Examining potential gaps in supportive medication use for US and foreign-born Hispanic women with breast cancer
- 12 Downloads
Compared to non-Hispanic Whites, Hispanic women are more likely to report pain, depression, and other mental health concerns. However, little is known about Hispanic women’s use of supportive medications, and whether use differs depending on nativity (US- vs. foreign-born). This study’s objectives were to examine patterns of supportive medication use and investigate potential differences by ethnicity/nativity among women with breast cancer.
We used the Surveillance, Epidemiology, and End Results data linked with Medicare claims to identify women diagnosed with incident breast cancer between July 1, 2007, and December 31, 2011. Supportive medication use (opioid pain and non-opioid psychotropic medications) in the 90 days after diagnosis was the primary outcome. We categorized ethnicity/nativity as US-Born non-Hispanic, US-born Hispanic, foreign-born non-Hispanic, and foreign-born Hispanic. Modified Poisson models examined associations between ethnicity/nativity and medication use, adjusting for tumor, treatment, and demographic characteristics.
We included 23,091 women, of whom 88% were US-born non-Hispanics, 4% US-born Hispanics, 6% foreign-born non-Hispanics, and 2% foreign-born Hispanics. Supportive medication use varied by ethnicity/nativity. Compared to US-born non-Hispanics, foreign-born Hispanics and non-Hispanics were 5% (95% CI 0.92–0.98) and 10% (95% CI 0.85–0.96) less likely to receive supportive medications, respectively. US-born Hispanics were 5% (95% CI 1.02–1.09) more likely to receive supportive medications. Observed differences persisted when analyses were limited to stage I–III breast cancer cases.
This work highlights potential disparities in the pharmacologic treatment of psychosocial needs of foreign-born breast cancer patients. Future studies should explore if differences observed here are reflective of health disparities or differential patient preferences.
KeywordsHispanic Latina Supportive care Breast cancer Disparities
The database infrastructure used for this project was funded by the CER Strategic Initiative of UNC’s Clinical &Translational Science Award (UL1TR001111), and the UNC School of Medicine. Additional funding for the SEER-Medicare data was provided by the UNC Lineberger Comprehensive Cancer Center’s University Cancer Research Fund (UCRF) via the State of North Carolina.
Compliance with ethical standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Conflicts of interest
The authors declare that they have no conflicts of interest or financial disclosures.
This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the National Cancer Institute; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.
Human and animal rights and informed consent
This article does not contain any studies with animals performed by any of the authors. Informed consent from study subjects was not needed as the University of North Carolina at Chapel Hill IRB granted this research exemption from review. All authors have read and approved the manuscript for submission to Supportive Care in Cancer. This manuscript has not been published elsewhere and is not under consideration by another journal.
- 1.Colby S, Ortman JM (2014) Projections of the size and composition of the U.S. population: 2014 to 2060. U.S Census Bureau, Washington, DCGoogle Scholar
- 2.Society AC (2015) Cancer facts and figures for Hispanics/Latinos 2015–2017. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-facts-and-figures-for-hispanics-and-latinos/cancer-facts-and-figures-for-hispanics-and-latinos-2015-2017.pdf
- 4.Luckett T, Goldstein D, Butow PN, Gebski V, Aldridge LJ, McGrane J, Ng W, King MT (2011) Psychological morbidity and quality of life of ethnic minority patients with cancer: a systematic review and meta-analysis. Lancet Oncol 12(13):1240–1248. https://doi.org/10.1016/s1470-2045(11)70212-1 CrossRefPubMedGoogle Scholar
- 6.Alegria M, Canino G, Rios R, Vera M, Calderon J, Rusch D, Ortega AN (2002) Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino whites. Psychiatr Serv (Washington, DC) 53(12):1547–1555. https://doi.org/10.1176/appi.ps.53.12.1547 CrossRefGoogle Scholar
- 7.Alegria M, Chatterji P, Wells K, Cao Z, Chen CN, Takeuchi D, Jackson J, Meng XL (2008) Disparity in depression treatment among racial and ethnic minority populations in the United States. Psychiatr Serv (Washington, DC) 59(11):1264–1272. https://doi.org/10.1176/appi.ps.59.11.1264 CrossRefGoogle Scholar
- 10.Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Basch EM, Firn JI, Paice JA, Peppercorn JM, Phillips T, Stovall EL, Zimmermann C, Smith TJ (2017) Integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 35(1):96–112. https://doi.org/10.1200/jco.2016.70.1474 CrossRefPubMedGoogle Scholar
- 11.Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF (2002) Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care 40(8 Suppl):iv-3-18. https://doi.org/10.1097/01.mlr.0000020942.47004.03 PubMedGoogle Scholar
- 12.Check DK, Samuel CA, Rosenstein DL, Dusetzina SB (2016) Investigation of racial disparities in early supportive medication use and end-of-life care among Medicare beneficiaries with stage IV breast Cancer. J Clin Oncol 34(19):2265–2270. https://doi.org/10.1200/jco.2015.64.8162 CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Group NRaEW (2011) NAACCR Guideline for Enhancing Hispanic/Latino Identification: Revised NAACCR Hispanic/Latino Identification Algorithm [NHIA v2.2.1]. North American Association of Central Cancer Registries, SpringfieldGoogle Scholar
- 15.Gomez SL, Glaser SL, Kelsey JL, Lee MM (2004) Bias in completeness of birthplace data for Asian groups in a population-based cancer registry (United States). Cancer Causes Control: CCC 15(3):243–253. https://doi.org/10.1023/b:caco.0000024244.91775.64 CrossRefPubMedGoogle Scholar
- 27.Samuel CA, Landrum MB, McNeil BJ, Bozeman SR, Williams CD, Keating NL (2014) Racial disparities in cancer care in the veterans affairs health care system and the role of site of care. Am J Public Health 104(Suppl 4):S562–S571. https://doi.org/10.2105/ajph.2014.302079 CrossRefPubMedPubMedCentralGoogle Scholar
- 33.Tavernise S (2013) The health toll of immigration. The New York times, 05/18/2013,Google Scholar
- 34.Hoffman J (2017) Sick and afraid, some immigrants forgo medical care. The New York Times, 06/26/2017Google Scholar