Abstract A006: Can expert second opinions reduce treatment disparities for African American breast cancer patients? An exploratory study
Authors: Campbell Brittany , Harris Marion , Rugo Hope , Joseph Galen , Pasick Rena 
Published: August 2020

Purpose: The excess breast cancer mortality among African Americans is well documented, and insufficient treatment quality in low-resource settings is a key cause. The second opinion could connect patients with the best available medical knowledge. We explored the extent to which treatment plans can be improved through consultations at NCI-designated Comprehensive Cancer Centers (CCC) that deliver the latest treatments, and to describe the experience of patients and consulting clinicians.

Methods: Eligible patients, those who self-identify as African American and have concerns about breast cancer, were recruited from communities and clinics. The research grant covered the cost of consultations. Ethnographic methods (audio-recorded observations and in-depth interviews) were used to ascertain consultation impacts. Data sources were transcripts from consultations; post-consult patient interviews, once following the consultation and again after treatment decisions were made; and one clinician interview per consultation. Standard grounded theory analytic methods were used.

Results: A total of 17 consultations were conducted with 14 female patients ages 32-71. Treating health care institutions were public hospitals, an integrated health care delivery system, an academic medical center, private not-for-profit community hospitals, and a private cancer center. Patients sought consults for concerns such as the possibility that a breast change was cancer, diagnosis of lobular carcinoma in situ (LCIS), treatment plans for invasive breast cancers at every stage, management of metastases, and prevention of recurrence. Some changes were recommended in every case, from simple routine procedures to major transformations. For example: An LCIS patient was advised to start an aromatase inhibitor, have yearly mammograms and MRIs, and to change her diet.A patient with advanced disease was advised to add CDK 4/6 inhibitor to her treatment.Whether and how to administer complex intrathecal chemotherapy (injection into the space between the thin layers of tissue that cover the brain and spinal cord) was discussed for a young patient with brain metastases.A clinical trial and genetic testing were recommended to a Stage IV breast cancer patient.

Overall consulting doctors' proposals were adopted. Patients learned about their cancer, the benefits and limitations of their current treatment, and about clinical trials. They appreciated confirmation that they were receiving quality care or recommended changes. CCC clinicians were eager to help patients with the greatest needs.

Conclusions: Second opinion consultations can open communication channels between leading cancer experts and oncologists in low-resource settings, increasing prospects for equal treatment.

Citation Format: Brittany Campbell, Marion Harris, Hope Rugo, Galen Joseph, Rena Pasick. Can expert second opinions reduce treatment disparities for African American breast cancer patients? An exploratory study [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A006.