Ancillary Treatment Referrals and Visits After Breast Cancer Surgery in a Sociodemographically Diverse Population

Chan, Vernice Hui Yan; Heller, Danielle R.; Berger, Elizabeth R.; Capozza, Scott; Greenup, Rachel A.; Sanft, Tara

doi:10.1245/s10434-023-13431-5

Cited by 2 publications

(3 citation statements)

References 19 publications

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“…In our study, 70% of patients were referred for lymphedema therapy, with the highest uptake of therapy among Black and Hispanic women, likely because a higher proportion of these women were symptomatic at the time of referral. A recent study examining variations in ancillary service referrals and use in patients with cancer found that, while Black and Hispanic patients were referred for rehabilitative services more often than White patients, use of services among Black women was not commensurately higher . Although our study did not specifically address the association between early lymphedema therapy referral and QOL overall or across racial and ethnic groups, future studies from this cohort will be able to answer whether early intervention can mitigate arm symptoms and provide benefit.…”

Section: Discussionmentioning

confidence: 99%

“…Of these, 281 women with a baseline measurement and at least 6 months of follow-up were included. Median (IQR) pa-tient age was 48 (41-58) years; median (IQR) BMI was 26 (23)(24)(25)(26)(27)(28)(29)(30)(31). Overall, 11% of patients (n = 30) self-identified as Asian, 20% (n = 57) as Black, 8% (n = 23) as Hispanic, 58% (n = 162) as White, and 3% (n = 9) as other or unknown race or ethnicity.…”

Section: Clinicopathological Characteristicsmentioning

confidence: 99%

“…Table 1 summarizes clinicopathological characteristics of the cohort stratified by race and ethnicity. Compared with Asian and White women, Black and Hispanic women had a higher baseline BMI (median [IQR], 30 [26][27][28][29][30][31][32][33][34] and 28 [23][24][25][26][27][28][29][30][31][32] vs 23 [21][22][23][24][25][26][27][28][29] and 26 [22][23][24][25][26][27][28][29][30], respectively; P < .001), higher clinical nodal stage at presentation (clinical nodal positivity, 83% and 87% vs 60% and 72%, respectively; P = .03), and higher rates of objective lymphedema (40% and 39% vs 17% and 21%; P = .02). Additionally, Black women were less likely than other racial or ethnic groups to have private insurance (46% vs ≥70% for the other 3 groups; P < .001).…”

Section: Clinicopathological Characteristicsmentioning

confidence: 99%

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Quality of Life After Axillary Lymph Node Dissection Among Racial and Ethnic Minority Women

Heller,

Axelrod,

Sevilimedu

et al. 2024

JAMA Surg

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ImportanceHigher lymphedema rates after axillary lymph node dissection (ALND) have been found in Black and Hispanic women; however, there is poor correlation between subjective symptoms, quality of life (QOL), and measured lymphedema. Additionally, racial and ethnic differences in QOL have been understudied.ObjectiveTo evaluate the association of race and ethnicity with long-term QOL in patients with breast cancer treated with ALND.Design, Setting, and ParticipantsThis cohort study enrolled women aged 18 years and older with breast cancer who underwent unilateral ALND at a tertiary cancer center between November 2016 and March 2020. Preoperatively and at 6-month intervals, arm volume was measured by perometer and QOL was assessed using the Upper Limb Lymphedema-27 (ULL-27) questionnaire, a validated tool for assessing lymphedema that evaluates how arm symptoms affect physical, psychological, and social functioning. Data were analyzed from November 2016 to October 2023.ExposuresBreast surgery and unilateral ALND in the primary setting or after sentinel lymph node biopsy.Main Outcomes and MeasuresScores in each domain of the ULL-27 were compared by race and ethnicity. Factors impacting QOL were identified using multivariable regression analyses.ResultsThe study included 281 women (median [IQR] age, 48 [41-58] years) with breast cancer who underwent unilateral ALND and had at least 6 months of follow-up. Of these, 30 patients (11%) self-identified as Asian individuals, 57 (20%) as Black individuals, 23 (8%) as Hispanic individuals, and 162 (58%) as White individuals; 9 individuals (3%) who did not identify as part of a particular group or who were missing race and ethnicity data were categorized as having unknown race and ethnicity. Median (IQR) follow-up was 2.97 (1.96-3.67) years. The overall 2-year lymphedema rate was 20% and was higher among Black (31%) and Hispanic (27%) women compared with Asian (15%) and White (17%) women (P = .04). Subjective arm swelling was more common among Asian (57%), Black (70%), and Hispanic (87%) women than White (44%) women (P &lt; .001), and lower physical QOL scores were reported by racial and ethnic minority women at nearly every follow-up. For example, at 24 months, median QOL scores were 87, 79, and 80 for Asian, Black, and Hispanic women compared with 92 for White women (P = .003). On multivariable analysis, Asian race (β = –5.7; 95% CI, −9.5 to −1.8), Hispanic ethnicity (β = –10.0; 95% CI, −15.0 to −5.2), and having Medicaid (β = −5.4; 95% CI, −9.2 to −1.7) or Medicare insurance (β = −6.9; 95% CI, −10.0 to −3.4) were independently associated with worse physical QOL (all P &lt; .001).Conclusions and RelevanceFindings of this cohort study suggest that Asian, Black, and Hispanic women experience more subjective arm swelling after unilateral ALND for breast cancer compared with White women. Black and Hispanic women had higher rates of objective lymphedema than their White counterparts. Both minority status and public medical insurance were associated with worse physical QOL. Understanding disparities in QOL after ALND is an unmet need and may enable targeted interventions to improve QOL for these patients.

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Section: Discussionmentioning

confidence: 99%