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Project Title Protocol for Narrowing the Gap in Adjuvant Therapy

Researcher: Vanessa Sheppard, PhD, Georgetown University, Washington, DC at Georgetown University

Study Abstract: African American (“Black”) women are more likely to die of breast cancer than Caucasian women, despite lower incidence and steady improvements in screening use. This disparity has been widening over the last two decades, with Black women even experiencing poorer within stage survival than White women. Once diagnosed with breast cancer, the single modality with the greatest potential to reduce disparities and improve survival is adjuvant chemotherapy and hormonal therapy. At present, it is estimated that adjuvant therapy would be considered standard of care for up to 80% of women with invasive, non-metastatic disease, but many Black women eligible for adjuvant therapy are not receiving it or are receiving sub-optimal regimens. However, at present there are few data about Black women’s breast cancer experiences or factors that influence treatment adherence. The overarching goal of this career development award is to obtain the skills and experience needed to become an independent investigator focused on filling this knowledge gap. To meet this goal, we will conduct a prospective cohort study of adjuvant treatment determinants among 400 newly diagnosed Black women and 400 White women with invasive breast cancer for whom systemic therapy would be indicated by current professional guidelines. Guided by the Adherence Model of Bastani and colleagues, the aims are to evaluate the factors associated with outcomes in the process of adjuvant care: 1) having a surgeon referral to a medical oncologist; 2) keeping an oncology appointment once referred; 3) initiation of chemotherapy and hormonal therapies; and 4) completion of therapy. Secondary analyses will be conducted to explore factors associated with other therapy adherence outcomes such as the percent of cycles completed and relative dose and intensity. Also, since determinants of use and time course of administration of hormonal and non-hormonal adjuvant therapy differ, analyses will also examine and compare outcomes separately for each modality; analyses of hormone therapy use will be restricted to women with ER positive tumors. Finally, we will explore interactions among patients’ rating of patient-provider communication and cultural and subjective norms. For example, we will assess whether patients who perceive good communication with their cancer provider will be likely to adhere regardless of their cultural and subjective norms. To our knowledge this will be the first comprehensive study of adherence to systemic treatment in a cohort of Black women. Moreover, the results of this project, in conjunction with the training proposed under this award, will leave the candidate well-positioned to become an independent investigator poised to develop interventions targeting the determinants identified in this study. This work will contribute to the 2010 goals of reducing breast cancer mortality by 24% and reducing cancer disparities.

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