Hispanic Breast Cancer Patients Travel Further for Equitable Surgical Care at a Comprehensive Cancer Center.

Rachel L Yang,Irene Wapnir

doi:10.1089/heq.2017.0021

Abstract

Purpose: Disparities in surgical breast cancer care have been documented for racial and ethnic minorities. On average, these minorities are less likely to utilize National Cancer Institute (NCI)-designated cancer centers and travel shorter distances to receive care. With the growing population of Hispanic patients in California, we analyzed the travel distance and surgical care of Hispanic and non-Hispanic patients at our large referral cancer center.Methods: Patients included were those who initiated treatment for a new diagnosis of ductal carcinoma in situ or invasive breast cancer at our NCI-designated cancer center during the period 2010–2014. Ethnicity was dichotomized as Hispanic and non-Hispanic. Google Maps were used to determine the distance from patient zip code to our institution, classified as 0–10, 10–30, 30–60, and >60 miles.Results: A total of 1765 non-Hispanic and 173 Hispanic patients were identified. Clinical stage by tumor size and nodal status were comparable between the two groups. Hispanic patients were younger (p<0.001) and more had Medicaid insurance (p<0.001). Hispanic patients traveled further when compared with non-Hispanics (p<0.001). In non-Hispanics and Hispanics, rates of breast conservation were 57.4% and 52.3% (p=0.30), unilateral mastectomy 34.2% and 36.2% (p=0.44), bilateral mastectomy 8.4% and 11.5% (p=0.24), and immediate postmastectomy reconstruction 42.6% and 50.6% (p=0.34), respectively. Hispanic ethnicity was not associated with different odds of receiving breast conservation (odds ratio [OR] 1.01, confidence interval [CI] 0.73–1.40), unilateral mastectomy (OR 1.05, CI 0.75–1.44), bilateral mastectomy (OR 1.37, CI 0.81–2.31), or immediate postmastectomy breast reconstruction (OR 1.27, CI 0.86–1.88), when compared with non-Hispanic ethnicity, after controlling for patient age, insurance status, and distance traveled.Conclusions: Surgical care was similar for Hispanic and non-Hispanic patients treated at our NCI-designated cancer center. However, this Hispanic population traveled further than non-Hispanic patients. Our findings suggest that accessibility to transportation and institutional practices are instrumental in delivering equitable breast cancer surgical care for Hispanic patients.

Highlights

In the United States, racial and ethnic disparities in breast cancer surgical care have been demonstrated extensively at the state and nationwide levels.[1,2,3] Investigators have shown that disparities exist in the receipt of cancerdirected surgery, breast conservation, breast reconstruction, and bilateral mastectomy, even after controlling for the stage of disease.[4,5,6,7,8,9] studies have demonstrated lower utilization of breast conservation, contralateral prophylactic mastectomy, and postmastectomyDepartment of Surgery, Stanford University School of Medicine, Stanford, California.a Rachel L
We identified a total of 1677 non-Hispanic patients (90.5%) and 175 Hispanic patients (9.4%) who received treatment for newly diagnosed ductal carcinoma in situ (DCIS) or invasive breast cancer over a 5-year period
When evaluating immediate postmastectomy breast reconstruction, we found that 42.6% of non-Hispanics and 50.6% of Hispanics underwent reconstruction ( p = 0.34, Fig. 2b)

Summary

Introduction

In the United States, racial and ethnic disparities in breast cancer surgical care have been demonstrated extensively at the state and nationwide levels.[1,2,3] Investigators have shown that disparities exist in the receipt of cancerdirected surgery, breast conservation, breast reconstruction, and bilateral mastectomy, even after controlling for the stage of disease.[4,5,6,7,8,9] studies have demonstrated lower utilization of breast conservation, contralateral prophylactic mastectomy, and postmastectomya Rachel L. In the United States, racial and ethnic disparities in breast cancer surgical care have been demonstrated extensively at the state and nationwide levels.[1,2,3] Investigators have shown that disparities exist in the receipt of cancerdirected surgery, breast conservation, breast reconstruction, and bilateral mastectomy, even after controlling for the stage of disease.[4,5,6,7,8,9] studies have demonstrated lower utilization of breast conservation, contralateral prophylactic mastectomy, and postmastectomy. While patient-related factors such as income,[10] insurance,[10] primary language,[11] and cultural beliefs[12] contribute to differences in receipt of surgical care and surgical decision-making, recent studies have implicated hospitallevel factors as significant contributors to persistent disparities.[13,14]

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Results

Discussion

Conclusion