Sociodemographic: SABCS 2022 Megan Kruse Disparities in AYA Breast Cancer

 

Sociodemographic: SABCS 2022 Megan Kruse Disparities in AYA Breast Cancer

What does the sociodemographics present study of Adolescent and Young Adults (AYA) patients with invasive breast cancer tell us? This study was presented at the San Antonio Breast Cancer Symposium (SABCS) as a poster in 2022, and it’s a look at the effect of sociodemographic disparities on overall survival for adolescent and young adult patients with invasive breast cancer.

 

So this is a unique population of patients within the breast cancer community. In the Adolescent and Young Adults (AYA) group, and we think about these patients age group are ages 15 to 39. So those patients have some unique aspects of their care, including the. Segment of life that they’re in at that moment and the unique characteristics that may go along with that young age.

 

And so when we wanted to look at this population, we knew that each individual site that sees breast cancer patients may have a limited number of patients. So we look to answer this question in the National Cancer Database or NCDB, and what we found there was over 18,000 patients that fit into this Adolescent and Young Adults (AYA) group, and that for those patients, there are certain sociodemographic factors that contribute to outcomes for breast cancer.

 

In general, what we found was that for patients who had lower median household income may live in a community where there is less attainment of a high school degree, and for those who had government insurance compared to a private insurer, that their overall survival was decreased anywhere from a magnitude of about 6% to 10% at the 5 year mark after breast cancer diagnosis. So this was concerning to us because we wonder if there are aspects of socioeconomic status or sociodemographic characteristics that may be playing into how the patients are able to access care and how they go on to receive care even after their initial diagnosis and treatment.

 

So some of the important things for us as we move forward with this assessment of the data collected is really how other health factors play into this. We really looked at breast cancer specific factors and the sociodemographic factors, but I think for this population, other health factors, including other comorbidities, other health related risks, probably play into these overall survival results and will need to be taken into account when we do a multi-variate analysis looking at that overall survival as an endpoint.

 

What are sociodemographic (variables) disparities?

Multiple factors, including socioeconomic determinants of health, behavior, biology, and genetics, all of which can have dramatic influence on health, including cancer risk and outcomes, interact to produce cancer disparities.

Certain populations in the United States are disproportionately affected by cancer because they are more likely to face barriers in obtaining health care services.

Multiple factors, including socioeconomic determinants of health, behavior, biology, and genetics, all of which can have dramatic influence on health, including cancer risk and outcomes, interact to produce cancer disparities.

Certain populations in the United States are disproportionately affected by cancer because they are more likely to face barriers in obtaining health care.

 

Will this data affect clinicians?  

I think this data definitely can affect clinicians today. I think many of us are thinking about ways that we better serve our patients, knowing that our treatments are improving, but that really only matters if patients have access to treatments. So we’re really looking for ways in patients’ lives, in their health stories that may impact their ability to receive optimal treatment for breast cancer.

 

And certainly their sociodemographic factors are a big piece of this. So we looked at this question on a national scale, and I hope that will be relevant for many practices. And we’d love to take the next step to look at this in our local community and see how we might be able to improve our processes, the way patients come into the door, the way they’re screened for breast cancer, and the way we approach their treatment, planning and surveillance to see if we can prove their outcomes.

 

What is the next step for this research?  

So we would love to actually broaden our reach in the a YA population in general, I think there’s really a lot to learn about this group of very young people with breast cancer. And so certainly the factors that affect the way they enter the medical system the way they interact with care in the optimal way.

 

The type of resources that they may need as they approach a breast cancer diagnosis and treatment. And that may go into features such as support for fertility, for job and school planning. Things like student debt may play a very large role in how patients are able to access their healthcare or the choices they make related to their healthcare and socioeconomic.

 

And this all may also play into the education that we provide for patients. So in our study we did see that patients who had or came from. An environment where there was less completion of a high school education had worse overall survival outcomes. And so this makes you think, are there parts of our education that we give to patients with breast cancer that we can improve upon based on an individual patient’s?

Education level and how is information received from various groups of patients within our care. And so our next steps are really going to be to hone in on the specifics of this group to look at the way we deliver care, and see if we can come up with some best practices that really do influence the outcomes for young patients with breast cancer.

 

Watch and Share the Video Here: https://oncologytube.com/v/41612

Listen and Share the Audio Podcast Here: https://oncologytube.com/v/41610

 

Important Highlights from this Trial

1. Women of racial/ethnic minorities are diagnosed with advanced breast cancer (BC) at a younger age and have a greater morbidity, recurrence risk, and fatality rate. In addition to clinicopathologic and physiologic disparities, sociodemographic variables may affect these patients’ overall survival (OS).

2. We conducted a retrospective cohort analysis utilizing de-identified data obtained from the NCDB. Patients diagnosed with invasive BC between 2004 and 2019 and classified as AYA (ages 15 to 39) were included in the study.

3. Investigators identified 18,018 adolescents and young adults with invasive BC. The median age was 36, the median time between diagnosis and therapy was 25 days, and the median duration of follow-up was 82.9 months (range 0.1 – 207.1 months). The majority of patients were of European descent (66%), followed by African Americans (14%), Hispanics (10%), and Asians (6%). 61% of Asians and 47% of Caucasians reported an annual income of less than $63,000, compared to 31% of Hispanics and 26% of Blacks. While Black patients made up the majority of the low-income group (median income $40,000), Hispanics had the highest proportion of high school dropouts (44%). The 5-year OS for all patients was 92% (95% confidence interval [CI]: 0.91 to 0.92) over the study period.

4. In this research, we discovered that the OS of AYA patients with invasive BC included in the NCDB is dependent on demographic and socioeconomic variables and characteristics. At 2 and 5 years, patients with private insurance, higher incomes, a higher level of education, and who resided in a metropolitan region had improved OS.

 

What are the key takeaways from this research and data?  

I think the key takeaways from this presentation specifically make us wonder about these sociodemographic factors and how important it is to know about these factors for our patients, and this can be a really tough area of a patient’s history to get at for a clinician. I think we’re very, Used to and adept at getting at a patient’s medical history, but there’s sociodemographic, socioeconomics are not maybe something that we’re asking about.

And I think that it really does have impact. Clearly here we’re seeing some impact on overall survival after a breast cancer diagnosis. And so when we put in that sort of term, I think it becomes part of our forefront history taking and something that we do need to account for as we go on and care for patients.

 

And I think this also probably highlights the importance of having that multidisciplinary team. Again, we as clinicians may not know what to do with the information that we receive or how to help. With various resources that may be available, but this is where having social workers (social support) is part of our team.

 

Patient educators can be really influential as to how we go forward with providing best possible care. And I’m fortunate to be in an institution where we have all those resources at our disposal. I think we, if we find out that this is more and more important for giving optimal cancer treatment related outcomes, hopefully these will be resources that are incorporated into practices across the united states.

Megan Kruse, MD – About The Author, Credentials, and Affiliations

Megan Kruse, MD is an expert in breast oncology; she is currently affiliated with Cleveland Clinic, where she also practices medicine. Her involvement in a variety of insurance programs is extensive. Board-certified in internal medicine is Dr. Kruse’s specialty. Dr. Kruse practices internal medicine in Cleveland, Ohio, where she is board-certified in breast oncology as well as internal medicine.

 

Reference

1. NIH – Cancer Disparities.NIH, March 28, 2022

2. SABCS – (P4-03-27) The impact of Sociodemographic Disparities on Overall Survival of Adolescent and Young Adults (AYA) with Invasive Breast Cancer. SABCS, December 8, 2022