Determinants of Breast Cancer Treatment in the Underserved
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: Breast cancer is a devastating diagnosis under any circumstances, but it can be especially distressing for low-income, uninsured women without sufficient resources to pay for their care. Twenty-four percent of the California population is medically uninsured, with rates estimated as high as 33% in Los Angeles County. Low-income and less-educated women are more likely to be diagnosed with advanced breast cancer, less likely to receive standard treatment, and less likely to survive 5 years, than breast cancer patients in the general population. Devising interventions to reduce suffering and death in this vulnerable population will require identifying the most changeable predictors of receiving appropriate treatment. For example, psychosocial factors, such as the patient-physician interaction or empowering patients in interacting with the health care system, are more likely to be alterable than hospital characteristics. However, little research has been done to examine aspects of patient-physician interactions and treatment decision-making that impede or facilitate obtaining optimal treatment, relative to other determinants of care, especially in low-income and underserved cancer patients.
 
 
 
 
 
 
 
 In a defined population of low-income, underserved breast cancer patients we will examine:
 
 
 
 
 
 
 
 1. What patient- (e.g., transportation, competing life needs) and health care system-level factors (e.g., volume of breast cancer patients treated), determine receipt of appropriate breast cancer treatment?
 
 
 
 
 
 
 
 2. What psychosocial and informational support do low-income, underserved breast cancer patients receive from cancer care providers and from informal and formal support networks, at the time of breast cancer diagnosis and treatment?
 
 
 
 
 
 
 
 3. What interpersonal processes of care, especially the patient-physician interaction, mitigate the impact of patient- and system-level barriers on receipt of appropriate breast cancer care?
 
 
 
 
 
 
 
 We will survey 230 low-income (200% federal poverty level or lower), uninsured, newly diagnosed breast cancer patients in Los Angeles County, as identified by the California Breast Cancer Treatment Fund. Participants will be interviewed 6 months after breast cancer surgery with regard to difficulties encountered with obtaining medical attention and treatment for their breast cancer, individual psychosocial factors (e.g., their social support, confidence in communicating with physicians), and their interactions with their cancer treatment providers and staff. Participants will then be interviewed again 18 months after surgery about any subsequent patient-provider interactions, reasons for not beginning or stopping any recommended treatment, and their health-related quality of life. To assess health care system-level factors, all cancer providers and practice characteristics will be assessed via mailed surveys. To assess quality of breast cancer treatment received, all participants’ cancer-related medical records will be obtained and abstracted. An advisory committee of breast cancer advocates will provide input into questionnaire development and into translation of the study findings into programmatic changes.
 
 
 
 
 
 
 
 The proposed study will be amongst the first to comprehensively identify the most influential determinants, at the patient, patient-physician interaction, and health care system levels, of receipt of appropriate breast cancer treatment in low-income, underserved women. In so doing, the study will provide a strong empirical foundation for developing the most effective interventions to facilitate appropriate treatment and reduce suffering and death in this vulnerable population of breast cancer patients.