Self-reported racial and ethnic discrimination in patient-provider interactions and the initiation of adjuvant therapies for breast cancer in the pathways study

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PURPOSE: Despite advancements in breast cancer adjuvant therapies, some patients with indications may not receive treatment. We examined the association of self-reported racial/ethnic discrimination in patient-provider interactions and the receipt of clinically indicated therapies. METHODS: The Pathways Study is a prospective cohort of women diagnosed with invasive breast cancer from 2005 to 2013 at Kaiser Permanente Northern California. Racial/ethnic discrimination in patient-provider interactions was assessed from the Interpersonal Processes of Care survey at baseline, 6 months, and 24 months post-diagnosis. Logistic regression compared women who did not initiate clinically-indicated adjuvant therapy with those who did overall, and by race and ethnicity. Covariates included race and ethnicity, age at diagnosis, country of birth, education level, income, marital status, and American Joint Committee on Cancer staging. RESULTS: Overall, 3,610 women had indication for hormonal therapy, 2,450 for chemotherapy, and 3,258 for radiation therapy. In multivariable analyses, women reporting discrimination were at increased odds of not initiating hormonal therapy (adjusted odds ratio [aOR] = 1.43, 95% CI = 1.05-1.93) than those who did not self-report discrimination, regardless of their race/ethnicity. An increased odds of non-initiation for reported discrimination was found for radiation therapy (aOR = 1.26, 95% CI = 0.99-1.61), although it was not statistically significant. There was no association for chemotherapy initiation (aOR = 0.96, 95% CI = 0.69-1.33). CONCLUSION: Self-reported racial/ethnic discrimination in patient-provider interactions was associated with the non-initiation of hormonal therapy in women with breast cancer. Further studies are needed to explore the impact of this association on breast cancer prognosis. CLINICAL TRIAL REGISTRATION: Not applicable.

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