September 24, 2019
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Comprehensive cancer center second opinions benefit black patients with breast cancer

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Rena J. Pasick, DrPH
Rena J. Pasick

Black patients with breast cancer routinely experienced changes to their treatment plans after receiving second opinions from oncologists at NCI-designated comprehensive cancer centers, according to study results presented at American Association for Cancer Research Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved.

The findings highlight the feasibility and benefits of second opinions from these centers — which receive NCI support for research, including clinical trials — for underserved patient populations, researchers noted.

“Emerging research shows that NCI-designated comprehensive care centers have the best cancer outcomes compared with all other clinical settings,” Rena J. Pasick, DrPH, professor in the division of general internal medicine at University of California, San Francisco, and member of UCSF Helen Diller Family Comprehensive Cancer Center, said in a press release.

Research suggests inadequate treatment contributes to excess breast cancer mortality among blacks. Specifically, researchers have cited a lack of guideline-concordant care, underuse of medical advances, and limited opportunities to participate in clinical trials and genetic counseling. Other studies have shown underrepresentation of blacks and other ethnic minorities as patients at comprehensive cancer centers, for reasons that include geographic distance, insufficient insurance and the perception that academic medical centers are not as welcoming to diverse patients, according to Pasick.

Pasick and colleagues sought to determine the feasibility of comprehensive cancer center consultations and their impact on treatment quality for black women with breast cancer.

They assigned 14 black patients with breast cancer receiving treatment at local hospitals or clinics to receive free consultations with UCSF physicians from comprehensive cancer centers. Physicians interviewed patients 3 weeks after the consultation and 1 year later.

The impact of the consultations on the patients’ treatment plans served as the study’s primary endpoint.

Results showed recommendations from the cancer center physicians led to treatment plan changes for all 14 patients. These ranged from new strategies to manage treatment-related adverse events to medication changes, modified monitoring plans and protocols for recurrence prevention.

One public hospital patient with stage III breast cancer and a P53 mutation who had been undergoing unsuccessful treatment with carboplatin and taxol received a recommendation for a switch to doxorubicin and cyclophosphamide. After 2 years of follow-up, the woman was in remission and gave birth to a child, researchers noted.

Future studies should explore the cost-effectiveness of these consultations and whether second opinions would benefit certain groups more than others, according to researchers.

“[Comprehensive cancer center] second-opinion consultations are feasible, and can lead to improvements in treatment, monitoring and management of side effects,” Pasick said. “For a relatively small cost to the [center] for each consultation, the institution can directly serve high-risk communities in a unique and potentially high-impact way.” – by John DeRosier

Reference:

Pasick RJ, et al. Abstract 16. Presented at: AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Sept. 20-23, 2019; San Francisco.

Disclosures: Pasick reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.