Breast Cancer Research and Treatment

, Volume 139, Issue 1, pp 207–216 | Cite as

Narrowing racial gaps in breast cancer chemotherapy initiation: the role of the patient–provider relationship

  • Vanessa B. SheppardEmail author
  • Claudine Isaacs
  • George Luta
  • Shawna C. Willey
  • Marc Boisvert
  • Felicity W. K. Harper
  • Karen Smith
  • Sara Horton
  • Minetta C. Liu
  • Yvonne Jennings
  • Fikru Hirpa
  • Felicia Snead
  • Jeanne S. Mandelblatt


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.


Chemotherapy initiation Disparities Patient–provider communication 



This work was funded in part by grants from the American Cancer Society (Sheppard: PI MRSGT-06-132 CPPB), Komen for the Cure, Inc. (PI: Sheppard POP0503398), and the National Cancer Institute (Mandelblatt: RO1 CA124924, RO1 CA 127617 and KO5 CA96940). It was also supported by the Biostatistics and Bioinformatics Shared Resource (Luta) and the Nontherapeutic Subject Registry (NTSR) Shared Resource (Isaacs) at Lombardi Comprehensive Cancer Center under NCI Grant #P30CA51008. We thank the study participants and the research and clinical staff who helped to recruit women. We also acknowledge the support of Ms. Becky Montalvo, Ms. Nancy Muzeck, Dr. Susan Love, and Ms. Leah Wilcox.

Conflict of interest

Claudine Isaacs: Genetech and Glaxo Smith Kline (consultation). All remaining authors have declared no conflicts of interest.

Ethical standards

The study complies with the current laws of the country in which it was performed.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Vanessa B. Sheppard
    • 1
    Email author
  • Claudine Isaacs
    • 2
  • George Luta
    • 2
    • 3
  • Shawna C. Willey
    • 4
  • Marc Boisvert
    • 5
  • Felicity W. K. Harper
    • 6
  • Karen Smith
    • 5
  • Sara Horton
    • 7
  • Minetta C. Liu
    • 8
  • Yvonne Jennings
    • 1
  • Fikru Hirpa
    • 1
  • Felicia Snead
    • 9
  • Jeanne S. Mandelblatt
    • 2
  1. 1.Breast Cancer Program, Lombardi Comprehensive Cancer Center and Department of OncologyGeorgetown UniversityWashingtonUSA
  2. 2.Breast Cancer Program, Lombardi Comprehensive Cancer Center Departments of Medicine and OncologyMedStar Georgetown University HospitalWashingtonUSA
  3. 3.Department of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer CenterGeorgetown University Medical CenterWashingtonUSA
  4. 4.Betty Lou Ourisman Breast Health CenterMedstar Georgetown University HospitalWashingtonUSA
  5. 5.Medstar Washington Hospital CenterWashingtonUSA
  6. 6.Population and Disparities Research Program, Karmanos Cancer Institute, and Department of OncologyWayne State University School of MedicineDetroitUSA
  7. 7.Department of OncologyHoward University HospitalWashingtonUSA
  8. 8.Departments of Medical Oncology and Anatomic PathologyThe Mayo Clinic College of MedicineRochesterUSA
  9. 9.First Coast OncologyJacksonvilleUSA

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