A new study reveals that racial and ethnic disparities in breast cancer treatment refusal are associated with factors such as age, insurance type, and income level. The research, published in JAMA Oncology, found that patients who received all recommended treatments had better survival rates, highlighting the need for interventions to improve access and reduce disparities.
The study analyzed data from nearly 3 million breast cancer patients between 2004 and 2020. It found that chemotherapy was the most commonly declined treatment (9.6%), followed by radiotherapy (6.1%), hormone therapy (5%), and surgery (0.6%). White patients were more likely to decline chemotherapy compared to other racial and ethnic groups, while Black patients were more likely to refuse radiotherapy and surgery.
Older age, public insurance or lack of insurance, and lower household income were consistently associated with higher treatment refusal rates across all therapies. Patients with late-stage disease were less likely to decline chemotherapy but more likely to refuse hormone therapy.
The research also revealed significant disparities in overall survival rates. Black patients receiving chemotherapy, radiotherapy, or surgery had higher mortality risks than White patients. Even among those who declined chemotherapy, Black patients faced a greater mortality risk.
Dr. Danielle Roman, a clinical pharmacy expert, noted, “There are known racial disparities in breast cancer. When compared to non-Hispanic White patients, the non-Hispanic Black patients have earlier onset of disease, often more aggressive disease or advanced stage at diagnosis, and aggressive subtypes.”
The study authors emphasize the importance of targeted health equity interventions to improve overall survival through treatment benefits, enhanced communication, shared decision-making, and disparity reduction in breast cancer care.
