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Racial/ethnic group differences in treatment decision-making and treatment received among older breast carcinoma patients
Article first published online: 9 JAN 2006
Copyright © 2006 American Cancer Society
Volume 106, Issue 4, pages 957–965, 15 February 2006
How to Cite
Maly, R. C., Umezawa, Y., Ratliff, C. T. and Leake, B. (2006), Racial/ethnic group differences in treatment decision-making and treatment received among older breast carcinoma patients. Cancer, 106: 957–965. doi: 10.1002/cncr.21680
- Issue published online: 3 FEB 2006
- Article first published online: 9 JAN 2006
- American Cancer Society. Grant Number: TURSG-02-081-01-PBP
- California Breast Cancer Research Program. Grant Number: 4PB-0161
- Robert Wood Johnson Foundation. Grant Number: 036833
- California Breast Cancer Research Program. Grant Number: 7PB-070
- John A. Hartford Foundation/American Federation of Aging Research Medical Student Geriatric Scholars Program. Grant Number: EB940621
- racial/ethnic disparities;
- treatment decision-making;
- breast carcinoma;
- breast carcinoma treatment;
- older patients
Health care disparities have been identified in the treatment of older and racial/ethnic minority breast carcinoma patients. The purpose of the current study was to examine racial/ethnic group differences in the treatment decision-making process of older breast carcinoma patients and the differential impact on treatment received.
A cross-sectional survey was conducted of a population-based, consecutive sample identified by the Los Angeles Cancer Surveillance Program comprised of Latina (n = 99), African-American (n = 66), and white (n = 92) women age ≥ 55 years (total n = 257) and who were between 3–9 months after their primary breast carcinoma diagnosis.
Approximately 49% of less acculturated Latinas and 18% of more acculturated Latinas indicated that their family members determined the final treatment decision, compared with less than 4% of African-Americans and whites (P < 0.001). This disparity remained in multiple logistic regression analysis, controlling for potential confounders, including sociodemographic, physician–patient communication, social support, and health variables. Compared with African-American and white women, Latina women were more likely to identify a family member as the final treatment decision-maker (adjusted odds ratio [AOR] of 7.97; 95% confidence interval [95% CI], 2.43–26.20, for less acculturated Latinas; and AOR of 4.48; 95% CI, 1.09–18.45, for more acculturated Latinas). A multiple logistic regression model, controlling for sociodemographic and health characteristics, indicated that patients were less likely to receive breast-conserving surgery (BCS) when the family made the final treatment decision (AOR of 0.39; 95% CI, 0.18–0.85).
Family appears to play a powerful role in treatment decision-making among older Latina breast carcinoma patients, regardless of the level of acculturation. This family influence appears to contribute to racial/ethnic group differences in treatment received. Physicians should acknowledge and educate patients' family members as potential key participants in medical decision-making, rather than merely as translators and providers of social support. Cancer 2006. © 2006 American Cancer Society.