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Overcoming disparities: Multidisciplinary breast cancer care at a public safety net hospital

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Public safety net hospitals (SNH) serve a disparate patient population; however, little is known about long-term oncologic outcomes of patients receiving care at these facilities. This study is the first to examine overall survival (OS) and the initiation of treatment in breast cancer patients treated at a SNH.

Methods

Patients presenting to a SNH with stage I-IV breast cancer from 2005 to 2017 were identified from the local tumor registry. The hospital has a weekly breast tumor board and a multidisciplinary approach to breast cancer care. Kaplan-Meier survival analysis was performed to identify patient, tumor, and treatment characteristics associated with OS. Factors with a p < 0.1 were included in the Cox proportional hazards model.

Results

2709 breast cancer patients were evaluated from 2005 to 2017. The patient demographics, tumor characteristics, and treatments received were analyzed. Five-year OS was 78.4% (93.9%, 87.4%, 70.9%, and 23.5% for stages I, II, III, and IV, respectively). On multivariable analysis, higher stage, age > 70 years, higher grade, and non-Hispanic ethnicity were associated with worse OS. Patients receiving surgery (HR = 0.33, p < 0.0001), chemotherapy (HR = 0.71, p = 0.006), and endocrine therapy (HR = 0.61, p < 0.0001) had better OS compared to those who did not receive these treatments.

Conclusion

Despite serving a vulnerable minority population that is largely poor, uninsured, and presenting with more advanced disease, OS at our SNH approaches national averages. This novel finding indicates that in the setting of multidisciplinary cancer care and with appropriate initiation of treatment, SNHs can overcome socioeconomic barriers to achieve equitable outcomes in breast cancer care.

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Acknowledgements

The authors acknowledge support from the National Cancer Institute (NCI) of the National Institutes of Health (NIH) Award—1K12CA226330-01 (Alan Pollack, Neha Goel).

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Authors and Affiliations

  1. Division of Surgical Oncology, University of Miami, Miami, FL, USA

    Kristin N. Kelly, Emily Ryon, Dido Franceschi, Eli Avisar, Nipun Merchant, Susan Kesmodel & Neha Goel

  2. Division of Surgical Oncology, Upstate Medical University, Syracuse, NY, USA

    Kristin N. Kelly

  3. University of Miami, Miller School of Medicine, Miami, FL, USA

    Alexandra Hernandez, Sina Yadegarynia & Erin N. Kobetz

  4. Department of Internal Medicine, Public Health Sciences, and Obstetrics and Gynecology, University of Miami, Miami, FL, USA

    Erin N. Kobetz

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  1. Kristin N. Kelly
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  2. Alexandra Hernandez
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  3. Sina Yadegarynia
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Correspondence to Neha Goel.

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Conflict of Interest

Kristin N. Kelly, Alexandra Hernandez, Sina Yadegarynia, Emily Ryon, Dido Franceschi, Eli Avisar, Erin N. Kobetz, Nipun Merchant, Susan Kesmodel, Neha Goel declares that they have no conflict of interest.

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Kelly, K.N., Hernandez, A., Yadegarynia, S. et al. Overcoming disparities: Multidisciplinary breast cancer care at a public safety net hospital. Breast Cancer Res Treat 187, 197–206 (2021). https://doi.org/10.1007/s10549-020-06044-z

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  • DOI: https://doi.org/10.1007/s10549-020-06044-z

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