Abstract A86: Identifying system-level barriers to breast cancer treatment which lead to health disparities for vulnerable communities: A qualitative approach
Authors: Noel Lailea , Goodman Melody , Connors Shahnjayla K. , Butler Dwayne , McMullen Ron , Oliver Cheryl , McCullough Isaac , Gehlert Sarah 
Published: May 2015

Abstract
Purpose of Study: This study is a part of a larger community-based participatory research (CBPR) project to decrease African-American and white breast cancer mortality disparities in Saint Louis, Missouri. Specifically, we explore the course of breast cancer treatment for a group of primarily low-income African American women living in North St. Louis at the time of diagnosis to identify factors that may contribute to discontinuation of breast cancer treatment.
Methods: For this study, funded by Susan G Komen for the Cure, two sources of data (semi-structured interviews and medical record extraction) were explored to fully capture reasons for completion or discontinuation of prescribed treatment. We analyze data for 85 women for whom both sources of data were available and were treated at a large teaching hospital. Inclusionary criteria were at least 18 years of age and diagnosed with breast cancer while living in eight zip codes of North St. Louis, the latter chosen because they have been identified as part of a cluster of late stage diagnosis. Women were recruited via letters from the Missouri Cancer Registry and flyers prepared and distributed by community partner organizations. The approach had two components: (1) individual in-home interviews were conducted based on narrative theory to collect treatment history in the women's own voices; and (2) review of electronic medical records of the women to determine what supports were offered, and what treatment prescribed, to them. Patient narratives were coded using NVivo 10.0 and themes derived using grounded theory.
Results: Two themes were most prevalent among the narratives from the women interviewed that suggest reasons why African-American women in the study may not have complete treatment prescribed. First, women did not connect radiation therapy with survival in the same way that they did surgery and chemotherapy. Rather, they described it in terms that made it seem optional, like breast reconstruction. Second, while women seemed to have been supported in terms of obstacles to treatment near the time of surgery, they reported no such services after receiving chemotherapy. Chart review revealed that patient navigation tapers off after surgery, with only one navigator employed by medical oncology and none in radiation oncology.
Conclusions and Implications: Women describing radiation therapy as an optional treatment reflects a misunderstanding of the importance of radiation therapy in breast cancer survival. Relatedly, having navigators associated with each service (surgical, medical, and radiation oncology) who communicate regularly with one another may help to ensure that women complete prescribed treatment, thus decreasing the African American and white breast cancer mortality disparity in St. Louis. Further study is suggested to determine if these findings persist in other locations.
Citation Format: Lailea Noel, Melody Goodman, Shahnjayla K. Connors, Dwayne Butler, Ron McMullen, Cheryl Oliver, Isaac McCullough, Sarah Gehlert. Identifying system-level barriers to breast cancer treatment which lead to health disparities for vulnerable communities: A qualitative approach. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A86. doi:10.1158/1538-7755.DISP13-A86