Abstract PD8-10: Identifying racial and ethnic disparities in psychosocial care among adults with metastatic breast cancer (mBC): A retrospective analysis across six New York health systems
Authors: Pinheiro Laura , An Anjile , Walker Desiree , Mercurio Anne Marie , Hershman Dawn , Rosenberg Shoshana 
Published: March 2023

Background: More than 150,000 men and women are currently living with mBC in the United States. A diagnosis of mBC and its associated treatment can have pronounced consequences on patients’ psychosocial well-being. However, to date, few studies have described patterns of psychosocial care among this population. Identifying disparities in psychosocial care utilization at the systems level may uncover gaps in mBC supportive care more broadly. Using a large retrospective cohort inclusive of patients treated at six health systems across New York City (NYC), we sought to determine if there were racial or ethnic differences in receipt of outpatient psychosocial care and psychosocial medications.

Methods: Adults diagnosed with mBC between 2010-2020 were identified using ICD-9 and ICD-10 diagnosis codes from the INSIGHT-Clinical Research Network database, which includes electronic health record, administrative, and clinical data from 12 million patients who received care across six NYC health systems. Receipt of outpatient psychosocial care was operationalized using Common Procedure Terminology codes for receipt of any outpatient psychotherapy or counseling visit with a licensed provider. Receipt of psychosocial medications (e.g., antidepressants, anxiolytics, sleep aids, benzodiazepines) were identified using RxCUI codes. Associations between race/ethnicity and outpatient psychosocial care and medications use was evaluated using logistic regression. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated for all estimates.

Results: We included 6,934 adults with mBC. Mean age was 61 (SD: 14) years and &lt; 1% were male. Overall, 42% were non-Hispanic white, 17% non-Hispanic Black, 12%, Hispanic/Latinx, 4.8% Asian/Native Hawaiian/Pacific Islander, and 24.4% “other or unknown.” Only 159 patients (2.3%) had ≥1 outpatient psychosocial care visits with a mean of 17 (SD: 42) visits per patient. Of the overall cohort, 4,308 patients (62%) were prescribed at least one psychosocial medication during the study period. Both psychosocial outpatient care and psychosocial medication use differed by race/ethnicity (see Table). Compared to Non-Hispanic Whites, Black (OR 1.81; 95% CI 1.12-2.90) and Hispanic/Latinx (OR 4.46; 95% CI 2.96-6.77) mBC patients were more likely to have a documented outpatient psychosocial visit. Black (OR 0.63; 95% CI 0.54-0.72) and Asian (OR 0.40; 95% CI 0.32-0.50) mBC patients were less likely to be prescribed psychosocial medications compared to Non-Hispanic White patients.

Conclusion: Among a large, diverse cohort of mBC patients treated across NYC, we observed low utilization of outpatient psychosocial care. This finding may be attributable in part to patterns of referral/use of psychosocial support in the private practice setting that cannot be captured in administrative data. Sub-optimal health insurance coverage for psychosocial support may also be responsible for low utilization of outpatient psychosocial care. In contrast, psychosocial medication use was far more prevalent than outpatient care among our mBC cohort with significant differences observed by race/ethnicity. Identified differences suggest that unmet needs may exist and warrant further investigation.

Table. Psychosocial Outpatient Care & Medication Use by Race/Ethnicity.

Citation Format: Laura Pinheiro, Anjile An, Desiree Walker, Anne Marie Mercurio, Dawn Hershman, Shoshana Rosenberg. Identifying racial and ethnic disparities in psychosocial care among adults with metastatic breast cancer (mBC): A retrospective analysis across six New York health systems [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD8-10.