Dr. Vidal on the Role of Social Determinants of Health in Breast Cancer Care

Gregory Vidal, MD, PhD, associate professor, College of Medicine – Memphis, Department of Medicine, Division of Oncology, The University of Tennessee; medical oncologist, West Cancer Center, discusses racial disparities in the treatment of patients with breast cancer.

Breast cancer care guidelines are in place to recommend breast cancer treatments based on disease histology and help all patients with access to these treatments receive the appropriate care, Vidal says. Guidelines surrounding mammograms, ultrasounds, biopsies, the timing of surgery, and the timing and type of neoadjuvant chemotherapy should be standardized for all patients with breast cancer, regardless of their race, ethnicity, or socioeconomic status, Vidal emphasizes.

However, both biology and social determinants of health play a role in whether patients receive certain treatments and how effective those treatments are, Vidal explains. The phase 3 RxPONDER trial (NCT01272037) randomized 2,833 White patients, 248 Black patients, 610 Hispanic patients, 324 Asian patients, and 33 Native-American/Pacific Islander patients with hormone receptor–positive, HER2-negative, N1, noninflammatory breast cancer with no distant metastases to receive either chemotherapy followed by endocrine therapy or chemotherapy alone. Although all patients received standardized treatments, Black patients had a lower 5-year invasive disease–free survival rate than White patients, at 87.2% vs 91.5%, respectively.

Social determinants of health include factors such as the timing of a patient’s breast cancer presentation and diagnosis, which can influence whether they need more aggressive treatment; whether they have insurance; and whether they have access to transportation and can come to their biopsy and treatment appointments, Vidal says. Comorbidities also play a role. For instance, patients with diabetes, a common comorbidity in the African American population, are more likely to have diabetes-associated neuropathy at the time of their breast cancer diagnosis, which affects the type and dose of chemotherapy they should receive, Vidal notes.

Patients’ personal support systems can also affect the decisions they make regarding the treatment options offered to them, Vidal says. As many patients of color do not trust health care systems to provide them with care that understands and appropriately meets their needs, they may turn to members of their families or communities for advice on whether to receive the cancer care recommended by their oncologists, Vidal emphasizes. Additionally, although clinical trials often offer patients the opportunity to receive the most effective treatments for their disease, patients may be hesitant to participate in these trials, which health care providers need to be aware of so they can earn their patients’ trust and educate them on the benefits of these trials and treatments, Vidal concludes.