Understanding barriers in early stage breast cancer treatment

Introduction: A deeper understanding of barriers in early stage breast cancer treatment and the ways patients respond to these barriers can be used to develop, assess, and identify patient behaviors that may negatively impact treatment decision-making. Objectives: With regard to delays in time to diagnosis and treatment, refusal of treatment, and surgical choice issues in early stage breast cancer: 1) examine barriers faced by patients at the patient, care process, and health system–levels and examine responses to these barriers; 2) identify the patient behavior types that lead to poor treatment decision-making; and 3) discuss observations by patient race, age, and socioeconomic status and suggest interventions that can help address barriers. Methods: African American and European American patients diagnosed with early stage breast cancer between 2005 and 2011 were identified in northern and central New Jersey. Patients were between age 20 and 85 years at diagnosis and were identified through rapid case ascertainment methodology by the New Jersey State Cancer Registry Staff. Three data collection methods were used: 1) face-to-face in-depth interviews; 2) semi-structured telephone interviews; and 3) medical chart abstraction. Analyses of patient transcripts were conducted using Atlas.ti qualitative data analysis software. Results: In objective 1, delays in time to diagnosis and treatment resulted from behaviors described as ‘seriousness-unaware,’ refusal of treatment resulted from behaviors described as ‘treatment avoidance,’ and surgical choice issues resulted from behaviors described as ‘low involvement’ and ‘body image priority.’ Per objective 2, poor treatment decision-making largely resulted from the experience of a higher proportion of barriers at the patient-level for all three treatment decisions as compared to barriers at the care process-level and health system-level, suggesting the need for interventions that directly impact patients. Per objective 3, responses to barriers varied by patient race, age, and socioeconomic status and targeted interventions and assistance can be used to address these patient experiences. Interventions such as developing an assessment tool to identify patient behaviors that may negatively impact treatment decision-making can be incorporated as alerts in data collection systems. An independent entity can also be utilized to survey early stage breast cancer patients on a monthly basis to ensure objective feedback about the treatment process is obtained and that appropriate actions are taken. Conclusion: Patient behaviors which led to poor treatment decision-making in early stage breast cancer were observed. Additional assistance provided to patients when they are experiencing challenges during the treatment process can improve survival, adherence, and satisfaction with treatment. Findings in this study suggest that interventions are needed to eliminate barriers that can reduce disparities in early stage breast cancer treatment.Ph.D.Includes bibliographical referencesby Susan Kalapura Josep