Interventions to reduce racial/ethnic disparities across the breast cancer care continuum.

Authors

null

Milan George

Rice University, Houston, TX

Milan George , Matheus José Barbosa Moreira , Jeremy Yang , Gabriela Rangel Brandão , Bruno Murad Carvalho , Ana Carolina Marin Comini , Carlos Alberto Campello Jorge , Isabele Ayumi Miyawaki , Beatriz Mella Soares Pessôa , Pedro Reis , Caroliny Silva , Debora Xavier , Rachel S Hicklen , Nazer Lama , Lisa M. Lowenstein , Lorna H McNeill , Felipe Batalini , John Kent Lin

Organizations

Rice University, Houston, TX, Universidade federal do Rio Grande do Norte, Natal, Brazil, The University of Texas MD Anderson Cancer Center, Houston, TX, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil, Faculdade de Medicina de Barbacena FAME-FUNJOB, Lavras, Brazil, A.C. Camargo Cancer Center, São Paulo, Brazil, Universidade Federal do Mato Grosso, Cuiabá, Brazil, Universidade Federal do Parana, Curitiba, NA, Brazil, Universidade Federal do Amazonas, Manaus, Brazil, Universidade Federal do Rio de Janeiro, Rio De Janeiro, Brazil, Federal University of Para, Belem, Brazil, King Hussein Cancer Center, Amman, Jordan, Mayo Clinic, Phoenix, AZ

Research Funding

National Cancer Institute

Background: In the United States, racial/ethnic disparities in adoption of breast cancer evidence-based practices (EBPs) persist along the cancer care continuum. This scoping review applied an implementation science lens to describe the current evidence base for interventions to reduce disparities, synthesizing evidence on effective interventions while highlighting gaps in the literature. Methods: A formalized search strategy identified USA-based interventional studies aiming to improve adoption of an EBP along the breast cancer care continuum among racially/ethnically minoritized patients. Relevant articles from 1/2010 - 8/2022 (Medline, Embase, Cochrane, and Scopus) were included. For each article, two reviewers screened and extracted data, with a third resolving discrepancies. The PRISMA-ScR checklist and JBO Manual for Evidence Synthesis framework were followed. Results: Our search strategy yielded 45,215 articles. After applying inclusion/exclusion criteria, 59 articles were retained, targeting screening (85%, 50 of 59), treatment (12%, 7 of 59), and survivorship (5%, 3 of 59) (2 targeted multiple areas). No articles targeted end-of-life care. Of these, 49% (29 of 59) were randomized controlled trials (RCTs). Among 24 screening RCTs, the most common interventions—and fraction with statistically significant improved screening uptake—were patient navigation (100%, 11 of 11) and patient education (80%, 4 of 5). Among 4 treatment RCTs, 3 targeted adjuvant chemotherapy uptake. Of these, 1 had significant improvements and used patient navigation. The 2 studies without significant improvements used a patient tracking tool/alert system or patient education. Among 2 survivorship RCTs, one used email interventions, resulting in significantly improved physical activity and dietary health. A second used a nurse-facilitated internet support group, resulting in significantly improved physical/psychological symptoms. Early to mid-stage implementation outcomes (acceptability, adoption, appropriateness, feasibility, or fidelity) were commonly measured (81%, 48 of 59). No study measured later stage implementation outcomes (sustainability or costs). Conclusions: In multiple studies, patient navigation and education improved breast cancer screening among racially/ethnically minoritized populations. In one study, patient navigation improved completion of adjuvant treatment. Despite these studies, patient navigation is not reimbursed for cancer screening, and adoption has not been widespread. Future studies should focus on evaluating and improving later stage implementation outcomes (sustainability and costs). Based on these results, insurance reimbursement mechanisms for screening-related navigation may be warranted. Future breast cancer care delivery disparities research should also be expanded to include treatment, survivorship, and end-of-life care.

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Abstract Details

Meeting

2024 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

Poster Session B

Track

Health Care Access, Equity, and Disparities,Technology and Innovation in Quality of Care,Survivorship

Sub Track

Interventions and Policies to Optimize Health Equity

Citation

JCO Oncol Pract 20, 2024 (suppl 10; abstr 160)

DOI

10.1200/OP.2024.20.10_suppl.160

Abstract #

160

Poster Bd #

E8

Abstract Disclosures

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