Breast Cancer Research and Treatment

, Volume 156, Issue 2, pp 351–359 | Cite as

Investigating racial disparities in use of NK1 receptor antagonists to prevent chemotherapy-induced nausea and vomiting among women with breast cancer

  • Devon K. CheckEmail author
  • Katherine E. Reeder-Hayes
  • Ethan M. Basch
  • Leah L. Zullig
  • Morris Weinberger
  • Stacie B. Dusetzina


Chemotherapy-induced nausea and vomiting (CINV) is a major concern for cancer patients and, if uncontrolled, can seriously compromise quality of life (QOL) and other treatment outcomes. Because of the expense of antiemetic medications used to prevent CINV (particularly oral medications filled through Medicare Part D), disparities in their use may exist. We used 2006–2012 SEER-Medicare data to evaluate the use of neurokinin-1 receptor antagonists (NK1s), a potent class of antiemetics, among black and white women initiating highly emetogenic chemotherapy for the treatment of early-stage breast cancer. We used modified Poisson regression to assess the relationship between race and (1) any NK1 use, (2) oral NK1 (aprepitant) use, and (3) intravenous NK1 (fosaprepitant) use. We report adjusted risk ratios (aRR) and 95 % confidence intervals (CI). The study included 1130 women. We observed racial disparities in use of any NK1 (aRR: 0.68, 95 % CI 0.51–0.91) and in use of oral aprepitant specifically (aRR: 0.54, 95 % CI 0.35–0.83). We did not observe disparities in intravenous fosaprepitant use. After controlling for variables related to socioeconomic status, disparities in NK1 and aprepitant use were reduced but not eliminated. We found racial disparities in women’s use of oral NK1s for the prevention of CINV. These disparities may be partly explained by racial differences in socioeconomic status, which may translate into differential ability to afford the medication.


Supportive care Palliative care Health services research Racial disparities 



This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. 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.


Ms. Check is supported by the National Cancer Institute under Award Number R25CA116339. Dr. Dusetzina is supported by the National Institutes of Health Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) K12 Program and the North Carolina Translational and Clinical Sciences Institute (UL1TR001111). Drs. Weinberger and Zullig are supported by the Department of Veterans Affairs Office of Health Services Research and Development (Grant No. RCS 91-408 to MW and Grant No. CDA 13-025 to LLZ).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10549_2016_3747_MOESM1_ESM.docx (128 kb)
Supplementary material 1 (DOCX 128 kb)


  1. 1.
    Hickok JT, Roscoe JA, Morrow GR, King DK, Atkins JN, Fitch TR (2003) Nausea and emesis remain significant problems of chemotherapy despite prophylaxis with 5-hydroxytryptamine-3 antiemetics: a University of Rochester James P. Wilmot Cancer Center Community Clinical Oncology Program Study of 360 cancer patients treated in the community. Cancer 97(11):2880–2886. doi: 10.1002/cncr.11408 CrossRefPubMedGoogle Scholar
  2. 2.
    National Cancer Institute (2014) Nausea and vomiting. Accessed 18 Feb 2015
  3. 3.
    Cohen L, de Moor CA, Eisenberg P, Ming EE, Hu H (2007) Chemotherapy-induced nausea and vomiting: incidence and impact on patient quality of life at community oncology settings. Support Care Cancer 15(5):497–503. doi: 10.1007/s00520-006-0173-z CrossRefPubMedGoogle Scholar
  4. 4.
    Bloechl-Daum B, Deuson RR, Mavros P, Hansen M, Herrstedt J (2006) Delayed nausea and vomiting continue to reduce patients’ quality of life after highly and moderately emetogenic chemotherapy despite antiemetic treatment. J Clin Oncol 24(27):4472–4478. doi: 10.1200/JCO.2006.05.6382 CrossRefPubMedGoogle Scholar
  5. 5.
    Glaus A, Knipping C, Morant R, Bohme C, Lebert B, Beldermann F, Glawogger B, Ortega PF, Husler A, Deuson R (2004) Chemotherapy-induced nausea and vomiting in routine practice: a European perspective. Support Care Cancer 12(10):708–715. doi: 10.1007/s00520-004-0662-x CrossRefPubMedGoogle Scholar
  6. 6.
    Burke TA, Wisniewski T, Ernst FR (2011) Resource utilization and costs associated with chemotherapy-induced nausea and vomiting (CINV) following highly or moderately emetogenic chemotherapy administered in the US outpatient hospital setting. Support Care Cancer 19(1):131–140. doi: 10.1007/s00520-009-0797-x CrossRefPubMedGoogle Scholar
  7. 7.
    Langford P, Chrisp P (2010) Fosaprepitant and aprepitant: an update of the evidence for their place in the prevention of chemotherapy-induced nausea and vomiting. Core Evid 5:77–90CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Basch E, Prestrud AA, Hesketh PJ, Kris MG, Feyer PC, Somerfield MR, Chesney M, Clark-Snow RA, Flaherty AM, Freundlich B, Morrow G, Rao KV, Schwartz RN, Lyman GH, American Society of Clinical Oncology (2011) Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 29(31):4189–4198. doi: 10.1200/JCO.2010.34.4614 CrossRefPubMedGoogle Scholar
  9. 9.
    Roila F, Herrstedt J, Aapro M, Gralla RJ, Einhorn LH, Ballatori E, Bria E, Clark-Snow RA, Espersen BT, Feyer P, Grunberg SM, Hesketh PJ, Jordan K, Kris MG, Maranzano E, Molassiotis A, Morrow G, Olver I, Rapoport BL, Rittenberg C, Saito M, Tonato M, Warr D, Group EMGW (2010) Guideline update for MASCC and ESMO in the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting: results of the Perugia consensus conference. Ann Oncol 21(Suppl 5):v232–243. doi: 10.1093/annonc/mdq194 CrossRefPubMedGoogle Scholar
  10. 10.
    National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology, Anti-emesis. Version 1.2012. Accessed 18 Feb 2015
  11. 11.
    Center for Medicare and Medicaid Services. Medicare Plan Finder. Accessed 7 Oct 2015
  12. 12.
    Gomez DR, Liao KP, Giordano S, Nguyen H, Smith BD, Elting LS (2013) Adherence to national guidelines for antiemesis prophylaxis in patients undergoing chemotherapy for lung cancer: a population-based study. Cancer 119(7):1428–1436. doi: 10.1002/cncr.27899 CrossRefPubMedGoogle Scholar
  13. 13.
    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. doi: 10.2105/AJPH.2014.302079 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Griggs JJ, Sorbero ME, Stark AT, Heininger SE, Dick AW (2003) Racial disparity in the dose and dose intensity of breast cancer adjuvant chemotherapy. Breast Cancer Res Treat 81(1):21–31. doi: 10.1023/A:1025481505537 CrossRefPubMedGoogle Scholar
  15. 15.
    John DA, Kawachi I, Lathan CS, Ayanian JZ (2014) Disparities in perceived unmet need for supportive services among patients with lung cancer in the Cancer Care Outcomes Research and Surveillance Consortium. Cancer 120(20):3178–3191. doi: 10.1002/cncr.28801 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Reyes-Gibby CC, Anderson KO, Shete S, Bruera E, Yennurajalingam S (2012) Early referral to supportive care specialists for symptom burden in lung cancer patients: a comparison of non-Hispanic whites, Hispanics, and non-Hispanic blacks. Cancer 118(3):856–863. doi: 10.1002/cncr.26312 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Martinez KA, Snyder CF, Malin JL, Dy SM (2014) Is race/ethnicity related to the presence or severity of pain in colorectal and lung cancer? J Pain Symptom Manage 48(6):1050–1059. doi: 10.1016/j.jpainsymman.2014.02.005 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Fisch MJ, Lee JW, Weiss M, Wagner LI, Chang VT, Cella D, Manola JB, Minasian LM, McCaskill-Stevens W, Mendoza TR, Cleeland CS (2012) Prospective, observational study of pain and analgesic prescribing in medical oncology outpatients with breast, colorectal, lung, or prostate cancer. J Clin Oncol 30(16):1980–1988. doi: 10.1200/JCO.2011.39.2381 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    McNeill JA, Reynolds J, Ney ML (2007) Unequal quality of cancer pain management: disparity in perceived control and proposed solutions. Oncol Nurs Forum 34(6):1121–1128. doi: 10.1188/07.ONF.1121-1128 CrossRefPubMedGoogle Scholar
  20. 20.
    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. Medical care 40 (8 Suppl):IV-3-18. doi: 10.1097/01.MLR.0000020942.47004.03
  21. 21.
    Roila F, Hesketh PJ, Herrstedt J, Antiemetic Subcommitte of the Multinational Association of Supportive Care in C (2006) Prevention of chemotherapy- and radiotherapy-induced emesis: results of the 2004 Perugia International Antiemetic Consensus Conference. Ann Oncol 17(1):20–28. doi: 10.1093/annonc/mdj078 PubMedGoogle Scholar
  22. 22.
    Kris MG, Hesketh PJ, Somerfield MR, Feyer P, Clark-Snow R, Koeller JM, Morrow GR, Chinnery LW, Chesney MJ, Gralla RJ, Grunberg SM (2006) American Society of Clinical Oncology guideline for antiemetics in oncology: update 2006. J Clin Oncol 24(18):2932–2947. doi: 10.1200/JCO.2006.06.9591 CrossRefPubMedGoogle Scholar
  23. 23.
    Klabunde CN, Potosky AL, Legler JM, Warren JL (2000) Development of a comorbidity index using physician claims data. J Clin Epidemiol 53(12):1258–1267CrossRefPubMedGoogle Scholar
  24. 24.
    Zou G (2004) A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol 159(7):702–706CrossRefPubMedGoogle Scholar
  25. 25.
    Biggers A, Neuner J, Smith E, Pezzin L, Laud P, Charlson JA, Smallwood A (2014) Medicare Part D low-income subsidy and disparities in breast cancer treatment. J Clin Oncol 32 (suppl 30, abstrat 2)Google Scholar
  26. 26.
    Neuman P, Strollo MK, Guterman S, Rogers WH, Li A, Rodday AM, Safran DG (2007) Medicare prescription drug benefit progress report: findings from a 2006 national survey of seniors. Health Aff 26(5):w630–w643. doi: 10.1377/hlthaff.26.5.w630 CrossRefGoogle Scholar
  27. 27.
    Institute of Medicine (2002) Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DCGoogle Scholar
  28. 28.
    Le Cook B, McGuire TG, Lock K, Zaslavsky AM (2010) Comparing methods of racial and ethnic disparities measurement across different settings of mental health care. Health Serv Res 45(3):825–847. doi: 10.1111/j.1475-6773.2010.01100.x CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    McGuire TG, Alegria M, Cook BL, Wells KB, Zaslavsky AM (2006) Implementing the Institute of Medicine definition of disparities: an application to mental health care. Health Serv Res 41(5):1979–2005. doi: 10.1111/j.1475-6773.2006.00583.x CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Joslyn SA, West MM (2000) Racial differences in breast carcinoma survival. Cancer 88(1):114–123CrossRefPubMedGoogle Scholar
  31. 31.
    Clegg LX, Li FP, Hankey BF, Chu K, Edwards BK (2002) Cancer survival among US whites and minorities: a SEER (Surveillance, Epidemiology, and End Results) Program population-based study. Arch Intern Med 162(17):1985–1993CrossRefPubMedGoogle Scholar
  32. 32.
    Elledge RM, Clark GM, Chamness GC, Osborne CK (1994) Tumor biologic factors and breast cancer prognosis among white, Hispanic, and black women in the United States. J Natl Cancer Inst 86(9):705–712CrossRefPubMedGoogle Scholar
  33. 33.
    Kaiser Family Foundation. Medicare at a Glance. Accessed 03 Mar 2015
  34. 34.
    Jha AK, Orav EJ, Epstein AM (2011) Low-quality, high-cost hospitals, mainly in South, care for sharply higher shares of elderly black, Hispanic, and medicaid patients. Health Aff 30(10):1904–1911. doi: 10.1377/hlthaff.2011.0027 CrossRefGoogle Scholar
  35. 35.
    Neuner JM, Kamaraju S, Charlson JA, Wozniak EM, Smith EC, Biggers A, Smallwood AJ, Laud PW, Pezzin LE (2015) The introduction of generic aromatase inhibitors and treatment adherence among Medicare D enrollees. J Natl Cancer Inst. doi: 10.1093/jnci/djv130 PubMedGoogle Scholar
  36. 36.
    Sin DD, Svenson LW, Man SF (2001) Do area-based markers of poverty accurately measure personal poverty? Can J Public Health 92(3):184–187PubMedGoogle Scholar
  37. 37.
    Diez-Roux AV, Kiefe CI, Jacobs DR Jr, Haan M, Jackson SA, Nieto FJ, Paton CC, Schulz R (2001) Area characteristics and individual-level socioeconomic position indicators in three population-based epidemiologic studies. Ann Epidemiol 11(6):395–405CrossRefPubMedGoogle Scholar
  38. 38.
    Hassett MJ, Griggs JJ (2009) Disparities in breast cancer adjuvant chemotherapy: moving beyond yes or no. J Clin Oncol 27(13):2120–2121. doi: 10.1200/JCO.2008.21.1532 CrossRefPubMedGoogle Scholar
  39. 39.
    Hershman D, Weinberg M, Rosner Z, Alexis K, Tiersten A, Grann VR, Troxel A, Neugut AI (2003) Ethnic neutropenia and treatment delay in African American women undergoing chemotherapy for early-stage breast cancer. J Natl Cancer Inst 95(20):1545–1548CrossRefPubMedGoogle Scholar
  40. 40.
    Hershman DL, Unger JM, Barlow WE, Hutchins LF, Martino S, Osborne CK, Livingston RB, Albain KS (2009) Treatment quality and outcomes of African American versus white breast cancer patients: retrospective analysis of Southwest Oncology studies S8814/S8897. J Clin Oncol 27(13):2157–2162. doi: 10.1200/JCO.2008.19.1163 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Devon K. Check
    • 1
    Email author
  • Katherine E. Reeder-Hayes
    • 2
    • 3
  • Ethan M. Basch
    • 1
    • 2
    • 3
  • Leah L. Zullig
    • 4
    • 5
  • Morris Weinberger
    • 1
    • 4
  • Stacie B. Dusetzina
    • 1
    • 2
    • 6
  1. 1.Department of Health Policy and ManagementGillings School of Global Public Health, University of North Carolina at Chapel HillChapel HillUSA
  2. 2.Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.Division of Hematology/OncologyUNC School of Medicine, University of North Carolina at Chapel HillChapel HillUSA
  4. 4.Center for Health Services Research in Primary CareDurham Veterans Affairs Medical CenterDurhamUSA
  5. 5.Division of General Internal Medicine, Department of MedicineDuke UniversityDurhamUSA
  6. 6.Division of Pharmaceutical Outcomes and PolicyUNC Eshelman School of Pharmacy, University of North Carolina at Chapel HillChapel HillUSA

Personalised recommendations