Abstract PR07: Racial-ethnic disparities in patient-provider communication and overall perceptions of follow-up care quality among adult cancer survivors.
Authors: Palmer Nynikka R.A. , Arora Neeraj K. , Kent Erin , Forsythe Laura , Rowland Julia H. , Aziz Noreen , Weaver Kathryn E. 
Published: August 2014

Purpose: Poor patient-provider communication (PPC) may contribute to racial-ethnic disparities in healthcare, and is critical to quality cancer survivorship care. Racial-ethnic differences in PPC have been noted among cancer survivors; however, previous studies have focused primarily on comparing White and African American patients and survivors recently diagnosed or treated for cancer. This study examined racial-ethnic differences in PPC and its association with perceived follow-up care quality among a diverse sample of long-term cancer survivors.

Methods: Survivors of breast, prostate, colorectal, ovarian and endometrial cancers were recruited from Surveillance Epidemiology and End Results cancer registries in California to complete a mailed survey on cancer follow-up care. African American, Asian/Pacific Islander (Asian), Hispanic, and non-Hispanic White (White) cancer survivors were selected for this analysis if they had seen a doctor for cancer-related follow-up care in the past two years (n=1215). We conducted linear regression analyses to identify racial-ethnic differences in PPC (general follow-up care communication and explanation of medical tests). We used logistic regression models to examine the association between race-ethnicity and dichotomized perceived follow-up care quality outcomes: overall rating (very good/excellent vs. poor/fair/good) and receipt of desired help with symptoms/side effects (usually/always vs. never/sometimes). Finally, we added PPC to the adjusted logistic regression models to assess the effect of PPC on racial-ethnic differences in perceived follow-up care quality, adjusting for covariates (age, gender, education, insurance, comorbidities, cancer treatment modalities, cancer site, stage at diagnosis, number of provider visits for follow-up care, time since most recent follow-up care visit, duration of relationship with follow-up care provider, and whether it was the same provider seen for cancer treatment).

Results: Of the 1215 survivors, 24% were African American, 22% were Asian, 13% were Hispanic, and 39% were White. Compared to White survivors, all minority survivors reported poorer explanation of medical tests (F=4.69, p=0.003), and Asian and Hispanic survivors reported poorer follow-up care communication (F=11.42, p&lt;0.001). Asian survivors were also less likely to report receipt of desired help with symptoms/side effects (OR=0.46, 95%CI: 0.27-0.79), and both African American and Asian survivors were less likely to report high overall ratings of follow-up care quality (OR= 0.55, 95%CI: 0.38-0.79 and OR=0.43, 95%CI: 0.30-0.62, respectively) compared to White survivors. In fully adjusted models, including PPC, Asian survivors remained less likely to rate overall follow-up care quality as good/excellent (OR: 0.51, 95%CI: 0.28-0.93) compared to White survivors. No other significant racial-ethnic differences persisted.

Conclusions: Both Asian and Hispanic survivors reported poorer PPC. For some survivors, PPC may help to explain disparities in perceived follow-up care quality; however, Asian survivors reported poorer overall ratings of follow-up care, despite controlling for covariates and PPC. Addressing PPC is important as poor communication may also affect survivors' ability to actively participate in follow-up care.

This abstract is also presented as Poster A12.

Citation Format: Nynikka R.A. Palmer, Neeraj K. Arora, Erin Kent, Laura Forsythe, Julia H. Rowland, Noreen Aziz, Kathryn E. Weaver. Racial-ethnic disparities in patient-provider communication and overall perceptions of follow-up care quality among adult cancer survivors. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr PR07.