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Racial/ethnic disparities in the association between patient care experiences and receipt of initial surgical breast cancer care: findings from SEER-CAHPS

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

Abstract

Purpose

We determined whether racial/ethnic differences in patient experiences with care influence timeliness and type of initial surgical breast cancer treatment for a sample of female Medicare cancer patients.

Methods

We conducted a retrospective cohort study using the linked Epidemiology and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) dataset. The outcomes were: (1) time-to-initial surgical treatment, and (2) type of treatment [breast conserving surgery (BCS) vs. mastectomy]. The indicators were reports of four types of patient experiences with care including doctor communication, getting care quickly, getting needed care, and getting needed Rx. Interaction terms in each multivariable logistic model examined if the associations varied by race/ethnicity.

Results

Of the 2069 patients, 84.6% were White, 7.6% Black and 7.8% Hispanic. After adjusting for potential confounders, non-Hispanic Black patients who provided excellent reports of their ability to get needed prescriptions had lower odds of receiving surgery within 2-months of diagnosis, compared to NH-Whites who provided less than excellent reports (aOR: 0.29, 95% CI 0.09–0.98). There were no differences based on 1-month or 3-month thresholds. We found no other statistically significant effect of race/ethnicity. As to type of surgery, among NH Blacks, excellent reports of getting care quickly were associated with higher odds of receiving BCS versus mastectomy (aOR: 2.82, 95% CI 1.16–6.85) compared to NH Whites with less than excellent reports. We found no other statistically significant differences by race/ethnicity.

Conclusion

Experiences with care are measurable and modifiable factors that can be used to assess and improve aspects of patient-centered care. Improvements in patient care experiences of older adults with cancer, particularly among minorities, may help to eliminate racial/ethnic disparities in timeliness and type of surgical treatment.

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Data availability

Codes are available from the corresponding author upon reasonable request. SEER-CAHPS linked dataset used for this manuscript is publicly available through the National Cancer Institute, Division of Cancer Control and Population Sciences.

Abbreviations

US :

United States

BCS :

Breast conserving surgery

SEER-CAHPS :

Surveillance, epidemiology, and end results—consumer assessment of healthcare providers and systems

NCI :

National Cancer Institute

SEER :

Surveillance, epidemiology, and end results

CMS :

Centers for medicare and medicaid services

CAHPS :

Medicare consumer assessment of healthcare providers and systems

FFS :

Fee for service

ANOVA :

Analysis of variance

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Acknowledgements

This study used the linked SEER-CAHPS data resource. 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 Centers for Medicare & Medicaid Services; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-CAHPS data resource.

Funding

Efforts by Mariana Arevalo, PhD, MSPH were supported by a pre-doctoral fellowship at the University of Texas Health Science Center at Houston, School of Public Health, Susan G. Komen Traineeship in Breast Cancer Disparities (GTDR14300827). SEER-CAHPS data were procured by Albert J. Farias, PhD with support from a University of Texas Health Science Center at Houston School of Public Health Cancer Education and Career Development Program grant from the National Cancer Institute (R25-CA57712). Efforts by Trevor A. Pickering, PhD, MS were supported by grants UL1TR001855 and UL1TR000130 from the National Center for Advancing Translational Science (NCATS) of the U.S. National Institutes of Health. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the funding bodies.

Author information

Authors and Affiliations

  1. Department of Health Promotion & Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA

    Mariana Arevalo, Sally W. Vernon, Kayo Fujimoto & Melissa F. Peskin

  2. Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA

    Trevor A. Pickering

  3. Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA

    Albert J. Farias

  4. Gehr Family Center for Health System Science, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA

    Albert J. Farias

  5. Cancer Control Research Program, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA

    Albert J. Farias

  6. Health Outcomes & Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA

    Mariana Arevalo

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  1. Mariana Arevalo
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Contributions

MA, AJF, and SWV contributed to the conception and design of this study. TAP contributed to data management. MA, AJF, and SWV contributed to the analyses and interpretation of data. MA prepared the first draft of this manuscript with feedback from AJF. All authors reviewed and approved the final version of the manuscript.

Corresponding author

Correspondence to Mariana Arevalo.

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Conflict of interest

Authors have no relevant financial or non-financial interests to disclose.

Ethical approval

The study was reviewed and granted exempt status by the UTHealth Committee for Protection of Human Subjects (HSC-SPH-20–0812).

Patient consent to participate

This study used a large population-based dataset with unidentifiable patient information.

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Arevalo, M., Pickering, T.A., Vernon, S.W. et al. Racial/ethnic disparities in the association between patient care experiences and receipt of initial surgical breast cancer care: findings from SEER-CAHPS. Breast Cancer Res Treat 203, 553–564 (2024). https://doi.org/10.1007/s10549-023-07148-y

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