: Numerous trials proved the efficacy of adjuvant local and systemic therapies to increase disease-free and overall survival among women with early-stage breast cancer. Yet 14%-89% of women do not receive them, especially minority women. Despite lower incidence of the disease, African American women are more likely than white women to die of breast cancer. As we near racial equity in rates of breast cancer screening, disparities in treatment and mortality remain. Efforts to achieve control of breast cancer and reduce racial disparities in mortality will not be fully realized until proven effective treatments are provided to those who can benefit. Cancer patient-assistance programs provide practical support such as financial counseling, psychosocial support, and information about cancer and its treatment but often, patients are unaware of them. These services may increase receipt of effective therapies; this strategy has not been rigorously tested. We propose a patient-centered RCT to evaluate the effect of patient-assistance programs on receipt of adjuvant therapies among minority and nonminority women with newly operated early-stage breast cancer. We will build on an ongoing physician-centered intervention to reduce adjuvant underuse. We will assess 548 patients' beliefs about cancer, its treatment, their needs and barriers to care. Intervention patients will be given information about services that target their barriers and create an action plan for contact; controls will receive an NCI breast cancer pamphlet. All patients will be called within 1 month; intervention patients who have not connected with the recommended services will then be contacted by a trained outreach worker for more intensive assistance. We will identify and train employees in existing cancer assistance services as outreach workers in order to increase the sustainability of this program beyond the grant-funded cycle. We will survey patients 6 months later about treatments received, satisfaction, health and emotional status; we will abstract records to ascertain adjuvant therapy receipt. This study will provide new knowledge about racial differences in patient beliefs about cancer, its treatment, as well as the effectiveness of existing patient assistance programs to reduce underuse of breast cancer treatment.
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| Bickell, Nina A; Neuman, Jennifer; Fei, Kezhen et al. (2012) Quality of breast cancer care: perception versus practice. J Clin Oncol 30:1791-5 |
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