Abstract PO3-11-02: Characterizing Breast Cancer Care Fragmentation Among Young Black Women Diagnosed with Breast Cancer

Abstract

Abstract Introduction Fragmented cancer care is defined as receiving care across multiple institutions. The National Academy of Medicine has identified cancer care fragmentation as a priority area for cost reduction. However, little is known about the role of fragmented care on receipt of guideline-recommended care patient-reported outcomes, particularly among populations affected by health inequities like Black women. The objective of this study was to characterize breast cancer care fragmentation among a population-based cohort of young Black women with breast cancer. Methods Study participants were a population-based sample of self-identified Black women diagnosed with invasive breast cancer at or below age 50, recruited since 2017 through the Florida and Tennessee state cancer registries. As part of the study, participants completed baseline questionnaires about their cancer care delivery experiences. Participants were eligible if they self-reported the locations where they received their cancer treatment (i.e., diagnosis, surgery, chemotherapy, and radiation). Indicator variables for care fragmentation were created to identify participants who received their diagnosis, surgery, chemotherapy, and radiation within the same health system and those who received their cancer care across multiple health systems. Chi-squared tests were used to assess the relationship between care fragmentation, receipt of guideline-recommended genetic testing, and self-rated health. Self-rated health was dichotomized into Excellent/Very Good/Good and Fair/Poor. Results A total of 183 Black women diagnosed breast cancer ≤ age 50 were included in the analysis. Among the included participants, 11% (n=20) only had surgery, 15% (n=27) had surgery and radiation, 17% (n=31) had surgery and chemotherapy, and 57% (n=105) had surgery, chemotherapy, and radiation. Among the 105 women who had surgery, chemotherapy, and radiation, 17% (n=17) received all cancer treatment within the same health system of diagnosis, 21% (n=21) received all cancer treatment within the same health system but were diagnosed within a different health system, and the remaining 62% of participants received their cancer treatment across different health systems, representing care fragmentation. In chi-squared analyses, fragmented care was not associated with lower receipt of genetic testing(p=0.33) or self-rated health (p=0.28). Conclusion In this population-based study, most participants had fragmented breast cancer care, however fragmentation was not associated with lower self-rated health or receipt of guideline-recommended germline genetic testing. Current approaches for assessing care fragmentation are often too coarse to capture the complexity of breast cancer care delivery and service availability. Patient-centered conceptual models of what drives cancer care fragmentation and the specific aspects of fragmentation that have the potential to drive adverse outcomes are critical. Citation Format: Mya Roberson, Jordyn Brown, Brianna Taffe, Anne Weidner, Lindsay Venton, Sonya Reid, Tuya Pal. Characterizing Breast Cancer Care Fragmentation Among Young Black Women Diagnosed with Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-11-02.