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Racial/Ethnic Disparities in Emergency Department Visits After Breast Cancer Surgery


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Among women undergoing surgery for breast cancer, up to 13% will have a postoperative visit to an emergency department, according to recent research. A new study published by Falcone et al in Breast Cancer Research and Treatment discovered there is a greater likelihood that Hispanic and non-Hispanic Black women will have a postoperative emergency department visit within 90 days than non-Hispanic White women.

“It is well documented that women of color consistently experience worse outcomes in breast cancer—for example, they tend to be diagnosed with later-stage cancer and experience longer delays in treatment—and we wanted to see if this disparity was reflected in emergency department visits following surgery as well,” said Mary Falcone, PhD, a research scientist at USC Norris Comprehensive Cancer Center and lead author of the study.

Study Details and Findings

Led by Caryn Lerman, PhD, Director of USC Norris and senior author of the study, researchers used data from the California Cancer Registry and California’s Office of Statewide Health Planning and Development to identify approximately 151,000 women in California who were diagnosed with stage 0 to III breast cancer between 2005 and 2013 and received surgical treatment.

After examining other potential influences on emergency room visits, such as age, socioeconomic status, and type of hospital where the patients received their treatment, they discovered that non-Hispanic Black women had an almost 40% greater chance of an emergency room visit, and Hispanic women had an 11% greater chance than non-Hispanic White women.

KEY POINTS

  • Non-Hispanic Black women had an almost 40% greater chance of an emergency room visit and Hispanic women an 11% greater chance than non-Hispanic White women.
  • Among patients with breast cancer–related emergency department visits, the most common reasons included complications from surgery or cancer treatments such as chemotherapy.
  • Receiving surgery at a National Cancer Institute–designated comprehensive cancer center was associated with reduced odds of an emergency department visit across all demographics.

The study tracked both breast cancer–related emergency department visits and visits not related to breast cancer. Among patients with breast cancer–related emergency department visits, the most common reasons included complications from surgery or cancer treatments such as chemotherapy.

The study also found increased rates of emergency department visits for women covered by Medicaid and Medicare vs commercial insurance. However, not all patients benefited equally from similar insurance coverage: Hispanic and non-Hispanic Black women with commercial insurance had a slightly smaller reduction in visits than non-Hispanic White women.

Notably, receiving surgery at a National Cancer Institute–designated comprehensive cancer center was associated with reduced odds of an emergency department visit across all demographics.

“Understanding and reducing inequities in access to cancer care is vital to reducing the significant ethnic and racial disparities in cancer mortality,” said Dr. Lerman, who is also the H. Leslie and Elaine S. Hoffman Chair in Cancer Research and Associate Dean for Cancer Programs at the Keck School of Medicine of USC. “Women should not have to seek emergency treatment for conditions that may be avoided with access to proper care.”

Future studies at USC Norris will examine the interaction among insurance coverage, health-care utilization, and race and ethnicity, as well as how culturally competent patient navigation might improve outcomes for patients of diverse ethnic and racial backgrounds.

“We hope our study can shed light on a previously unreported problem and, in doing so, guide the development of interventions to reduce the burden of cancer for patients,” Dr. Falcone said.

Disclosure: For full disclosures of the study authors, visit link.springer.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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