Breast cancer is the second most common cause of cancer death in women. Black women are less likely than white women to develop breast cancer but, they are more likely to die of the disease. Some of this survival discrepancy is likely due to underuse of adjuvant therapies proven to increase survival. Breast cancer treatment often requires coordination among surgeons, pathologists, primary care physicians, medical and radiation oncologists. In NYC, black and Hispanic women who accessed care and underwent surgical treatment of their breast cancer were twice as likely as whites to experience underuse of adjuvant treatment. Disturbingly, 1/3 of these underuse cases were episodes in which the surgeon recommended treatment, the patient did not refuse and yet, care did not ensue. Underuse in such circumstances is attributable to system failures than to specific provider or patient factors. In this proposed randomized controlled trial, we aim to test the effectiveness of a Tracking and Feedback (T&F) registry innovation to increase rates of completed oncology consultation and reduce both underuse of needed adjuvant therapy and racial disparities in receipt of these treatments. We also aim to assess the feasibility of implementing a T&F Registry in these high-risk hospitals by evaluating implementation effectiveness for that innovation. We have recruited 11 hospitals that serve large proportions of minority women with breast cancer. We will randomize hospitals and aim to recruit 540 women with a new breast cancer, 270 per intervention arm. We choose these """"""""high risk"""""""" hospitals because they serve predominantly minority populations, and such hospitals have higher rates of the system failure cause of underuse, and particularly, the type of underuse targeted by our Tracking and Feedback Registry.

Public Health Relevance

Coordination of fragmented care among breast cancer patients is crucial to ensuring high quality healthcare. Unfortunately, minority groups diagnosed with this disease have been shown to experience underuse of adjuvant treatment after surgery. This project aims to implement an intervention to increase timely receipt and reduce the underuse of breast cancer adjuvant treatment in women with early stage breast cancer.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
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Special Emphasis Panel (ZRG1-HDM-G (03))
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Prabhudas, Irene
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Icahn School of Medicine at Mount Sinai
Internal Medicine/Medicine
Schools of Medicine
New York
United States
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Bickell, Nina A; Moss, Alexandra DeNardis; Castaldi, Maria et al. (2017) Organizational Factors Affect Safety-Net Hospitals' Breast Cancer Treatment Rates. Health Serv Res 52:2137-2155
McAlearney, Ann Scheck; Walker, Daniel; Moss, Alexandra D et al. (2016) Using Qualitative Comparative Analysis of Key Informant Interviews in Health Services Research: Enhancing a Study of Adjuvant Therapy Use in Breast Cancer Care. Med Care 54:400-5
McAlearney, Ann Scheck; Murray, Kelsey; Sieck, Cynthia et al. (2016) The Challenge of Improving Breast Cancer Care Coordination in Safety-net Hospitals: Barriers, Facilitators, and Opportunities. Med Care 54:147-54