Disparities in the receipt of National Comprehensive Cancer Network (NCCN) guideline adherent care in triple-negative breast cancer (TNBC) by race/ethnicity, socioeconomic status, and insurance type.

Abstract

1080 Background: Breast cancer is the most commonly diagnosed cancer in women in the United States and the second leading cause of cancer mortality in women.TNBC is more likely to present at an earlier age with more advanced and aggressive disease. The overarching goal of treatment recommendations listed in the National Comprehensive Cancer Network (NCCN) guidelines are to improve patient outcomes. Here we examine factors which may contribute to NCCN guideline adherence. Methods: This was a retrospective cohort study of women with triple negative breast cancer using data from the California Cancer Registry (CCR) between 2004-2016 (with follow-up through 11/2018). Indicators for concordance with NCCN guidelines for TNBC was used as the dependent variable in the analysis. A multivariable logistic regression was used to determine the effects of independent variables on adherence to NCCN guidelines. Odds ratios and 95% Confidence Intervals (CI) were calculated. Non-Hispanic Whites, having medical insurance and highest socioeconomic status (SES) were set as references values in the regression models. Disease specific survival was calculated using the Cox regression analysis. Results: A total of 16,858 women were included in this study, 32.5% (n = 5,472) received NCCN adherent care (p < 0.0001). Non-Hispanic Blacks (NHB) and Hispanic patients were less likely to receive guideline adherent care (respectively, OR 0.87, 95%CI 0.79-0.95 and OR 0.87, 95%CI 0.79-0.95). Patients of lowest and lower-middle socioeconomic status (SES) were less likely to receive NCCN guideline adherent care (respectively, OR 0.77, 95%CI 0.68-0.87 and OR 0.88, 95%CI 0.79-0.98). Overall, non-adherent care was associated with an increased disease-specific mortality (HR 1.21, 95%CI 1.11-1.31, p < 0.0001). Hazard ratios were calculated after adjusting for adherent care and NHB patients had an increased disease-specific mortality (HR 1.28, 95%CI 1.16-1.42, p < 0.0001) in addition to patients with Medicare or Medicaid payer status (respectively, HR 1.20, 95%CI 1.08-1.34, p < 0.001 and HR 1.29, 95%CI 1.15-1.43, p < 0.0001). Conclusions: A significant portion of TNBC patients in California continue to receive non-guideline adherent care. Non-Hispanic black patients and lower SES quintile groups were less likely to receive guideline adherent care. Patients with non-adherent care had worse disease specific survival compared to recipients of NCCN-adherent care.