Top

Published in:

01-12-2019 | Breast Cancer

Patient-clinician interactions and disparities in breast cancer care: the equality in breast cancer care study

Authors: Felisa A. Gonzales, Meera Sangaramoorthy, Laura A. Dwyer, Salma Shariff-Marco, Amani M. Allen, Allison W. Kurian, Juan Yang, Michelle M. Langer, Laura Allen, Bryce B. Reeve, Stephen H. Taplin, Scarlett Lin Gomez

Published in: Journal of Cancer Survivorship | Issue 6/2019

Abstract

Purpose

To examine whether interpersonal aspects of patient-clinician interactions, such as patient-perceived medical discrimination, clinician mistrust, and treatment decision-making contribute to racial/ethnic/educational disparities in breast cancer care.

Methods

A telephone interview was administered to 542 Asian/Pacific Islander (API), Black, Hispanic, and White women identified through the Greater Bay Area Cancer Registry, ages 20 and older diagnosed with a first primary invasive breast cancer. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated from logistic regression models that assessed associations between race/ethnicity/education, medical discrimination, clinician mistrust, and treatment decision-making with concordance to breast cancer treatment guidelines (guideline-concordant treatment) and perceived quality of care (pQoC).

Results

Approximately three-quarters of women received treatment that was guideline-concordant (76.6%) and reported that their breast cancer care was excellent (72.1%). Non-college-educated Black women had lower odds of guideline-concordant care (aOR (CI) = 0.29 (0.12–0.67)) vs. college-educated White women. Odds of excellent pQoC were lower among the following: college-educated Hispanic women (aOR (CI) = 0.09 (0.02–0.47)) and API women regardless of education (aORs ≤ 0.50) vs. college-educated White women, women reporting low and moderate levels of discrimination (aORs ≤ 0.44) vs. none, and women reporting any clinician mistrust (aOR (CI) = 0.50 (0.29–0.88)) vs. none. Disparities in guideline-concordant care and pQoC persisted after controlling for medical discrimination, clinician mistrust, and decision-making.

Conclusions

Interpersonal aspects of the patient-clinician interaction had an impact on pQoC but not receipt of guideline-concordant treatment and did not explain disparities in either outcome.

Implications for Cancer Survivors

Although breast cancer survivors’ interpersonal interactions with clinicians did not influence receipt of appropriate treatment, intervention strategies to improve patient-clinician relations may help attenuate disparities in survivors’ pQoC.

National Cancer Institute S, Epidemiology, and End Results Program. SEER Stat Fact Sheets: Female Breast Cancer. http://seer.cancer.gov/statfacts/html/breast.html. Accessed March 25 2016.

Shariff-Marco S, Yang J, John EM, Kurian AW, Cheng I, Leung R, et al. Intersection of race/ethnicity and socioeconomic status in mortality after breast cancer. J Community Health. 2015;40(6):1287–99. https://doi.org/10.1007/s10900-015-0052-y.CrossRefPubMedPubMedCentral

DeSantis CE, Fedewa SA, Goding Sauer A, Kramer JL, Smith RA, Jemal A. Breast cancer statistics, 2015: Convergence of incidence rates between black and white women. CA Cancer J Clin. 2016;66(1):31–42. https://doi.org/10.3322/caac.21320.CrossRefPubMed

Kohler BA, Sherman RL, Howlader N, Jemal A, Ryerson AB, Henry KA, et al. Annual report to the nation on the status of cancer, 1975-2011, featuring incidence of breast cancer subtypes by race/ethnicity, poverty, and state. J Natl Cancer Inst. 2015;107(6):djv048. https://doi.org/10.1093/jnci/djv048.CrossRefPubMedCentralPubMed

Wheeler SB, Reeder-Hayes KE, Carey LA. Disparities in breast cancer treatment and outcomes: biological, social, and health system determinants and opportunities for research. Oncologist. 2013;18(9):986–93. https://doi.org/10.1634/theoncologist.2013-0243.CrossRefPubMedPubMedCentral

Chen L, Li CI. Racial disparities in breast cancer diagnosis and treatment by hormone receptor and HER2 status. Cancer Epidemiol Biomark Prev. 2015. https://doi.org/10.1158/1055-9965.epi-15-0293.CrossRef

Wu X, Richardson LC, Kahn AR, Fulton JP, Cress RD, Shen T, et al. Survival difference between non-Hispanic black and non-Hispanic white women with localized breast cancer: the impact of guideline-concordant therapy. J Natl Med Assoc. 2008;100(5):490–8.CrossRefPubMed

Kurian AW, Lichtensztajn DY, Keegan TH, Nelson DO, Clarke CA, Gomez SL. Use of and mortality after bilateral mastectomy compared with other surgical treatments for breast cancer in California, 1998-2011. Jama. 2014;312(9):902–14. https://doi.org/10.1001/jama.2014.10707.CrossRefPubMedPubMedCentral

Maly RC, Stein JA, Umezawa Y, Leake B, Anglin MD. Racial/ethnic differences in breast cancer outcomes among older patients: effects of physician communication and patient empowerment. Health psychology : official journal of the Division of Health Psychology, American Psychological Association. 2008;27(6):728–36. https://doi.org/10.1037/0278-6133.27.6.728.CrossRef

10.

Li CI, Malone KE, Daling JR. Differences in breast cancer stage, treatment, and survival by race and ethnicity. Arch Intern Med. 2003;163(1):49–56.CrossRefPubMed

11.

Gomez SL, Press DJ, Lichtensztajn D, Keegan TH, Shema SJ, Le GM, et al. Patient, hospital, and neighborhood factors associated with treatment of early-stage breast cancer among Asian American women in California. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2012;21(5):821–34. https://doi.org/10.1158/1055-9965.epi-11-1143.CrossRef

12.

Palmer NR, Kent EE, Forsythe LP, Arora NK, Rowland JH, Aziz NM, et al. Racial and ethnic disparities in patient-provider communication, quality-of-care ratings, and patient activation among long-term cancer survivors. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2014;32(36):4087–94. https://doi.org/10.1200/jco.2014.55.5060.CrossRef

13.

Bickell NA, Neuman J, Fei K, Franco R, Joseph KA. Quality of breast cancer care: perception versus practice. J Clin Oncol Off J Am Soc Clin Oncol. 2012;30(15):1791–5. https://doi.org/10.1200/jco.2011.38.7605.CrossRef

14.

Taplin SH, Anhang Price R, Edwards HM, Foster MK, Breslau ES, Chollette V, et al. Introduction: understanding and influencing multilevel factors across the cancer care continuum. J Natl Cancer Inst Monogr. 2012;2012(44):2–10. https://doi.org/10.1093/jncimonographs/lgs008.CrossRefPubMedPubMedCentral

15.

Bickell NA, Weidmann J, Fei K, Lin JJ, Leventhal H. Underuse of breast cancer adjuvant treatment: patient knowledge, beliefs, and medical mistrust. J Clin Oncol Off J Am Soc Clin Oncol. 2009;27(31):5160–7. https://doi.org/10.1200/jco.2009.22.9773.CrossRef

16.

Katz SJ, Lantz PM, Janz NK, Fagerlin A, Schwartz K, Liu L, et al. Patient involvement in surgery treatment decisions for breast cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2005;23(24):5526–33. https://doi.org/10.1200/jco.2005.06.217.CrossRef

17.

Gerend MA, Pai M. Social determinants of Black-White disparities in breast cancer mortality: a review. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2008;17(11):2913–23. https://doi.org/10.1158/1055-9965.epi-07-0633.CrossRef

18.

(IOM) IoM. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press; 2003.

19.

Jary D, Jary J. Collins Dictionary of Sociology. 2nd ed. ed. Glasgow, UK: HarperCollins; 1995.

20.

Shavers VL, Fagan P, Jones D, Klein WM, Boyington J, Moten C, et al. The state of research on racial/ethnic discrimination in the receipt of health care. Am J Public Health. 2012;102(5):953–66. https://doi.org/10.2105/ajph.2012.300773.CrossRefPubMedPubMedCentral

21.

Shariff-Marco S, Klassen AC, Bowie JV. Racial/ethnic differences in self-reported racism and its association with cancer-related health behaviors. Am J Public Health. 2010;100(2):364–74. https://doi.org/10.2105/ajph.2009.163899.CrossRefPubMedPubMedCentral

22.

Taylor TR, Williams CD, Makambi KH, Mouton C, Harrell JP, Cozier Y, et al. Racial discrimination and breast cancer incidence in US Black women: the Black Women’s Health Study. Am J Epidemiol. 2007;166(1):46–54. https://doi.org/10.1093/aje/kwm056.CrossRefPubMed

23.

LaVeist TA, Nickerson KJ, Bowie JV. Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients. Medical Care Research and Review : MCRR. 2000;57(Suppl 1):146–61.CrossRefPubMed

24.

Sorkin DH, Ngo-Metzger Q, De Alba I. Racial/ethnic discrimination in health care: impact on perceived quality of care. J Gen Intern Med. 2010;25(5):390–6. https://doi.org/10.1007/s11606-010-1257-5.CrossRefPubMedPubMedCentral

25.

Lam WW, Kwok M, Chan M, Hung WK, Ying M, Or A, et al. Does the use of shared decision-making consultation behaviors increase treatment decision-making satisfaction among Chinese women facing decision for breast cancer surgery? Patient Educ Couns. 2014;94(2):243–9. https://doi.org/10.1016/j.pec.2013.11.006.CrossRefPubMed

26.

Lopez ME, Kaplan CP, Napoles AM, Hwang ES, Livaudais JC, Karliner LS. Satisfaction with treatment decision-making and treatment regret among Latinas and non-Latina whites with DCIS. Patient Educ Couns. 2014;94(1):83–9. https://doi.org/10.1016/j.pec.2013.09.005.CrossRefPubMed

27.

Lewis TT, Cogburn CD, Williams DR. Self-reported experiences of discrimination and health: scientific advances, ongoing controversies, and emerging issues. Annu Rev Clin Psychol. 2015;11:407–40. https://doi.org/10.1146/annurev-clinpsy-032814-112728.CrossRefPubMedPubMedCentral

28.

Williams DR, Kontos EZ, Viswanath K, Haas JS, Lathan CS, MacConaill LE, et al. Integrating multiple social statuses in health disparities research: the case of lung cancer. Health Serv Res. 2012;47(3 Pt 2):1255–77. https://doi.org/10.1111/j.1475-6773.2012.01404.x.CrossRefPubMedPubMedCentral

29.

Reuben SH, Milliken EL, Paradis LJ. America’s demographic and cultural transformation: implications for cancer. Bethesda, MD: National Cancer Institute; 2011.

30.

Stepanikova I, Oates GR. Perceived discrimination and privilege in health care: the role of socioeconomic status and race. Am J Prev Med. 52(1):S86–94. https://doi.org/10.1016/j.amepre.2016.09.024.CrossRefPubMedPubMedCentral

31.

Shih T-H, Fan X. Comparing response rates in e-mail and paper surveys: a meta-analysis. Educational Research Review. 2009;4(1):26–40. https://doi.org/10.1016/j.edurev.2008.01.003.CrossRef

32.

National Comprehensive Cancer Network Breast Cancer Guidelines. https://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site. Accessed April 20 2016.

33.

Kurian AW, Lichtensztajn DY, Keegan TH, Leung RW, Shema SJ, Hershman DL, et al. Patterns and predictors of breast cancer chemotherapy use in Kaiser Permanente Northern California, 2004-2007. Breast Cancer Res Treat. 2013;137(1):247–60. https://doi.org/10.1007/s10549-012-2329-5.CrossRefPubMed

34.

Blayney DW, McNiff K, Hanauer D, Miela G, Markstrom D, Neuss M. Implementation of the Quality Oncology Practice Initiative at a university comprehensive cancer center. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2009;27(23):3802–7. https://doi.org/10.1200/jco.2008.21.6770.CrossRef

35.

Malin JL, Ko C, Ayanian JZ, Harrington D, Nerenz DR, Kahn KL, et al. Understanding cancer patients’ experience and outcomes: development and pilot study of the Cancer Care Outcomes Research and Surveillance patient survey. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer. 2006;14(8):837–48. https://doi.org/10.1007/s00520-005-0902-8.CrossRef

36.

Kehl KL, Landrum MB, Arora NK, Ganz PA, van Ryn M, Mack JW, et al. Association of actual and preferred decision roles with patient-reported quality of care: shared decision making in cancer care. JAMA oncology. 2015;1(1):50–8. https://doi.org/10.1001/jamaoncol.2014.112.CrossRefPubMedPubMedCentral

37.

Williams DR, Yan Y, Jackson JS, Anderson NB. Racial Differences in physical and mental health: socio-economic status, stress and discrimination. J Health Psychol. 1997;2(3):335–51. https://doi.org/10.1177/135910539700200305.CrossRefPubMed

38.

Quach T, Nuru-Jeter A, Morris P, Allen L, Shema SJ, Winters JK, et al. Experiences and perceptions of medical discrimination among a multiethnic sample of breast cancer patients in the Greater San Francisco Bay Area, California. Am J Public Health. 2012;102(5):1027–34. https://doi.org/10.2105/ajph.2011.300554.CrossRefPubMedCentralPubMed

39.

Shariff-Marco S, Gonzales FA, Langer MM, Dwyer LA, Nuru-Jeter A, Allen L et al. Measuring medical discrimination in a diverse cohort of breast cancer patients: equality in breast cancer care study. 2016 (in preparation).

40.

Sen G, Iyer A, Mukherjee C. A methodology to analyse the intersections of social inequalities in health. Journal of Human Development and Capabilities. 2009;10(3):397–415. https://doi.org/10.1080/19452820903048894.CrossRef

41.

Vandergrift JL, Niland JC, Theriault RL, Edge SB, Wong YN, Loftus LS, et al. Time to adjuvant chemotherapy for breast cancer in National Comprehensive Cancer Network institutions. J Natl Cancer Inst. 2013;105(2):104–12. https://doi.org/10.1093/jnci/djs506.CrossRefPubMedPubMedCentral

42.

Rosenzweig MQ, Wiehagen T, Brufsky A, Arnold R. Challenges of illness in metastatic breast cancer: a low-income African American perspective. Palliative & supportive care. 2009;7(2):143–52. https://doi.org/10.1017/s1478951509000194.CrossRef

43.

Jagsi R, Pottow JA, Griffith KA, Bradley C, Hamilton AS, Graff J, et al. Long-term financial burden of breast cancer: experiences of a diverse cohort of survivors identified through population-based registries. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2014;32(12):1269–76. https://doi.org/10.1200/jco.2013.53.0956.CrossRef

44.

(IOM) IoM. Delivering high-quality cancer care: charting a new course for a system in crisis. Washington, DC: National Academies Press; 2013.

45.

Abraido-Lanza AF, Echeverria SE, Florez KR. Latino immigrants, acculturation, and health: promising new directions in research. Annu Rev Public Health. 2016;37:219–36. https://doi.org/10.1146/annurev-publhealth-032315-021545.CrossRefPubMedPubMedCentral

46.

Yoon H, Chatters L, Kao TS, Saint-Arnault D, Northouse L. Factors affecting quality of life for Korean American cancer survivors: an integrative review. Oncol Nurs Forum. 2016;43(3):E132–42. https://doi.org/10.1188/16.ONF.E132-E142.CrossRefPubMedPubMedCentral

47.

Farias AJ, Ornelas IJ, Hohl SD, Zeliadt SB, Hansen RN, Li CI, et al. Exploring the role of physician communication about adjuvant endocrine therapy among breast cancer patients on active treatment: a qualitative analysis. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2017;25(1):75–83. https://doi.org/10.1007/s00520-016-3389-6.CrossRef

48.

Burgess D, van Ryn M, Dovidio J, Saha S. Reducing racial bias among health care providers: lessons from social-cognitive psychology. J Gen Intern Med. 2007;22(6):882–7. https://doi.org/10.1007/s11606-007-0160-1.CrossRefPubMedPubMedCentral

49.

Glicksman E. Unconscious bias in academic medicine: Overcoming the prejudices we don't know we have. Association of American Medical Colleges, Washington, DC. 2016, January. https://www.aamc.org/news-insights/unconscious-bias-academic-medicine-overcoming-prejudices-we-don-t-know-we-have. Accessed July 8 2016.

50.

Greenwald AG, McGhee DE, Schwartz JL. Measuring individual differences in implicit cognition: the implicit association test. J Pers Soc Psychol. 1998;74(6):1464–80. https://doi.org/10.1037//0022-3514.74.6.1464.CrossRefPubMed

51.

FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics. 2017;18(1):19. https://doi.org/10.1186/s12910-017-0179-8.CrossRefPubMedPubMedCentral

52.

Kool M, Bastiaannet E, Van de Velde CJH. Marang-van de Mheen PJ. Reliability of self-reported treatment data by patients with breast cancer compared with medical record data. Clin Breast Cancer. 2018;18(3):234–8. https://doi.org/10.1016/j.clbc.2017.08.005.CrossRefPubMed

53.

Liu Y, Diamant AL, Thind A, Maly RC. Validity of self-reports of breast cancer treatment in low-income, medically underserved women with breast cancer. Breast Cancer Res Treat. 2010;119(3):745–51. https://doi.org/10.1007/s10549-009-0447-5.CrossRefPubMed

54.

Phillips KA, Milne RL, Buys S, Friedlander ML, Ward JH, McCredie MR, et al. Agreement between self-reported breast cancer treatment and medical records in a population-based Breast Cancer Family Registry. J Clin Oncol Off J Am Soc Clin Oncol. 2005;23(21):4679–86. https://doi.org/10.1200/JCO.2005.03.002.CrossRef

55.

Krieger N. Discrimination and health inequities. In: Berkman L, Kawachi I, Glymour M, editors. Social Epidemiology. New York, NY: Oxford University Press; 2014. p. 63–125.

56.

Society AC. Breast cancer. 2016. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. Accessed March 25, 2016 2016.

Title: Patient-clinician interactions and disparities in breast cancer care: the equality in breast cancer care study
Authors: Felisa A. Gonzales
Meera Sangaramoorthy
Laura A. Dwyer
Salma Shariff-Marco
Amani M. Allen
Allison W. Kurian
Juan Yang
Michelle M. Langer
Laura Allen
Bryce B. Reeve
Stephen H. Taplin
Scarlett Lin Gomez
Publication date: 01-12-2019
Publisher: Springer US
Keywords: Breast Cancer
Care
Breast Cancer
Published in: Journal of Cancer Survivorship / Issue 6/2019
Print ISSN: 1932-2259
Electronic ISSN: 1932-2267
DOI: https://doi.org/10.1007/s11764-019-00820-7

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Implications for Cancer Survivors

Please log in to get access to this content

Other articles of this Issue 6/2019

Utilization of an audit tool to evaluate accuracy of treatment summary and survivorship care plans

Correction to: Cancer survivors who fully participate in the PROFILES registry have better health-related quality of life than those who drop out

Social attainment in survivors of pediatric central nervous system tumors: a systematic review and meta-analysis from the Children’s Oncology Group

Computerized programs for cancer survivors with cognitive problems: a systematic review

Talking about sexual health during survivorship: understanding what shapes breast cancer survivors’ willingness to communicate with providers

Supportive care needs of patients following treatment for colorectal cancer: risk factors for unmet needs and the association between unmet needs and health-related quality of life—results from the ColoREctal Wellbeing (CREW) study

Keynote webinar | Spotlight on antibody–drug conjugates in cancer