Racial differences in receipt of adjuvant hormonal therapy among Medicaid enrollees in South Carolina diagnosed with breast cancer.
Several factors contribute to the pervasive Black-White disparity in breast cancer mortality in the U.S., such as tumor biology, access to care, and treatments received including adjuvant hormonal therapy (AHT), which significantly improves survival for hormone receptor-positive breast cancers (HR+). We analyzed South Carolina Central Cancer Registry-Medicaid linked data to determine if, in an equal access health care system, racial differences in the receipt of AHT exist. We evaluated 494 study-eligible, Black (n = 255) and White women (n = 269) who were under 65 years old and diagnosed with stages I-III, HR+ breast cancers between 2004 and 2007. Bivariate and multivariate analyses were conducted to assess receipt of ≥1 AHT prescriptions at any point in time following (ever-use) or within 12 months of (early-use) breast cancer diagnosis. Seventy-two percent of the participants were ever-users (70 % Black, 74 % White) and 68 % were early-users (65 % Black, 71 % White) of AHT. Neither ever-use (adjusted OR (AOR) = 0.75, 95 % CI 0.48-1.17) nor early-use (AOR = 0.70, 95 % CI 0.46-1.06) of AHT differed by race. However, receipt of other breast cancer-specific treatments was independently associated with ever-use and early-use of AHT [ever-use: receipt of surgery (AOR = 2.15, 95 % CI 1.35-3.44); chemotherapy (AOR = 1.97, 95 % CI 1.22-3.20); radiation (AOR = 2.33, 95 % CI 1.50-3.63); early-use: receipt of surgery (AOR = 2.03, 95 % CI 1.30-3.17); chemotherapy (AOR = 1.90, 95 % CI 1.20-3.03); radiation (AOR = 1.73, 95 % CI 1.14-2.63)]. No racial variations in use of AHT among women with HR+ breast cancers insured by Medicaid in South Carolina were identified, but overall rates of AHT use by these women is low. Strategies to improve overall use of AHT should include targeting breast cancer patients who do not receive adjuvant chemotherapy and/or radiation.
College of Nursing, University of South Carolina, 1601 Greene Street, Room 620, Columbia, SC, 29208, USA. feldert@mailbox.sc.edu.|Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Suite 200, Columbia, SC, 29208, USA. feldert@mailbox.sc.edu.
Tisha M
0000-0001-5693-7749
TM
Felder
Public Health Policy and Administration, Zilber School of Public Health, University of Wisconsin-Milwaukee, 1240 N. 10th Street, Milwaukee, WI, 53201, USA.
D Phuong
DP
Do
Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, 715 Sumter Street, Columbia, SC, 29208, USA.
Z Kevin
ZK
Lu
Management, Policy & Community Health, University of Texas School of Public Health, University of Texas Health Science Center, 1200 Herman Pressler Drive, Houston, TX, 77030, USA.
Lincy S
LS
Lal
College of Nursing, University of South Carolina, 1601 Greene Street, Room 617, Columbia, SC, 29208, USA.
Sue P
SP
Heiney
Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, 715 Sumter Street, Columbia, SC, 29208, USA.|SmartState Center for Medication Safety and Efficacy, University of South Carolina, 715 Sumter Street, Columbia, SC, 29208, USA.|Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA.|Arnold School of Public Health, University of South Carolina, 921 Assembly St, Columbia, SC, 29201, USA.
Charles L
CL
Bennett
D000328:Adult; D001741:Black or African American; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000208:ethnology; D017024:Chemotherapy, Adjuvant; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008484:Medicaid; D008875:Middle Aged; D013022:South Carolina; D016019:Survival Analysis; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014481:United States; D044465:White People; D055815:Young Adult
D018931:Antineoplastic Agents, Hormonal
Breast neoplasms; Medicaid, healthcare disparities, antineoplastic agents, hormonal; Practice guidelines