Racial disparities in low‐value surgical care and time to surgery in high‐volume hospitals

Jackson, Destiny; Li, Yaming; Eskander, Mariam F.; Tsung, Allan; Oppong, Bridget A.; Bhattacharyya, Oindrila; Paskett, Electra D.; Obeng‐Gyasi, Samilia

doi:10.1002/jso.26320

Cited by 21 publications

(22 citation statements)

References 38 publications

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“…The reasons why those who identified as Black race, uninsured or Medicaid insured, and were of single marital status were less likely to receive surgical management is most likely due to a combination of disease presentation, patient preference, and surgeon recommendations. Black, uninsured, and Medicaid patients face barriers in receiving surgical care in the nonmetastatic setting, and we anticipate factors driving surgical access in MBC patients are similar [ 6 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…A multivariable analysis was performed using age, race, insurance status, marital status, neighborhood socioeconomic status, region of care delivery, chemotherapy status, and number of metastatic sites as independent variables to determine the odds of undergoing surgery. Independent variables were selected based on their association or recommendations to be considered for surgical decision making [ 6 , 14 , [21] , [22] , [23] , [24] , [25] ]. Odds ratios were reported along with the Wald Chi-Square tests.…”

Section: Methodsmentioning

confidence: 99%

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Low neighborhood socioeconomic status is associated with higher mortality and increased surgery utilization among metastatic breast cancer patients

Bhattacharyya

Tsung

et al. 2021

The Breast

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Purpose Low socioeconomic status (SES) is associated with advanced stage, lower-quality care, and higher mortality among breast cancer patients. The purpose of this study is to examine the association between neighborhood SES (nSES), surgical management, and disease-specific mortality in de novo metastatic breast cancer (MBC) patients in the Surveillance, Epidemiology, and End Results (SEER) Program. Methods MBC patients ages 18 to 85+ years diagnosed from 2010 through 2016 were identified in SEER. The cohort was divided into low, middle, and high nSES based on the NCI census tract-level index. Univariable and multivariable analyses were used to examine the relationship between nSES, surgery, and disease specific mortality in MBC patients. Results There were 24,532 de novo MBC patients who met study criteria, with 28.7 % undergoing surgery. Over the study period, surgery utilization decreased across all nSES groups. However, lower nSES was associated with a higher odds of undergoing surgery (low OR 1.25 [1.15–1.36] p < 0.001; middle OR 1.09 [1.01–1.18] p = 0.022; ref high). Living in an area with lower SES was associated with a worse disease specific mortality (low HR 1.24 [1.25, 1.44; ], middle 1.20 [1.1–1.29]: ref high). Specifically, there was a 9.26 month mean survival differences between the lowest (41.02 ± 0.47 months) and highest (50.28 ± 0.47 months) nSES groups. Conclusion These results suggest area of residence may contribute to differences in surgical management and clinical outcomes among de novo MBC patients. Future studies should examine the contributions of patient characteristics and preferences within the context of surgeon recommendations.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Low neighborhood socioeconomic status is associated with higher mortality and increased surgery utilization among metastatic breast cancer patients

Bhattacharyya

Tsung

et al. 2021

The Breast

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“…Emerging studies suggest minority‐serving cancer centers with high‐volume breast cancer cases tend to have similar uptake of clinical trial guidelines compared to academic facilities 26,28,29 . For instance, Jackson et al showed no racial differences in receipt of ALND among women meeting ACOSOG Z0011 criteria receiving treatment in high volume centers in the National Cancer Database 30 . On the other hand, other studies have shown people who face difficulties in accessing oncologic care such as people of color, uninsured patients, individuals with lower levels of education or income are more likely to have ALND over SLNB despite current guidelines 28,31–33 .…”

Section: Discussionmentioning

confidence: 99%

“…26,28,29 For instance, Jackson et al showed no racial differences in receipt of ALND among women meeting ACOSOG Z0011 criteria receiving treatment in high volume centers in the National Cancer Database. 30 On the other hand, other studies have shown people who face difficulties in accessing oncologic care such as people of color, uninsured patients, individuals with lower levels of education or income are more likely to have ALND over SLNB despite current guidelines. 28,[31][32][33] Similarly, our findings of an association between decreasing nSES and increasing ALND use suggest place of residence may have implications for receipt of some low value breast surgical oncology procedures.…”

Section: Low Value Surgical Carementioning

confidence: 99%

Neighborhood socioeconomic status and low‐value breast cancer care

Chen

Bhattacharyya

et al. 2022

Journal of Surgical Oncology

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Background The objective of this study is to examine the association between neighborhood socioeconomic status (nSES) and receipt of low‐value breast cancer procedures. Methods Patients with breast cancer diagnosed between 2010 and 2016 were identified in the Surveillance, Epidemiology, and End Results (SEER) Program. Low value procedures included: (1) axillary lymph node dissection (ALND) for patients with limited nodal disease receiving breast conservation therapy (BCT); (2) contralateral prophylactic mastectomies (CPM); and (3) sentinel lymph node biopsies (SLNB) in patients ≥70 years old with clinically node negative early‐stage hormone‐positive breast cancer. The cohort was divided by nSES. Univariable and multivariable logistic regression analysis compared the groups. Results The study included 412 959 patients. Compared to patients in high nSES areas, residing in neighborhoods with low nSES (odd ratio [OR] 2.20, 95% confidence interval [CI] 2.0−2.42) and middle nSES (OR 1.42, 95% CI 1.20−1.56) was associated with a higher probability of undergoing low value ALND. Conversely, patients in low SES neighborhoods were less likely to receive low value SLNB (OR 0.89, 95% CI 0.85−0.94) or CPM than (low nSES OR 0.75, 95% CI 0.73−0.77); middle nSES OR 0.91 (0.89−0.92) those in high SES neighborhoods. Conclusion In the SEER Program, low nSES was associated with a lower probability of low value procedures except for ALND utilization.

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“…77 A recent evaluation of time to surgery among patients with stage I to III breast cancer in a national hospital-based registry showed 30% of non-Hispanic Black patients underwent surgery more than 60 days after diagnosis, compared with 18% of non-Hispanic White women. 78 Delay in time to surgery among Black women warrants additional investigation, because Black patients with breast cancer have a higher mortality rate compared with their White counterparts. 79 For surgeons in particular, racial disparities in time to surgery warrant additional knowledge and understanding.…”

Section: Factors Contributing To Surgical Delaymentioning

confidence: 99%

When the World Throws You a Curve Ball: Lessons Learned in Breast Cancer Management

Obeng‐Gyasi

Coles

Jones

et al. 2021

American Society of Clinical Oncology Educational Book

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In the care of patients with operable breast cancer, there has been a shift toward increasing use of neoadjuvant therapy. There are benefits to neoadjuvant therapy, such as monitoring for response, as well as an increased rate of breast conservation and reduction of potential morbidity associated with breast surgery, including axillary management. Among patients with highly proliferative tumors, such as HER2-positive or triple-negative breast cancer, those with residual disease are at higher risk of recurrence, which informs the recommended systemic therapy in the adjuvant setting. For instance, in patients with residual disease after neoadjuvant chemotherapy and HER2-targeted therapy, there is a role for adjuvant trastuzumab emtansine for those with residual disease at the time of surgery. The same holds true regarding the role of adjuvant capecitabine in patients with residual disease after neoadjuvant chemotherapy. With the added complexities of treating patients in the era of the COVID-19 outbreak, additional considerations are critical, including initiation of surgery within an appropriate time from completion of neoadjuvant therapy. National consensus guidelines on time to surgery must be developed to improve measurement and comparison across systems. In addition, there is emerging radiation treatment management research addressing a number of factors, including hypofractionation, role of proton beam therapy, safe omission of radiotherapy, and preoperative radiotherapy with or without drug combination. In this article, the multidisciplinary approach of treating patients with operable breast cancer is highlighted, with updates and future considerations described.

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Racial disparities in low‐value surgical care and time to surgery in high‐volume hospitals

Cited by 21 publications

References 38 publications

Low neighborhood socioeconomic status is associated with higher mortality and increased surgery utilization among metastatic breast cancer patients

Low neighborhood socioeconomic status is associated with higher mortality and increased surgery utilization among metastatic breast cancer patients

Neighborhood socioeconomic status and low‐value breast cancer care

When the World Throws You a Curve Ball: Lessons Learned in Breast Cancer Management

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