BPI19-008: Racial Disparities in Breast Cancer Treatment Based on NCCN Quality Guidelines

Background: NCCN quality measures for breast cancer include (1) radiation therapy administered within 1 year of diagnosis for women under age 70 receiving breast-conserving surgery; (2) chemotherapy considered in 4 months of diagnosis for women under 70 with T1c or stage II/III ER/PR- tumors; (3) endocrine therapy administered within 1 year of diagnosis for women with AJCC T1 or stage II/III ER/PR+ breast cancer. These evidence-based measures promote accountability for providers and allow transparency in quality of care. Black women are less likely than white women to receive these therapies that are associated with a survival benefit. Improving adherence to guidelines can decrease the gap in mortality rates for minority women with breast cancer. Methods: We performed a retrospective chart review on patients with breast cancer between April 2010 and October 2015 at Rush University. Information collected included time of diagnosis, clinical stage, ER/PR status, surgical procedures, radiation, chemotherapy, endocrine therapy, and demographics. Chi-squared analysis was done to compare percent of black versus white women who met each quality guideline. Results: In total, 2,436 women were analyzed, of whom 30.3% were black, 66% were white, and 3.7% were other. Of this cohort, 779 women met inclusion criteria for quality guideline 1, and there was no significant difference between black and white women who did not receive radiation therapy (P=.21; 24.7% vs 20.4%). For quality guideline 2 (n=382), there was also no significant difference between black and white women who did not get chemotherapy within 4 months of diagnosis (P=.32; 36.6% vs 31.4%). However, for quality guideline 3 (n=1,222), there was a statistically significant difference between black and white women who did not get hormone therapy within a year of diagnosis (P=.0008; 36.9% vs 26.1%). Conclusions: Endocrine therapy reduces risk of recurrence and mortality in women with ER/PR positive breast cancer; however, there is a disparity between black versus white women who meet this NCCN quality measure. Further studies are needed to understand the reason for this gap in quality of care so that specific interventions can be implemented to eliminate this disparity.

Abstract

Background: NCCN quality measures for breast cancer include (1) radiation therapy administered within 1 year of diagnosis for women under age 70 receiving breast-conserving surgery; (2) chemotherapy considered in 4 months of diagnosis for women under 70 with T1c or stage II/III ER/PR- tumors; (3) endocrine therapy administered within 1 year of diagnosis for women with AJCC T1 or stage II/III ER/PR+ breast cancer. These evidence-based measures promote accountability for providers and allow transparency in quality of care. Black women are less likely than white women to receive these therapies that are associated with a survival benefit. Improving adherence to guidelines can decrease the gap in mortality rates for minority women with breast cancer. Methods: We performed a retrospective chart review on patients with breast cancer between April 2010 and October 2015 at Rush University. Information collected included time of diagnosis, clinical stage, ER/PR status, surgical procedures, radiation, chemotherapy, endocrine therapy, and demographics. Chi-squared analysis was done to compare percent of black versus white women who met each quality guideline. Results: In total, 2,436 women were analyzed, of whom 30.3% were black, 66% were white, and 3.7% were other. Of this cohort, 779 women met inclusion criteria for quality guideline 1, and there was no significant difference between black and white women who did not receive radiation therapy (P=.21; 24.7% vs 20.4%). For quality guideline 2 (n=382), there was also no significant difference between black and white women who did not get chemotherapy within 4 months of diagnosis (P=.32; 36.6% vs 31.4%). However, for quality guideline 3 (n=1,222), there was a statistically significant difference between black and white women who did not get hormone therapy within a year of diagnosis (P=.0008; 36.9% vs 26.1%). Conclusions: Endocrine therapy reduces risk of recurrence and mortality in women with ER/PR positive breast cancer; however, there is a disparity between black versus white women who meet this NCCN quality measure. Further studies are needed to understand the reason for this gap in quality of care so that specific interventions can be implemented to eliminate this disparity.

Background: NCCN quality measures for breast cancer include (1) radiation therapy administered within 1 year of diagnosis for women under age 70 receiving breast-conserving surgery; (2) chemotherapy considered in 4 months of diagnosis for women under 70 with T1c or stage II/III ER/PR- tumors; (3) endocrine therapy administered within 1 year of diagnosis for women with AJCC T1 or stage II/III ER/PR+ breast cancer. These evidence-based measures promote accountability for providers and allow transparency in quality of care. Black women are less likely than white women to receive these therapies that are associated with a survival benefit. Improving adherence to guidelines can decrease the gap in mortality rates for minority women with breast cancer. Methods: We performed a retrospective chart review on patients with breast cancer between April 2010 and October 2015 at Rush University. Information collected included time of diagnosis, clinical stage, ER/PR status, surgical procedures, radiation, chemotherapy, endocrine therapy, and demographics. Chi-squared analysis was done to compare percent of black versus white women who met each quality guideline. Results: In total, 2,436 women were analyzed, of whom 30.3% were black, 66% were white, and 3.7% were other. Of this cohort, 779 women met inclusion criteria for quality guideline 1, and there was no significant difference between black and white women who did not receive radiation therapy (P=.21; 24.7% vs 20.4%). For quality guideline 2 (n=382), there was also no significant difference between black and white women who did not get chemotherapy within 4 months of diagnosis (P=.32; 36.6% vs 31.4%). However, for quality guideline 3 (n=1,222), there was a statistically significant difference between black and white women who did not get hormone therapy within a year of diagnosis (P=.0008; 36.9% vs 26.1%). Conclusions: Endocrine therapy reduces risk of recurrence and mortality in women with ER/PR positive breast cancer; however, there is a disparity between black versus white women who meet this NCCN quality measure. Further studies are needed to understand the reason for this gap in quality of care so that specific interventions can be implemented to eliminate this disparity.

Corresponding Author: Surbhi Agarwal, MD, MPH

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