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

Breast Cancer Research and Treatment volume 139, pages 207–216 (2013)Cite this article

Abstract

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.

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Acknowledgments

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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Affiliations

  1. Breast Cancer Program, Lombardi Comprehensive Cancer Center and Department of Oncology, Georgetown University, 3300 Whitehaven St. NW, Suite 4100, Washington, DC, 20007, USA

    Vanessa B. Sheppard, Yvonne Jennings & Fikru Hirpa

  2. Breast Cancer Program, Lombardi Comprehensive Cancer Center Departments of Medicine and Oncology, MedStar Georgetown University Hospital, Washington, DC, USA

    Claudine Isaacs, George Luta & Jeanne S. Mandelblatt

  3. Department of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA

    George Luta

  4. Betty Lou Ourisman Breast Health Center, Medstar Georgetown University Hospital, Washington, DC, USA

    Shawna C. Willey

  5. Medstar Washington Hospital Center, Washington, DC, USA

    Marc Boisvert & Karen Smith

  6. Population and Disparities Research Program, Karmanos Cancer Institute, and Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA

    Felicity W. K. Harper

  7. Department of Oncology, Howard University Hospital, Washington, DC, USA

    Sara Horton

  8. Departments of Medical Oncology and Anatomic Pathology, The Mayo Clinic College of Medicine, Rochester, MN, USA

    Minetta C. Liu

  9. First Coast Oncology, Jacksonville, FL, USA

    Felicia Snead

Authors
  1. Vanessa B. Sheppard
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  2. Claudine Isaacs
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  3. George Luta
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  4. Shawna C. Willey
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  5. Marc Boisvert
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  6. Felicity W. K. Harper
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  7. Karen Smith
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  8. Sara Horton
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  9. Minetta C. Liu
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  10. Yvonne Jennings
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  11. Fikru Hirpa
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  12. Felicia Snead
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  13. Jeanne S. Mandelblatt
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Correspondence to Vanessa B. Sheppard.

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Sheppard, V.B., Isaacs, C., Luta, G. et al. Narrowing racial gaps in breast cancer chemotherapy initiation: the role of the patient–provider relationship. Breast Cancer Res Treat 139, 207–216 (2013). https://doi.org/10.1007/s10549-013-2520-3

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  • DOI: https://doi.org/10.1007/s10549-013-2520-3

Keywords

  • Chemotherapy initiation
  • Disparities
  • Patient–provider communication