Ethnic disparities in adherence to breast cancer survivorship surveillance care

Abstract

Background Adherence to guidelines for surveillance mammography and clinic visits is an important component of breast cancer survivorship care. Identifying ethnic disparities in adherence may lead to improved care delivery and outcomes. Methods We evaluated records of 4,535 patients treated for stage I, II, or III breast cancer at our cancer center between January 1997 and December 2006. We used generalized estimating equations and Cox proportional hazards analyses to evaluate ethnic differences in missed mammograms and clinic visits up to 4 years of follow-up and the impact of those differences on overall survival. Results Nonadherence to guidelines for mammography (P = .0002) and clinic visits (P < .0001) increased over time. Hispanic and black patients were more likely to be nonadherent to guidelines for mammography (odds ratio [OR] = 1.35, 95% confidence interval [CI] = 1.10 to 1.65], OR = 1.36, 95% CI = 1.11 to 1.66, respectively) and clinic visits (OR = 1.62, 95% CI = 1.27 to 2.06, OR = 1.45, 95% CI = 1.13 to 1.86, respectively) than white patients. There was an interaction between Hispanic ethnicity and endocrine therapy on nonadherence to mammography guidelines (P = .001). Nonadherence to mammography and clinic visit guidelines was not associated with overall survival. Conclusions Withdrawal from breast cancer survivorship care increases over time, and black and Hispanic patients are more likely to be nonadherent. An understanding of the reasons for ethnic disparities in adherence to guidelines for mammography and clinic visits is needed to improve retention in survivorship care.

Perceived social support in African American breast cancer patients: Predictors and effects

“…Only 78% of African American women diagnosed with breast cancer survive five years, compared to 92% of White women (Office of Minority Health, 2013). In addition, there are differences between African American and white women in adherence to follow-up care recommendations, with African American patients having lower rates of clinic visits and surveillance mammography (Advani et al, 2014). The disparity in outcomes has been attributed to a variety of factors, including stage at diagnosis, type of tumor, access to care, and socioeconomic status, but much of the disparity remains unexplained (American Cancer Society, 2013).…”

Surveillance and beliefs about follow-up care among long-term breast cancer survivors: a comparison of primary care and oncology providers

“…In contrast, a recent report by Advani et al [18] indicates that black and Hispanic patients are more likely to be non-adherent in regard to missed mammograms and clinic visits. Our study included 89 Hispanic breast cancer survivors in contrast to the 518 included in their report, which may explain the difference in findings.…”

Participation and retention in the breast cancer screening program in New Brunswick Canada

“…Other methods estimated included the Anderson-Gill survival model (Andersen and Gill, 1982), Poisson, pooled logistic and generalized estimating equation models (Advani et al, 2014). The main results are qualitatively similar to what is obtained from the other approaches.…”