Guideline-concordant breast cancer care by patient race and ethnicity accounting for individual-, facility- and area-level characteristics: a SEER-Medicare study

Details

• Alternative Title:
  Cancer Causes Control
• Personal Author:
  Herbach, Emma L. ; Curran, Michaela ; Roberson, Mya L. ; Carnahan, Ryan M. ; McDowell, Bradley D. ; Wang, Kai ; Lizarraga, Ingrid ; Nash, Sarah H. ; Charlton, Mary
• Description:
  Purpose
  
  To examine racial–ethnic variation in adherence to established quality metrics (NCCN guidelines and ASCO quality metrics) for breast cancer, accounting for individual-, facility-, and area-level factors.
  
  Methods
  
  Data from women diagnosed with invasive breast cancer at 66+ years of age from 2000 to 2017 were examined using SEER-Medicare. Associations between race and ethnicity and guideline-concordant diagnostics, locoregional treatment, systemic therapy, documented stage, and oncologist encounters were estimated using multilevel logistic regression models to account for clustering within facilities or counties.
  
  Results
  
  Black and American Indian/Alaska Native (AIAN) women had consistently lower odds of guideline-recommended care than non-Hispanic White (NHW) women (Diagnostic workup: ORBlack 0.83 (0.79–0.88), ORAIAN 0.66 (0.54–0.81); known stage: ORBlack 0.87 (0.80–0.94), ORAIAN 0.63 (0.47–0.85); seeing an oncologist: ORBlack 0.75 (0.71–0.79), ORAIAN 0.60 (0.47–0.72); locoregional treatment: ORBlack 0.80 (0.76–0.84), ORAIAN 0.84 (0.68–1.02); systemic therapies: ORBlack 0.90 (0.83–0.98), ORAIAN 0.66 (0.48–0.91)). Commission on Cancer accreditation and facility volume were significantly associated with higher odds of guideline-concordant diagnostics, stage, oncologist visits, and systemic therapy. Black residential segregation was associated with significantly lower odds of guideline-concordant locoregional treatment and systemic therapy. Rurality and area SES were associated with significantly lower odds of guideline-concordant diagnostics and oncologist visits.
  
  Conclusions
  
  This is the first study to examine guideline-concordance across the continuum of breast cancer care from diagnosis to treatment initiation. Disparities were present from the diagnostic phase and persisted throughout the clinical course. Facility and area characteristics may facilitate or pose barriers to guideline-adherent treatment and warrant future investigation as mediators of racial–ethnic disparities in breast cancer care.
  
  
• Subjects:
  Aged Aged, 80 And Over American Indian Or Alaska Native Black Or African American Breast Neoplasms Ethnicity Female Guideline Adherence Healthcare Disparities Humans Medicare Practice Guidelines As Topic SEER Program United States White

  More +
• Keywords:
  Cancer Care Continuum Health Disparities Health Equity Multilevel Modeling Race
• Source:
  Cancer Causes Control. 35(7):1017-1031
• Pubmed ID:
  38546924
• Pubmed Central ID:
  PMC11706205
• Document Type:
  Journal Article
• Funding:
  UM1 CA221939/CA/NCI NIH HHSUnited States/ ; UM1 CA221940/CA/NCI NIH HHSUnited States/ ; HHSN261201000140C/CA/NCI NIH HHSUnited States/ ; HHSN261201000035C/CA/NCI NIH HHSUnited States/ ; Research Stimulus Award/Geographic Management of Cancer Health Disparities/ ; P30 CA086862/CA/NCI NIH HHSUnited States/ ; HHSN261201000035I/CA/NCI NIH HHSUnited States/ ; HHSN261201000034C/CA/NCI NIH HHSUnited States/ ; R50 CA243692/CA/NCI NIH HHSUnited States/ ; U58 DP003862/DP/NCCDPHP CDC HHSUnited States/ ; UM1 CA222035/CA/NCI NIH HHSUnited States/ ; U24 CA221936/CA/NCI NIH HHSUnited States/
• Volume:
  35
• Issue:
  7
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:a2ca1a091694020a39829291ab53e887c0ea6b510a413e996f145f86a170db8532da736c2588d7b57314fcbb5400d3016c001a31ccf86aaa32e2ebbd5162032f
• Download URL:
  https://stacks.cdc.gov/view/cdc/175572/cdc_175572_DS1.pdf
• File Type:
  [PDF - 781.76 KB ]