March 20, 2015
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Racial, ethnic disparities exist in choosing provider for breast cancer care

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White women with breast cancer are more likely to select their surgeon and treatment hospital based on reputation than black or Hispanic women, according to findings from a population-based study.

“Although preliminary, our findings suggest less active involvement in provider selection for minority patients, who may rely more on physician referral and health plans rather than reputation,” Rachel A. Freedman, MD, MPH, of the department of medical oncology at Dana-Farber Cancer Institute and an assistant professor of medicine at Harvard Medical School, told HemOnc Today. “Interventions to promote involvement in provider selection may have potential for addressing disparities related to care from lower-quality providers and may improve satisfaction with care.”

Rachel A. Freedman, MD, MPH

Rachel A. Freedman

Freedman and colleagues surveyed 500 women diagnosed with stage 0 to stage III breast cancer in 2010 or 2011 to determine racial and ethnic differences in how women selected surgeons and hospitals for their breast cancer surgery. Of the cohort, 222 women were non-Hispanic white, 142 were black, 89 were English-speaking Hispanics and 47 were Spanish-speaking Hispanics.

Overall, 78% of the women reported being referred to their surgeon by another physician and approximately 25% said they selected their surgeon based on reputation.

Adjusted analyses indicated referral-based surgeon selection was significantly more common in black women (87%) and Spanish-speaking Hispanics (79%) compared with white women (76%) and English-speaking Hispanic women (67%; P = .007).

Surgeon selection based on reputation occurred more frequently among white women (32%) than among Hispanic (22%) and black (18%) women (P = .02).

The most frequent response given for hospital selection was that it was within the patient’s health plan (58%).

Adjusted analyses also showed that white women (23%) were more likely to choose their hospital based on reputation than English-speaking Hispanic (15%), black (8%) and Spanish-speaking Hispanic women (7%; P = .003).

Women who chose their surgeon based on reputation were more likely to rate the level of care from their surgeon as excellent (adjusted OR = 2.21; 95% CI, 1.24-3.93), whereas those who chose their surgeon based on availability through their health plan were less likely to describe their quality of care as excellent (adjusted OR = 0.56; 95% CI, 0.34-0.91).

The researchers said there were study limitations; primarily, the cohort came from an area of the country where a majority of women were insured by the same carrier, which could lead to health plan-influenced choices.

“Most women in our study reported that they chose their surgeons because of a referral from another physician, and this response was most frequently provided by black and Spanish-speaking Hispanic women,” Freedman told HemOnc Today. “We also observed that black and Hispanic women were less likely (than white women) to select a surgeon based on reputation. And those selecting surgeons based on reputation more often rate their care as excellent. The importance of these findings will need to be assessed in future studies.” – by Anthony SanFilippo

For more information:

Rachel A. Freedman, MD, MPH, can be reached at the Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215; email: rafreedman@partners.org

Disclosure: The researchers report no relevant financial disclosures.