title: Disparities in barriers to follow-up care between African American and White breast cancer survivors.
abstract: OBJECTIVE
  Despite recommendations for breast cancer survivorship care, African American women are less likely to receive appropriate follow-up care, which is concerning due to their higher mortality rates. This study describes differences in barriers to follow-up care between African American and White breast cancer survivors.
  
  
  METHODS
  We conducted a mailed survey of women treated for non-metastatic breast cancer in 2009-2011, 6-24 months post-treatment (N = 203). Survivors were asked about 14 potential barriers to follow-up care. We used logistic regression to explore associations between barriers and race, adjusting for covariates.
  
  
  RESULTS
  Our participants included 31 African American and 160 White survivors. At least one barrier to follow-up care was reported by 62 %. Compared to White survivors, African Americans were more likely to identify barriers related to out-of-pocket costs (28 vs. 51.6 %, p = 0.01), other health care costs (21.3 vs. 45.2 %, p = 0.01), anxiety/worry (29.4 vs. 51.6 %, p = 0.02), and transportation (4.4 vs. 16.1 %, p = 0.03). After adjustment for covariates, African Americans were three times as likely to report at least one barrier to care (odds ratio (OR) = 3.3, 95 % confidence interval (CI) = 1.1-10.1).
  
  
  CONCLUSIONS
  Barriers to care are common among breast cancer survivors, especially African American women. Financial barriers to care may prevent minority and underserved survivors from accessing follow-up care. Enhancing insurance coverage or addressing out-of-pocket costs may help address financial barriers to follow-up care among breast cancer survivors. Psychosocial care aimed at reducing fear of recurrence may also be important to improve access among African American breast cancer survivors.
authors.affiliation: Division of General Internal Medicine at San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA. palmern@medsfgh.ucsf.edu.
authors.forename: Nynikka R A
authors.initials: NR
authors.lastname: Palmer
authors.affiliation: Social Science and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Weaver
authors.affiliation: General Surgery, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA.
authors.forename: Sally P
authors.initials: SP
authors.lastname: Hauser
authors.affiliation: General Surgery, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA.
authors.forename: Julia A
authors.initials: JA
authors.lastname: Lawrence
authors.affiliation: Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Talton
authors.affiliation: Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: L Douglas
authors.initials: LD
authors.lastname: Case
authors.affiliation: Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Geiger
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D001943:Breast Neoplasms / Q000191:economics / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005102:Health Expenditures; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology; D044465:White People / Q000706:statistics & numerical data*
keywords: Barriers; Breast cancer; Cancer survivor; Follow-up care; Health disparities
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