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Disparities in Appropriateness of Care among Metastatic Breast Cancer Patients

Investigator: Ami Vyas, University of Rhode Island

Scientific Theme: Cancer

Abstract: Cancer health disparities is considered a priority area of health services research.  Survival rates for women diagnosed with breast cancer (BC) have been improving over the past few decades, though these improvements are not observed equally in all the age groups, racial/ethnic groups, across the US regions, among all the socioeconomic groups.  African American women, women residing in rural regions, women belonging to lower socioeconomic status with BC experience worse outcomes than their respective counterparts.  Also, data regarding how these and other factors predict treatment access and utilization are lacking.  Furthermore, these disparities exists in the trastuzumab utilization with worse overall survival among disparate populations with HER2+ metastatic disease.  Even though elderly women bear higher burden of BC, they remain underrepresented in many clinical trials.  Based on the literature, we hypothesize that disparities in regard to appropriateness of care, identified as per the National Comprehensive Cancer Network (NCCN) treatment guidelines, exist among HER2+ metastatic elderly BC patients which may be contributing to decreased overall survival in disparate population.  The proposed research will evaluate this hypothesis in the following aim.  Aim 1: We will identify the proportion of elderly patients with HER2+ metastatic BC who received appropriate care as per standard guidelines.  We will also evaluate disparities in appropriateness of care among these patients using a multivariate framework.  In addition, if we identify significant disparities in care then we will utilize an advanced statistical technique, Fairlie decomposition method, to quantify these disparities.    A large linked database of the nationally representative cancer population in the United States, Surveillance Epidemiology and End Results-Medicare (SEER-Medicare), will be utilized.  With the availability of HER2 status from 2010 onwards in the SEER-Medicare database and with the inclusion of pertuzumab in the treatment regimen for metastatic disease from 2012, we will be able to evaluate appropriateness of care as per the updated NCCN treatment guidelines for the women with metastatic BC with identified HER2 status.  By identifying the disparities in appropriate care among women with metastatic BC, this work will suggest the improvement in the efforts of clinicians, patients and their advocates further closing the gap in cancer outcomes that exists among disparate groups.

Human Health Relevance: There is a growing need to understand if women with metastatic breast cancer are treated initially per practice guidelines and if any disparities exist, to identify the patient subgroups who lack standard cancer care.  Identifying the patient sub-groups who do not receive standard cancer care will help to guide the providers in addressing and closing the gap thereby improving cancer outcomes in the entire population.

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