Older adults’ receipt of guideline-concordant breast cancer care varies by race
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Key takeaways:
- Non-Hispanic Black patients received guideline-concordant care less often than white patients.
- Non-Hispanic white patients began treatment within 90 days more often than non-Hispanic Black patients.
Timing and type of treatment for older adults with early-stage breast cancer varied greatly by race, study results showed.
Non-Hispanic Black patients appeared less likely than non-Hispanic white patients to receive guideline-concordant care and timely treatment initiation.
Non-Hispanic Black individuals also had increased risk for all-cause mortality.
“Unfortunately, the findings were consistent with our original hypothesis that self-identified non-Hispanic Black race will be associated with less likelihood of receiving timely guideline-concordant care,” Yehoda M. Martei, MD, MSCE, assistant professor of medicine and vice chief of diversity, inclusion and health equity in the hematology-oncology division at University of Pennsylvania, told Healio. “What was surprising was that, in our adjusted model — which included guideline-concordant care receipt and neighborhood level determinants — the increased risk for death associated with non-Hispanic Black [race] compared with non-Hispanic white individuals decreased from 26% to 5%. While this was not a formal mediation analysis, the results provide insights into modifiable factors that could mitigate racial disparities in this population.”
Martei and colleagues conducted a cohort study to identify potential racial disparities in rates of guideline-concordant care, time to treatment initiation and all-cause mortality among older patients with stage I to III breast cancer.
Researchers used the National Cancer Database to identify 258,531 patients (9.4% non-Hispanic Black) aged older than 64 years diagnosed with stage I to stage III breast cancer between 2010 and 2019.
Nonreceipt of guideline-concordant care and all-cause mortality served as primary outcomes. Time to treatment initiation served as a secondary outcome.
Of the 25,174 non-Hispanic Black patients, 4,563 (18.1%) did not receive guideline-concordant care; of the 233,357 non-Hispanic white patients, 35,374 (15.2%) did not receive guideline-concordant care.
Results showed identifying as non-Hispanic Black appeared linked with increased odds of not receiving guideline-concordant care (adjusted OR = 1.13; 95% CI, 1.08-1.17).
Identifying as non-Hispanic Black also increased all-cause mortality risk by 26.1% in univariate analysis. This decreased to 4.7% after adjusting for guideline-concordant care and clinical and sociodemographic factors (adjusted HR = 1.05; 95% CI, 1.01-1.08).
Patients who identified as non-Hispanic white also had increased odds of initiating treatment within 30 days (OR = 1.65; 95% CI, 1.6-1.69), 60 days (OR = 2.11; 95% CI, 2.04-2.18) or 90 days (OR = 2.39; 95% CI, 2.27-2.51) of diagnosis compared with those who identified as non-Hispanic Black.
Additional studies investigating the potential of community-based approaches to address disparities are needed, researchers concluded.
“Older non-Hispanic Black adults are less likely to receive guideline-concordant breast cancer treatment for early-stage breast cancer that is potentially curative,” Martei told Healio. “Improving timely initiation and equitable access to guideline-concordant care can reduce survival disparities in this population. Our results emphasize the need for a ubiquitous approach to geriatric assessments in this population. It also emphasizes the need for integrated community-engaged approaches to address barriers to care.
“The association between adverse neighborhood level social determinants of health and health outcomes are crosscutting across several disciplines,” she added. “Therefore, more research studies that leverage community-based approaches are needed to design and test multilevel interventions to address these barriers.”
For more information:
Yehoda M. Martei, MD, MSCE can be reached at Yehoda.Martei@pennmedicine.upenn.edu.
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