title: Investigating racial disparities in use of NK1 receptor antagonists to prevent chemotherapy-induced nausea and vomiting among women with breast cancer.
abstract: Chemotherapy-induced nausea and vomiting (CINV) is a major concern for cancer patients and, if uncontrolled, can seriously compromise quality of life (QOL) and other treatment outcomes. Because of the expense of antiemetic medications used to prevent CINV (particularly oral medications filled through Medicare Part D), disparities in their use may exist. We used 2006-2012 SEER-Medicare data to evaluate the use of neurokinin-1 receptor antagonists (NK1s), a potent class of antiemetics, among black and white women initiating highly emetogenic chemotherapy for the treatment of early-stage breast cancer. We used modified Poisson regression to assess the relationship between race and (1) any NK1 use, (2) oral NK1 (aprepitant) use, and (3) intravenous NK1 (fosaprepitant) use. We report adjusted risk ratios (aRR) and 95 % confidence intervals (CI). The study included 1130 women. We observed racial disparities in use of any NK1 (aRR: 0.68, 95 % CI 0.51-0.91) and in use of oral aprepitant specifically (aRR: 0.54, 95 % CI 0.35-0.83). We did not observe disparities in intravenous fosaprepitant use. After controlling for variables related to socioeconomic status, disparities in NK1 and aprepitant use were reduced but not eliminated. We found racial disparities in women's use of oral NK1s for the prevention of CINV. These disparities may be partly explained by racial differences in socioeconomic status, which may translate into differential ability to afford the medication.
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB#7411, Chapel Hill, NC, 27599, USA. dkcheck@unc.edu.
authors.forename: Devon K
authors.initials: DK
authors.lastname: Check
authors.affiliation: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.|Division of Hematology/Oncology, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Reeder-Hayes
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB#7411, Chapel Hill, NC, 27599, USA.|Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.|Division of Hematology/Oncology, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Ethan M
authors.initials: EM
authors.lastname: Basch
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.|Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA.
authors.forename: Leah L
authors.initials: LL
authors.lastname: Zullig
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB#7411, Chapel Hill, NC, 27599, USA.|Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB#7411, Chapel Hill, NC, 27599, USA.|Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.|Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Stacie B
authors.initials: SB
authors.lastname: Dusetzina
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D044383:Black People / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000208:ethnology*; D005260:Female; D006801:Humans; D009025:Morpholines / Q000008:administration & dosage / Q000627:therapeutic use; D009325:Nausea / Q000139:chemically induced / Q000208:ethnology / Q000517:prevention & control*; D064729:Neurokinin-1 Receptor Antagonists / Q000008:administration & dosage* / Q000627:therapeutic use; D011788:Quality of Life; D012044:Regression Analysis; D018426:SEER Program; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014839:Vomiting / Q000139:chemically induced / Q000208:ethnology / Q000517:prevention & control*; D044465:White People / Q000706:statistics & numerical data
chemical_list: D000970:Antineoplastic Agents; D009025:Morpholines; D064729:Neurokinin-1 Receptor Antagonists; C579707:fosaprepitant
keywords: Health services research; Palliative care; Racial disparities; Supportive care