The role of knowledge, language, and insurance in endorsement of cancer screening in women of African origin

BACKGROUND

African women have lower use of cancer screening services compared to women born in the United States yet empirical data are limited about their cancer screening attitudes.

OBJECTIVE

To examine factors that are associated with higher endorsement of screening.

METHOD

We conducted a cross-sectional study of 200 women of African origin recruited via community-based outreach activities in Washington, DC. Endorsement of screening was assessed via self-report. The primary independent variables were cancer knowledge and English-language proficiency. Information was also collected about access, cancer-related beliefs, and prior breast screening behaviors.

RESULTS

Most participants (60%) were ≥ 40 years of age, 54% were married, and 77% were insured. Participants more likely to endorse breast cancer screening were insured (vs. uninsured) (odds ratio = 3.37; 95% confidence interval: 1.24, 9.17) and married (odds ratio = 3.23; 95% confidence interval: 1.14, 9.10) controlling for other factors. The likelihood of endorsing screening was higher among participants with English as a primary language (odds ratio = 3.83; 95% confidence interval: 1.24, 11.87) and those with greater breast cancer knowledge (odds ratio = 1.04; 95% confidence interval: 1.01, 1.08, per 1 point increase).

CONCLUSIONS

Average cancer knowledge in the sample was low as were non-conventional causes of cancer. Study results highlight the importance of improving cancer knowledge and reducing barriers related to language and insurance. Future studies are needed to consider nuances among diverse women of African origin.

Disparities in breast cancer surgery delay: the lingering effect of race

BACKGROUND

Delays to surgical breast cancer treatment of 90 days or more may be associated with greater stage migration. We investigated racial disparities in time to receiving first surgical treatment in breast cancer patients.

METHODS

Insured black (56 %) and white (44 %) women with primary breast cancer completed telephone interviews regarding psychosocial (e.g., self-efficacy) and health care factors (e.g., communication). Clinical data were extracted from medical charts. Time to surgery was measured as the days between diagnosis and definitive surgical treatment. We also examined delays of more than 90 days. Unadjusted hazard ratios (HRs) examined univariate relationships between delay outcomes and covariates. Cox proportional hazard models were used for multivariate analyses.

RESULTS

Mean time to surgery was higher in blacks (mean 47 days) than whites (mean 33 days; p = .001). Black women were less likely to receive therapy before 90 days compared to white women after adjustment for covariates (HR .58; 95 % confidence interval .44, .78). Health care process factors were nonsignificant in multivariate models. Women with shorter delay reported Internet use (vs. not) and underwent breast-conserving surgery (vs. mastectomy) (p < .01).

CONCLUSIONS

Prolonged delays to definitive breast cancer surgery persist among black women. Because the 90-day interval has been associated with poorer outcomes, interventions to address delay are needed.

Abstract B19: Improving initiation of adjuvant hormonal therapy in black women under 50 may contribute towards narrowing racial gaps in breast cancer

Background: The advent of adjuvant hormonal therapy has greatly improved breast cancer survival in women with hormonal receptor (HR) positive breast cancer. Unfortunately, racial disparities have been noted in both the uptake of adjuvant hormonal therapy and in women with HR positive breast cancer.

Purpose: In a prospective study, we examined the influence of race, socio-cultural factors, and process of care factors on initiation of adjuvant hormonal therapy.

Methods: Eligible women were newly diagnosed with invasive, non-metastatic hormonal receptor positive (HR) breast cancer. Socio-cultural and healthcare factors were collected via telephone surveys; clinical data were abstracted from charts. Stepwise logistic regression models examined associations between hormonal initiation and study factors.

Results: The sample was 56% Black (n=150) and 44% White (n=120). Overall 70% initiated therapy with Black women &lt;50 having the lowest rate of initiation (51%) among all Black and White age groups. A significant interaction (p= .002) was found between race and age so a stratified race – age composite variable was created. In multivariate models, Black women &lt; 50 years were less likely to initiate therapy compared to Whites ≥50 (OR: .28; 95% CI: .10 to .82), whites &lt;50 (OR: 0.19; 95% CI: 0.05 to 0.68), or compared to blacks ≥50 (OR: .34; 95% CI: 0.12 to 0.96). Women reporting having higher ratings of financial access were more likely to initiate therapy as were those with higher ratings of communication with their providers.

Conclusion: Attention to financial aspects of cancer care and patient-provider communication may be useful points of intervention to improve initiation in patients, particularly Black patients &lt;50 years of age.

Citation Format: Vanessa B. Sheppard, Claudine Isaacs, Mahlet G. Tadesse, Melissa Butler, Felicity Harper, Fikru Hirpa. Improving initiation of adjuvant hormonal therapy in black women under 50 may contribute towards narrowing racial gaps in breast cancer. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr B19.

The importance of contextual factors and age in association with anxiety and depression in Black breast cancer patients

OBJECTIVES

Limited research exists on correlates of psychosocial distress in Black breast cancer patients. The goals of the study were to describe the prevalence of distress (anxiety and depression) in Black women with breast cancer and to examine the influence of demographic, clinical, contextual (e.g., self-efficacy, medical mistrust), and process of care factors (e.g., patient satisfaction) on women's level of anxiety and depression.

METHODS

Eighty-two Black women diagnosed with invasive non-metastatic breast cancer were interviewed by phone. Collected data included demographic, clinical, contextual, and process of care factors. Bivariate correlations were used to examine relationships between those variables. Multiple linear regressions were used to examine predictors of anxiety and depression.

RESULTS

About one-third of the women (32%) met cut-off thresholds for distress. Medical mistrust and positive attitude had significant influences on anxiety levels, whereas age and positive attitude were determinants of levels of depression. Participants with higher medical mistrust reported more anxiety (r = .379; p < .001) and depression (r = .337; p = .002), whereas women with higher self-efficacy reported less anxiety (r = -.401; p < .001) and depression (r = -.427; p < .001). Age was inversely related to both anxiety and depression (r = -.224; r = -.296, respectively; p < .05).

CONCLUSIONS

Findings support national recommendations for routine distress screening in the delivery of cancer care particularly in younger Black patients. Interventions targeted to boost self-efficacy or reduce medical mistrust through enhanced patient-provider interactions may decrease psychological distress. Psychosocial needs of younger patients warrant particular attention.

Narrowing racial gaps in breast cancer chemotherapy initiation: the role of the patient-provider relationship

Chemotherapy improves breast cancer survival but is underused more often in black than in white women. We examined associations between patient-physician relationships and chemotherapy initiation and timeliness of initiation among black and white patients. Women with primary invasive, non-metastatic breast cancer were recruited via hospitals (in Washington, DC and Detroit) and community outreach between July 2006 and April 2011. Data were collected via telephone interviews and medical records. Logistic regression models evaluated associations between chemotherapy initiation and independent variables. Since there were race interactions, analyses were race-stratified. Factors associated with time from surgery to chemotherapy initiation and delay of ≥90 days were evaluated with linear and logistic regressions, respectively. Among eligible women, 82.8 % were interviewed and 359 (90.9 %) of those had complete data. The odds of initiating chemotherapy were 3.26 times (95 % CI: 1.51, 7.06) higher among black women reporting greater communication with physicians (vs. lesser), after considering covariates. In contrast, the odds of starting chemotherapy were lower for white women reporting greater communication (vs. lesser) (adjusted OR 0.22, 95 % CI: 0.07, 0.73). The opposing direction of associations was also seen among the sub-set of black and white women with definitive clinical indications for chemotherapy. Among those initiating treatment, black women had longer mean time to the start of chemotherapy than whites (71.8 vs. 55.0 days, p = 0.005), but race was not significant after considering trust in oncologists, where initiation time decreased as trust increased, controlling for covariates. Black women were also more likely to delay ≥90 days than whites (27 vs. 8.3 %; p = 0.024), but this was not significant after considering religiosity. The patient-physician dyad and sociocultural factors may represent leverage points to improve chemotherapy patterns in black women.

Abstract 140: Weight changes in African American and White breast cancer patients undergoing chemotherapy

PURPOSE: Weight gain after a breast cancer diagnosis is associated with cancer recurrence, worse cancer prognosis, higher comorbidity, and increased likelihood of inaccurate chemotherapy dose reductions during treatment. This health problem is especially relevant for African Americans, as they are more likely to be obese and to present comorbid conditions compared to their White counterparts. However, limited research describes patterns of weight change by race. The goal of this study was to assess and compare weight change after chemotherapy in Black and White breast cancer patients.

METHODS: Ninety-eight Black and White women diagnosed with invasive non-metastatic breast cancer were recruited from two metropolitan areas. Medical records were abstracted to obtain clinical (e.g. cancer stage) and treatment variables (e.g. chemotherapy regimen). Weight change was examined in women who underwent chemotherapy and it was conceptualized as the relative percent of weight change and change in body mass index (BMI - kg/m2) categorized as normal, overweight, and obese. Differences in baseline characteristics by race were evaluated using the chi-square or Fisher's exact test for categorical variables and t-test for continuous variables. We performed bivariate associations between study variables and relative weight change.

RESULTS: African-American women had higher BMI at baseline (at the start of therapy) as compared to Whites (p&lt;0.001). African American women were also more likely to have at least one comorbid condition compared to Whites. Most (62%) participants maintained their pre-treatment weight. About a third of the sample (29%) experienced a weight gain of more than 5% of their baseline weight after treatment for breast cancer.

Only 9% of women lost more than 5% of their pre-treatment weight. Normal weight women had the highest mean relative weight increase (3.57%; 95% CI: 1.05%, 6.10%) compared to those that were overweight or obese. Fifteen percent of women shifted to a higher BMI category; 26% of those that were normal became overweight; 17% of overweight patients became obese. Blacks were more likely than whites to shift to a higher BMI (p=0.006).

CONCLUSIONS: The American Cancer Society guidelines recommend cancer survivors to maintain a normal weight and avoid weight gain. We found that women in all BMI categories were likely to gain weigh with those in the normal category having the highest risk of weight gain. Results underscore the need for integrating weight control within cancer treatment plans to prevent weight gain and promote weight maintenance in patients undergoing chemotherapy. Interventions that address dietary habits and promote increased physical activity to maintain fat-free mass may be warranted. Future studies that help to elucidate behaviors and/or biological factors that contribute to weight gain overall and in blacks will be important.

Citation Format: Vanessa B. Sheppard, Chiranjeev Dash, Bridget Oppong, Fikru Hirpa, Elizabeth Dennis, Lucile L. Adams-Campbell. Weight changes in African American and White breast cancer patients undergoing chemotherapy. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 140. doi:10.1158/1538-7445.AM2013-140