Abstract PO1-06-08: Treatment utilization by race and insurance type among triple negative breast cancer patients
Authors: Sadetsky Natalia , Bakhuluma-Ncube Langa , Fox Emily , Okpala Laura , O'Hara Matt , Parr Jennifer 
Published: May 2024

Abstract
Introduction
Triple negative breast cancer (TNBC) is associated with poorer prognosis and its lower long-term survival rates disproportionately affect people of racial and ethnic minority groups. Ensuring timely and effective treatment for all patients regardless of race or insurance status is critical. The objective of this study is to describe treatment patterns by line of therapy, race, and insurance type to identify barriers to accessing healthcare using a physician survey and patient-chart review. Methods
This study employed a 60-minute physician survey and linked retrospective chart review of patients’ charts conducted June-July 2022. Participating oncologists across the US (34% Central; 19% Southeast; 18% Northeast; 21% West; 9% East Coast) were required to be board-certified, in practice 3 to 30 years post-residency, and managing at least 7 patients with TNBC in the past 3 years. Oncologists extracted patient-level data from 2-4 patient records for the chart review. A convenience sample of charts oversampled patients on Medicaid, Black and Latina patients, and patients with later stage TNBC to allow for robust disparities analysis. Data collection included provider characteristics, treatment by line of therapy (LOT), rationale for treatment decisions, barriers experienced in accessing care, and support services used. Results
Participating oncologists (n=101, 73% male; 62% community vs 39% academic setting) provided data on 283 patients with TNBC [99% female; median age = 46.0 years; race = Black (42%), Latina (31%), White (25%) or Other (2%); geographic location = Urban (53%), Suburban (39%), Rural (8%)]. White patients were more likely to be covered by private insurance (73%) compared to Black (25%) and Latina patients (32%). Black and Latina patients were more likely to be covered by Medicaid (White, 16%; Black, 71%; Latina, 52%). Over half of patients needed prior authorization for first-line (1L) treatment; mean wait time for prior authorization was 1.5 weeks. Black patients (58%) were more likely to require prior authorization in 1L as compared to White patients (49%); There were no significant differences in prior authorization requirements based on type of insurance (Medicaid, Medicare, Private/Commercial Insurance). Of the 283 patients treated with 1L therapy, 111 patients received second-line (2L) treatment [Black (n=52, 44%), Latina (n=29, 32%), White (n=26, 37%), Other (n=4, 71%)], and 45 patients received third-line (3L) treatment [Black (n=25, 21%), Latina (n=9, 10%), White (n=9, 13%), Other (n=2, 33%)]. Chemotherapy was the most common 1L (75%) and 2L (51%) treatment. Targeted therapy (TT), defined as immunotherapy, hormone therapy or antibody–drug conjugates, was most common in 3L (64%). A smaller proportion of Black patients who progressed to 3L received TT (n=13, 52%) compared to White (n=8, 89%) and Latina (n=7, 78%) patients. A larger proportion of patients with private/commercial insurance (n=18, 95%) received TT in 3L as compared to patients with Medicaid (n=10, 42%) or Medicare (0%). Conclusions
Findings indicated disparities both in pre-treatment barriers (specifically prior authorization) and the utilization of targeted therapy in later lines of therapy among Black patients. Although treatment patterns did not seem to differ by race in early lines of therapy, numerical differences in treatment patterns by race and insurance type emerged in later lines of therapy. Given the poor prognosis for patients diagnosed with TNBC and its disproportionate impact on communities of color, future policy efforts should be focused on achieving equity in treatment initiation and use of TT in TNBC patients.
Citation Format: Natalia Sadetsky, Langa Bakhuluma-Ncube, Emily Fox, Laura Okpala, Matt O'Hara, Jennifer Parr. Treatment utilization by race and insurance type among triple negative breast cancer patients [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-06-08.