Breast Cancer Therapy Disparities Decline
Racial and ethnic disparities in the use of targeted therapy among patients with ERBB2-positive breast cancer decreased among older Medicare beneficiaries between 2010 and 2019. Black and Hispanic women had significantly lower treatment rates early on, but gaps narrowed by the end of the study period.
METHODOLOGY:
ERBB2-targeted therapies are the standard of care in patients with ERBB2-positive breast cancer, yet studies have reported unequal access among racial and ethnic groups, particularly among older Black and Hispanic women.
Researchers included Surveillance, Epidemiology, and End Results-Medicare–linked data of 12,765 beneficiaries (median age, 74 years; 99.2% women) diagnosed with ERBB2-positive breast cancer between 2010 and 2019, with 85.0% White, 8.1% Black, and 6.9% Hispanic participants.
The primary outcome was receipt of ERBB2-targeted therapies, including trastuzumab- and pertuzumab-based products and their combinations, and ado-trastuzumab emtansine, within 12 months after diagnosis.
The analysis was adjusted for health status and geographic region.
TAKEAWAY:
A total of 54.2% of patients received ERBB2-targeted therapies within 12 months of diagnosis. The overall fraction of patients receiving ERBB2-targeted therapies increased from 41.3% in 2010-2011 to 64.3% in 2018-2019.
Compared with White patients in 2010-2011, Black patients (adjusted risk ratio [ARR], 0.81; 95% confidence limit [CL], 0.68-0.97) and Hispanic patients (ARR, 0.75; 95% CL, 0.62-0.92) had a lower likelihood of receiving ERBB2-targeted therapies. Treatment disparities reduced in 2018-2019, with no significant differences observed between Black (ARR, 0.97; 95% CL, 0.87-1.08) and Hispanic patients (ARR, 1.05; 95% CL, 0.95-1.16) compared with White patients.
Compared with beneficiaries aged 69 years or younger, the likelihood of treatment access among beneficiaries aged 80 years or older was persistently low from 2010-2011 (ARR, 0.42; 95% CL, 0.36-0.49) to 2018-2019 (ARR, 0.52, 95% CL, 0.47-0.58).
Geographic variations in treatment access improved over time with regional disparities between Southern and Northeastern regions reducing from 2010-2011 (ARR, 0.47; 95% CL, 0.41-0.54) to 2016-2017 (ARR, 0.96; 95% CL, 0.90-1.03).
IN PRACTICE:
'These findings suggest that identifying barriers associated with receipt of ERBB2-targeted therapies, even as guidelines broadly recommend using these drugs, is crucial for improving the quality and equity of breast cancer care,' the authors of the study wrote. 'Future research is needed to understand the practices that contributed to the narrowing of racial and ethnic disparities.'
SOURCE:
This study was led by Sudarshan Krishnamurthy, Wake Forest University School of Medicine, Winston-Salem, North Carolina. It was published online on May 1 in JAMA Network Open .
LIMITATIONS:
Findings might not be generalized to patients with private insurance, the uninsured, or those younger than 65 years. Data on patient preferences or provider decision-making were not available. Smaller racial and ethnic groups were excluded due to limited sample size.
DISCLOSURES:
This study was funded by the California Department of Public Health, Centers for Disease Control and Prevention's National Program of Cancer Registries, National Cancer Institute's Surveillance, Epidemiology, and End Results Program, and grants to individual authors from various sources. Some authors reported receiving grants and personal fees from various sources and holding membership or editorial roles. Details are provided in the original article.
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