title: Improving breast cancer services for African-American women living in St. Louis.
abstract: A mixed methods, community-based research study was conducted to understand how provider-level factors contribute to the African-American and white disparity in breast cancer mortality in a lower socioeconomic status area of North St. Louis. This study used mixed methods including: (1) secondary analysis of Missouri Cancer Registry data on all 885 African-American women diagnosed with breast cancer from 2000 to 2008 while living in the geographic area of focus; (2) qualitative interviews with a subset of these women; (3) analysis of data from electronic medical records of the women interviewed; and (4) focus group interviews with community residents, patient navigators, and other health care professionals. 565 women diagnosed with breast cancer from 2000 to 2008 in the geographic area were alive at the time of secondary data analysis; we interviewed (n = 96; 17 %) of these women. Provider-level obstacles to completion of prescribed treatment included fragmented navigation (separate navigators at Federally Qualified Health Centers, surgical oncology, and medical oncology, and no navigation services in surgical oncology). Perhaps related to the latter, women described radiation as optional, often in the same words as they described breast reconstruction. Discontinuous and fragmented patient navigation leads to failure to associate radiation therapy with vital treatment recommendations. Better integrated navigation that continues throughout treatment will increase treatment completion with the potential to improve outcomes in African Americans and decrease the disparity in mortality.
authors.affiliation: George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.
authors.forename: Lailea
authors.initials: L
authors.lastname: Noel
authors.affiliation: Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave., St. Louis, MO, 63110, USA.
authors.forename: Shahnjayla K
authors.initials: SK
authors.lastname: Connors
authors.affiliation: Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave., St. Louis, MO, 63110, USA.
authors.forename: Melody S
authors.initials: MS
authors.lastname: Goodman
authors.affiliation: George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA. sgehlert@wustl.edu.|Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave., St. Louis, MO, 63110, USA. sgehlert@wustl.edu.
authors.forename: Sarah
authors.identifier: http://orcid.org/0000-0001-6969-9882
authors.initials: S
authors.lastname: Gehlert
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D008923:Missouri; D012959:Socioeconomic Factors; D044465:White People
keywords: African-American; Breast cancer; Cancer; Disparities; Radiation therapy; Treatment