Do All Patients Receive Guideline-Concordant Cancer Care?

TOPLINE: 

Older non-Hispanic Black adults with breast cancer are less likely to receive guideline-concordant care and timely treatment than non-Hispanic White adults, according to findings from a recent cohort study.

METHODOLOGY:

• Data show that compared with White patients, Black patients with breast cancer are more likely to die from the disease. Although the reasons behind this survival difference are complex, disparities in receipt of guideline-concordant cancer care and the timely initiation of therapy may be partly to blame.
• In the current study, researchers analyzed racial disparities in guideline-concordant care, time to treatment initiation, and all-cause mortality among older adults diagnosed with stage I-III breast cancer.
• The study used data from the National Cancer Database and included patients aged 65 years or older diagnosed with breast cancer between 2010 and 2019.
• The primary outcome was nonreceipt of guideline-concordant care, defined using the National Comprehensive Cancer Network guidelines, and all-cause mortality. The secondary outcome was time to treatment initiation.
• A total of 258,531 patients were included, with 25,174 non-Hispanic Black patients (9.7%) and 233,357 non-Hispanic White patients (90.3%).

TAKEAWAY:

• Overall, 18.1% of non-Hispanic Black patients and 15.2% of non-Hispanic White patients did not receive guideline-concordant care.
• In the multivariate analysis, non-Hispanic Black race was associated with significantly increased odds of not receiving guideline-concordant care (adjusted odds ratio [OR], 1.13; P
• Non-Hispanic White race was associated with significantly higher odds of initiating curative surgery or neoadjuvant therapy within 30 days (OR, 1.65), 60 days (OR, 2.11), and 90 days (OR, 2.39) of a breast cancer diagnosis.
• In the univariate analysis, non-Hispanic Black race was associated with a significantly increased risk for all-cause mortality (hazard ratio [HR], 1.26). After adjusting for guideline-concordant care and clinical and sociodemographic factors, that increased risk fell to 4.7% (adjusted HR, 1.05; P = .006).

IN PRACTICE:

“These findings suggest that optimizing timely receipt of GCC [guideline concordant care] may represent a modifiable pathway to improving inferior survival outcomes among older non-Hispanic Black patients with breast cancer,” the authors concluded.

SOURCE:

This study, led by Brenda S. Castillo, MD; Taussia Boadi; Xiaoyan Han, MS; Lawrence N. Shulman, MD; and Yehoda M. Martei, MD, MSCE, at the University of Pennsylvania in Philadelphia, was published online on October 24 in JAMA Network Open.

LIMITATIONS:

The National Cancer Database only includes information from Commission on Cancer–accredited hospitals, which may have underrepresented some populations. Data on systemic therapy lacked granularity, and novel diagnostic tests in clinical practice were not included. 

DISCLOSURES:

Martei received grants from the Center for Improving Care Delivery for the Aging and the Doris Duke Foundation during the conduct of the study. No other disclosures were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.