Advertisement

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

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Barriers Follow-up care Health disparities Cancer survivor Breast cancer 

Notes

Acknowledgments

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.

References

  1. 1.
    De Moor JS, Mariotto AB, Parry C, Alfano CM, Padgett L, Kent EE et al (2013) Cancer survivors in the United States: prevalence across the survivorship trajectory and implications for care. Cancer Epidemiol Biomarkers Prev 22:561–70. doi: 10.1158/1055-9965.EPI-12-1356 PubMedCentralCrossRefPubMedGoogle Scholar
  2. 2.
    American Cancer Society (2012) Cancer Treatment and Survivorship Facts & Figures 2012-2013. American Cancer Society, Atlanta, Georgia. http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-033876.pdf. Accessed 02/09/13.
  3. 3.
    Khatcheressian JL, Hurley P, Bantug E, Esserman LJ, Grunfeld E, Halberg F, Hantel A, Henry NL, Muss HB, Smith TJ, Vogel VG, Wolff AC, Somerfield MR, Davidson NE (2012) Breast cancer follow-up and management after primary treatment: American society of clinical oncology clinical practice guideline update. J Clin Oncol 31:961–5. doi: 10.1200/JCO.2012.45.9859 CrossRefPubMedGoogle Scholar
  4. 4.
    National Comprehensive Cancer Network (2014) NCCN Clinical Practice Guidelines in Oncology, Breast Cancer. Version 1.2014. National Comprehensive Cancer Network, Inc. www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed 02/11/14.
  5. 5.
    Hewitt ME, Ganz P (2006) From cancer patient to cancer survivor: lost in transition. National Academies Press.Google Scholar
  6. 6.
    Keating NL, Landrum MB, Guadagnoli E, Winer EP, Zyanian JZ (2006) Factors related to underuse of surveillance mammography among breast cancer survivors. J Clin Oncol 24:85–94CrossRefPubMedGoogle Scholar
  7. 7.
    Corkum M, Hayden JA, Kephart G, Urquhart R, Schlievert C, Porter G (2013) Screening for new primary cancers in cancer survivors compared to non-cancer controls: a systematic review and meta-analysis. J Cancer Surviv 7:455–463. doi: 10.1007/s11764-013-0278-6 PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Snyder CF, Frick KD, Peairs KS, Kantsiper ME, Herbert RJ, Blackford AL, Wolff AC, Earle CC (2009) Comparing care for breast cancer survivors to non-cancer controls: a five-year longitudinal study. J Gen Intern Med 24:469–474PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Keating NL, Landrum MB, Guadagnoli E, Winer EP, Ayanian JZ (2007) Surveillance testing among survivors of early-stage breast cancer. J Clin Oncol 25:1074–1081CrossRefPubMedGoogle Scholar
  10. 10.
    Kukar M, Watroba N, Miller A, Kumar S, Edge SB (2013) Fostering coordinated survivorship care in breast cancer: who is lost to follow-up? J Cancer Surviv. doi: 10.1007/s11764-013-0323-5 PubMedGoogle Scholar
  11. 11.
    Earle CC (2003) Quality of non-breast cancer health maintenance among elderly breast cancer survivors. J Clin Oncol 21:1447–51CrossRefPubMedGoogle Scholar
  12. 12.
    Earle CC, Neville BA (2004) Under use of necessary care among cancer survivors. Cancer 101:1712–9CrossRefPubMedGoogle Scholar
  13. 13.
    Advani PS, Ying J, Theriault R, Melhem-Bertrand A, Moulder S, Bedrosian I, Tereffe W, Black S, Pini TM, Brewster AM (2013) Ethnic disparities in adherence to breast cancer survivorship surveillance care. Cancer 120:894–900. doi: 10.1002/cncr.28490 PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    Cancer Facts and Figures for African Americans 2013-2014 (2013) American Cancer Society, Atlanta, Georgia. Accessed 02/09/13. http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-036921.pdf
  15. 15.
    Weaver KE, Rowland JH, Bellizzi KM, Aziz NM (2010) Forgoing medical care because of cost. Cancer 116:3493–504PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Thompson HS, Littles M, Jacob S, Coker C (2006) Posttreatment breast cancer surveillance and follow-up care experiences of breast cancer survivors of African descent: an exploratory qualitative study. Cancer Nurs 29:478–87CrossRefPubMedGoogle Scholar
  17. 17.
    Miedema B, Easley J (2012) Barriers to rehabilitative care for young breast cancer survivors: a qualitative understanding. Support Care Cancer 20:1193–201CrossRefPubMedGoogle Scholar
  18. 18.
    Follow-up Care Use Among Survivors (FOCUS) Survey. National Cancer Institute. http://cancercontrol.cancer.gov/ocs/focus.html
  19. 19.
    Goins RT, Williams KA, Carter MQ, Spencer M, Solovieva T (2005) Perceived barriers to health care access among rural older adults: a qualitative study. J Rural Health 21:206–13CrossRefPubMedGoogle Scholar
  20. 20.
    Centers for Disease Control and Prevention. About the Behavioral Risk Factor Surveillance System (BRFSS). Centers for Disease Control and Prevention. http://www.cdc.gov/brfss/about/about_brfss.htm
  21. 21.
    United States Department of Agriculture. Economic Research Service. Rural-Urban Commuting Area (RUCA) Codes - Documentation. Available from: http://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes/documentation.aspx#.VDr-tfRDt8E.
  22. 22.
    Gallagher A, Liu J, Probst JC, Martin AB, Hall JW (2013) Maternal obesity and gestational weight gain in rural versus urban dwelling women in South Carolina. J Rural Health 29:1–11CrossRefPubMedGoogle Scholar
  23. 23.
    Hines RB, Markossian TW (2012) Differences in late-stage diagnosis, treatment, and colorectal cancer-related death between rural and urban African Americans and whites in Georgia. J Rural Health 28:296–305CrossRefPubMedGoogle Scholar
  24. 24.
    Hall SA, Kaufman JS, Ricketts TC (2006) Defining urban and rural areas in U.S. epidemiologic studies. J Urban Health 83:162–175PubMedCentralCrossRefPubMedGoogle Scholar
  25. 25.
    Hays RD, Bjorner JB, Revicki DA, Spritzer KL, Cella D (2009) Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Qual Life Res 18:873–80PubMedCentralCrossRefPubMedGoogle Scholar
  26. 26.
    Baker F, Denniston M, Smith T, West MM (2005) Adult cancer survivors: how are they faring? Cancer 104:2565–76CrossRefPubMedGoogle Scholar
  27. 27.
    Facione NC (1993) Delay versus help seeking for breast cancer symptoms: a critical review of the literature on patient and provider delay. Soc Sci Med 36:1521–1534CrossRefPubMedGoogle Scholar
  28. 28.
    Consedine NS, Magai C, Krivoshekova YS, Ryzewicz L, Neugut AI (2004) Fear, anxiety, worry, and breast cancer screening behavior: a critical review. Cancer Epidemiol Biomarkers Prev 13:501–510PubMedGoogle Scholar
  29. 29.
    Weaver KE, Rowland JH, Bellizzi KM, Aziz NM (2010) Forgoing medical care because of cost: assessing disparities in healthcare access among cancer survivors living in the US. Cancer 116:3493–504PubMedCentralCrossRefPubMedGoogle Scholar
  30. 30.
    Kent EE, Forsythe LP, Yabroff KR, Weaver KE, de Moor JS, Rodriguez JL, Rowland JH (2013) Are survivors who report cancer-related financial problems more likely to forgo or delay medical care? Cancer 119:3710–7PubMedCentralPubMedGoogle Scholar
  31. 31.
    Peek ME, Sayad JV, Markwardt R (2008) Fear, fatalism and breast cancer screening in low-income African-American women: the role of clinicians and the health care system. J Gen Intern Med 23:1847–53PubMedCentralCrossRefPubMedGoogle Scholar
  32. 32.
    Yabroff KR, Lund J, Kepka D, Mariotto A (2011) Economic burden of cancer in the United States: estimates, projections, and future research. Cancer Epidemiol Biomarkers Prev 20:2006–2014PubMedCentralCrossRefPubMedGoogle Scholar
  33. 33.
    Ramsey S, Blough D, Kirchhoff A, Kreizenbeck K, Fedorenko C, Snell K, Newcomb P, Hollingworth W, Overstreet K (2013) Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health Aff (Millwood) 32:1143–52CrossRefGoogle Scholar
  34. 34.
    Moy B, Polite BN, Halpern MT, Stranne SK, Winer EP, Wollins DS, Newman LA (2011) American society of clinical oncology policy statement: opportunities in the patient protection and affordable care act to reduce cancer care disparities. J Clin Oncol 29:3816–3824CrossRefPubMedGoogle Scholar
  35. 35.
    Asch DA, Jedrziewski MK, Christakis NA (1997) Response rates to mail surveys published in medical journals. J Clin Epidemiol 50:1129–1136CrossRefPubMedGoogle Scholar
  36. 36.
    Paskett ED, Harrop JP, Wells KJ (2011) Patient navigation: an update on the state of the science. CA Cancer J Clin 61:237–49PubMedCentralCrossRefPubMedGoogle Scholar
  37. 37.
    Ashing-Giwa K, Tapp C, Rosales M, McDowell K, Martin V, Santifer RH, Clark P, Steward J, Lewis L, Mitchell E (2012) Peer-based models of supportive care: the impact of peer support groups in African American breast cancer survivors. Oncol Nurs Forum 39:585–91CrossRefPubMedGoogle Scholar
  38. 38.
    Stanton AL (2006) Psychosocial concerns and interventions for cancer survivors. J Clin Oncol 24:5132–5137CrossRefPubMedGoogle Scholar
  39. 39.
    Crane-Okada R, Freeman E, Kiger H, Ross M, Elashoff D, Deacon L, Giuliano AE (2012) Senior peer counseling by telephone for psychosocial support after breast cancer surgery: effects at six months. Oncol Nurs Forum 39:78–89CrossRefPubMedGoogle Scholar
  40. 40.
    Shields CG, Ziner KW, Bourff SA, Schilling K, Zhao Q, Monahan P, Sledge G, Champion V (2010) An intervention to improve communication between breast cancer survivors and their physicians. J Psychosoc Oncol 28:610–629PubMedCentralCrossRefPubMedGoogle Scholar
  41. 41.
    Freeman L, Cohen L, Stewart M, White R, Link J, Palmer JL, Welton D (2008) Imagery intervention for recovering breast cancer patients: clinical trial of safety and efficacy. J Soc Integr Oncol 6:67–75PubMedGoogle Scholar
  42. 42.
    Cramer H, Lauche R, Paul A, Dobos G (2012) Mindfulness-based stress reduction for breast cancer—a systematic review and meta-analysis. Curr Oncol 19:e343–352PubMedCentralCrossRefPubMedGoogle Scholar
  43. 43.
    Ashing-Giwa K, Tapp C, Brown S, Fulcher G, Smith J, Mitchell E, Santifer RH, McDowell K, Martin V, Betts-Turner B, Carter D, Rosales M, Jackson PA (2013) Are survivorship care plans responsive to African-American breast cancer survivors?: voices of survivors and advocates. J Cancer Surviv 7:283–291CrossRefPubMedGoogle Scholar

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

Personalised recommendations