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Examining racial variation in antiemetic use and post-chemotherapy health care utilization for nausea and vomiting among breast cancer patients

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Abstract

Purpose

Racial minority cancer patients may experience underuse of antiemetic medications to prevent chemotherapy-induced nausea and vomiting (CINV). In addition to its adverse implications for quality of life, antiemetic underuse may contribute to observed disparities in acute illness during chemotherapy. To understand the potential contribution of CINV prophylaxis to breast cancer disparities, we assessed racial variation in potent antiemetic use and post-chemotherapy utilization related to CINV and the relationship between the two.

Methods

We used SEER-Medicare data to evaluate the health care utilization in the 14 days following chemotherapy initiation among black and white women receiving highly emetogenic chemotherapy for breast cancer. We used modified Poisson regression to assess the relationship between (1) race and CINV-related utilization and (2) NK1 use and CINV-related utilization, overall and stratified by race. We report adjusted risk ratios (aRR) and 95 % confidence intervals (CI).

Results

The study included 1130 women. Black women were 11 % less likely than white women to use neurokinin-1 receptor antagonists (NK1s) for CINV prophylaxis (p = 0.02); however, they experienced fewer CINV-related encounters following chemotherapy (unadjusted RR = 0.63, 95 %CI = 0.40–0.99; p = 0.05). After adjustment for clinical covariates, estimates were similar but no longer statistically significant (p = 0.07). Among white women, NK1 use was associated with increased CINV-related utilization (aRR NK1 users vs. non-users: 1.35, 95 % CI = 1.07–1.69, p = 0.01), likely resulting from unmeasured confounders.

Conclusion

Black women were less likely to use NK1s- and CINV-related services. Racial variation in CINV-related services use may be partly explained by differential symptom reporting or access to care.

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Acknowledgements

Dr. Check is supported by the National Cancer Institute under Award Number R25CA116339. Dr. Dusetzina is supported by 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. Zullig and Weinberger 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).

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Authors and Affiliations

  1. Department of Health Policy and Management, , CB#7411, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA

    Devon K. Check, Morris Weinberger, Ethan M. Basch & Stacie B. Dusetzina

  2. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA

    Katherine E. Reeder-Hayes, Ethan M. Basch & Stacie B. Dusetzina

  3. Division of Hematology/Oncology, UNC School of Medicine, University of North Carolina, Chapel Hill, NC, USA

    Katherine E. Reeder-Hayes & Ethan M. Basch

  4. Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA

    Leah L. Zullig & Morris Weinberger

  5. Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC, USA

    Leah L. Zullig

  6. Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA

    Stacie B. Dusetzina

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  1. Devon K. Check
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Correspondence to Devon K. Check.

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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.

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Check, D.K., Reeder-Hayes, K.E., Zullig, L.L. et al. Examining racial variation in antiemetic use and post-chemotherapy health care utilization for nausea and vomiting among breast cancer patients. Support Care Cancer 24, 4839–4847 (2016). https://doi.org/10.1007/s00520-016-3338-4

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