Comorbidity Management in Black Women Diagnosed with Breast Cancer: the Role of Primary Care in Shared Care

Abstract

BACKGROUND: Black women are more likely to have comorbidity at breast cancer diagnosis compared with White women, which may account for half of the Black-White survivor disparity. Comprehensive disease management requires a coordinated team of healthcare professionals including primary care practitioners, but few studies have examined shared care in the management of comorbidities during cancer care, especially among racial/ethnic minorities. OBJECTIVE: To examine whether the type of medical team composition is associated with optimal clinical care management of comorbidities. DESIGN: We used the Women's Circle of Health Follow-up Study, a population-based cohort of Black women diagnosed with breast cancer. The likelihood of receiving optimal comorbidity management after breast cancer diagnosis was compared by type of medical team composition (shared care versus cancer specialists only) using binomial regression. PARTICIPANTS: Black women with a co-diagnosis of diabetes and/or hypertension at breast cancer diagnosis between 2012 and 2016 (N = 274). MAIN MEASURES: Outcome-optimal clinical care management of diabetes (i.e., A1C test, LDL-C test, and medical attention for nephropathy) and hypertension (i.e., lipid screening and prescription for hypertension medication). Main predictor-shared care, whether the patient received care from both a cancer specialist and a primary care provider and/or a medical specialist within the 12 months following a breast cancer diagnosis. KEY RESULTS: Primary care providers were the main providers involved in managing comorbidities and 90% of patients received shared care during breast cancer care. Only 54% had optimal comorbidity management. Patients with shared care were five times (aRR: 4.62; 95% CI: 1.66, 12.84) more likely to have optimal comorbidity management compared with patients who only saw cancer specialists. CONCLUSIONS: Suboptimal management of comorbidities during breast cancer care exists for Black women. However, our findings suggest that shared care is more beneficial at achieving optimal clinical care management for diabetes and hypertension than cancer specialists alone.

Clinical Multiteam System Composition and Complexity Among Newly Diagnosed Early-Stage Breast, Colorectal, and Lung Cancer Patients With Multiple Chronic Conditions: A SEER-Medicare Analysis

“…36 Previous studies have shown that health-related outcomes, including chronic disease management and survival, are better when primary care is integrated as part of the care team. 37-41 In our study, it was encouraging that primary care was included in the clinical MTS for almost 74% of cancer patients. We also identified 16.7% lower incidence of high-complexity MTS care among patients with colorectal cancer compared with patients with breast cancer.…”

“…36 Previous studies have shown that health-related outcomes, including chronic disease management and survival, are better when primary care is integrated as part of the care team. [37][38][39][40][41] In our study, it was encouraging that primary care was included in the Abbreviation: MTS, multiteam system. a Clinician specialty represents the component team in which the clinician practices daily.…”

Fragmentation of Care Among Black Women With Breast Cancer and Comorbidities: The Role of Health Systems

“…The study protocol, including recruitment, procedures, and data abstraction, is described in detail elsewhere. 32,33 Briefly, eligible participants were identified by the New Jersey State Cancer Registry from 10 New Jersey counties and once recruited were contacted by the study team to schedule an in-person interview. Written informed consent was collected at the time of interview along with releases of medical and pharmacy records and contact information for all clinicians seen 12 months prior to cancer diagnosis through the interview date, which occurred approximately 9-12 months after diagnosis.…”

Team-Based Care for Cancer Survivors With Comorbidities: A Systematic Review

“…Twelve studies (92%) occurred during active treatment and 5 studies (38%) during survivorship (posttreatment). All U.S. studies explicitly stated that racial or ethnic minorities were included, [23][24][25][26][27][28][29][30] ranging from 20% to 100% of the study population. Four studies focused on populations that experience health and healthcare disparities, specifically Hispanic and Black cancer survivors.…”