from accessing follow-up care. Enhancing insurance coverage or addressing out-of-pocket costs may help address financial barriers to follow-up care among breast cancer survivors. Psychosocial care aimed at reducing fear of recurrence may also be important to improve access among African American breast cancer survivors.


Barriers Follow-up care Health disparities Cancer survivor Breast cancer 



This work was supported by the National Cancer Institute at the National Institutes of Health, grant numbers 5R21CA155932-02 (AM Geiger, PI) and R25CA122061 (NE Avis, PI). We thank Kim Derzen for her contribution to this study.

This article was prepared while Drs. Geiger and Palmer were employed at Wake Forest School of Medicine. The opinions expressed in this article are the author’s own and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States government.

Conflicts of interest

The authors, Nynikka R. A. Palmer, Kathryn E. Weaver, Sally P. Hauser, Julia A. Lawrence, Jennifer Talton, L. Douglas Case, and Ann M. Geiger, all declare that they have no conflict of interest. We have full control of all primary data and agree to allow the journal to review the data if requested.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients included in this study.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Nynikka R. A. Palmer
    • 1
  • Kathryn E. Weaver
    • 2
  • Sally P. Hauser
    • 3
  • Julia A. Lawrence
    • 3
  • Jennifer Talton
    • 4
  • L. Douglas Case
    • 4
  • Ann M. Geiger
    • 5
  1. 1.Division of General Internal Medicine at San Francisco General HospitalUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Social Science and Health Policy, Division of Public Health SciencesWake Forest School of MedicineWinston-SalemUSA
  3. 3.General SurgeryWake Forest Comprehensive Cancer CenterWinston-SalemUSA
  4. 4.Biostatistical Sciences, Division of Public Health SciencesWake Forest School of MedicineWinston-SalemUSA
  5. 5.Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population SciencesNational Cancer InstituteRockvilleUSA

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