Learning More about Disparities in Treatment Experiences and Outcomes for Women with Breast Cancer
Steven J. Katz, MD, MPH
Professor, Department of Health Management and Policy
Department of Internal Medicine, Division of General Medicine
Director, Health Services Research, Comprehensive Cancer Center
University of Michigan
What's the problem?
Our understanding of racial and ethnic disparities in the experience of cancer treatment and associated outcomes for women with breast cancer still has major gaps. Information is particularly limited about the treatment experiences of Latina women and the implications on return to work and quality of life in the survivorship period. In addition, concerns persist about disparities in outcomes related to paid work and quality of life for African American women with breast cancer.
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How has this research addressed the problem?
For some time, Dr. Steven Katz and his investigative team have been studying patterns and quality of breast cancer treatment in breast cancer patients from diverse racial and ethnic groups. This research is conducted through the Cancer Surveillance and Outcomes Research Team (CanSORT). CanSORT is a multidisciplinary group of investigators based at the University of Michigan and the Ann Arbor VA Center for Clinical Management Research and located at five universities and cancer centers throughout the United States. Dr. Katz’s most recent research focuses on the impact of breast cancer on patient quality of life and on work and financial issues for breast cancer survivors.
Dr. Katz and his team are surveying nearly 2,500 patients 3 years after their breast cancer diagnosis. The women were diagnosed between May 2005 and February 2007 and their cases were reported to the Los Angeles and Detroit Surveillance, Epidemiology and End Results (SEER) registries. The team also has identified and surveyed the surgeons and oncologists who treated the women. Data from the providers are merged with the patient-level data to create a dataset that is being used to examine racial and ethnic differences in disruption in paid work. Racial and ethnic differences in various aspects of quality of life, including financial stress, are also being examined.
In other work supported by ARP, Dr. Katz and his team are using a similar methodology of merging patient survey and SEER data, but supplementing them with data from additional sources to explore patterns of treatment and quality of diagnostic tests for women with breast cancer. This research will add medical record data about patterns of chemotherapy use and dosing. Data from both of these studies will fill gaps in our existing understanding about the experience of breast cancer treatment and the early survivorship period among vulnerable populations.
Dr. Katz’s other SEER-based studies in breast cancer supported by ARP have focused on topics related to quality of care and outcomes research, including evaluation of patient, physician, and system-level factors that influence treatment decision-making among women diagnosed with early-stage breast cancer.
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Significance of the research & results
By merging provider or other data with SEER-linked patient data, Dr. Katz and his team have created unique, population-based, multifaceted datasets that can be used to shed light on important breast cancer treatment issues from both the patient and provider perspectives. These studies in breast cancer have resulted in 43 peer-reviewed manuscripts.
Findings will be used to inform health care policy and interventions to improve the quality of breast cancer care. As one way of furthering this goal, ARP also has funded Dr. Katz to develop and evaluate a website focused on disseminating research related to the quality of cancer care. Physicians who care for breast cancer patients comprise the main audience for the website.
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Recent related publications of interest
Morrow M, Katz SJ.
The challenge of developing quality measures for breast cancer surgery.
JAMA 2012 Feb 1;307(5):509-10.
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Janz NK, Hawley ST, Mujahid MS, Griggs JJ, Alderman A, Hamilton AS, Graff JJ, Jagsi R, Katz SJ.
Correlates of worry about recurrence in a multiethnic population-based sample of women with breast cancer.
Cancer 2011 May 1;117(9):1827-36. doi: 10.1002/cncr.25740.
Mujahid MS, Janz NK, Hawley ST, Griggs JJ, Hamilton AS, Graff J, Katz SJ.
Racial/ethnic differences in job loss for women with breast cancer.
J Cancer Surviv 2011 Mar;5(1):102-11.
Hawley ST, Janz NK, Lillie SE, Friese CR, Griggs JJ, Graff JJ, Hamilton AS, Jain S, Katz SJ.
Perceptions of care coordination in a population-based sample of diverse breast cancer patients.
Patient Educ Couns 2010 Dec;81 Suppl:S34-40.
Katz SJ, Hawley ST, Abrahamse P, Morrow M, Friese CR, Alderman AK, Griggs JJ, Hamilton AS, Graff JJ, Hofer TP.
Does it matter where you go for breast surgery?: attending surgeon's influence on variation in receipt of mastectomy for breast cancer.
Med Care 2010 Oct;48(10):892-9.
Jagsi R, Abrahamse P, Morrow M, Hawley ST, Griggs JJ, Graff JJ, Hamilton AS, Katz SJ.
Patterns and correlates of adjuvant radiotherapy receipt after lumpectomy and after mastectomy for breast cancer.
J Clin Oncol 2010 May 10;28(14):2396-403.
Hawley ST, Griggs JJ, Hamilton AS, Graff JJ, Janz NK, Morrow M, Jagsi R, Salem B, Katz SJ.
Decision involvement and receipt of mastectomy among racially and ethnically diverse breast cancer patients.
J Natl Cancer Inst 2009 Oct 7;101(19):1337-47.
Jagsi R, Abrahamse P, Morrow M, Griggs JJ, Schwartz K, Katz SJ.
Postmastectomy radiotherapy for breast cancer: patterns, correlates, communication, and insights into the decision process.
Cancer 2009 Mar 15;115(6):1185-93.
Morrow M, Jagsi R, Alderman AK, Griggs JJ, Hawley ST, Hamilton AS, Graff JJ, Katz SJ.
Surgeon recommendations and receipt of mastectomy for treatment of breast cancer.
JAMA 2009 Oct 14;302(14):1551-6.
Alderman AK, Hawley ST, Janz NK, Mujahid MS, Morrow M, Hamilton AS, Graff JJ, Katz SJ.
Racial and ethnic disparities in the use of postmastectomy breast reconstruction: results from a population- based study.
J Clin Oncol 2009 Nov 10;27(32):5325-30.
Katz SJ, Hawley ST, Morrow M, Griggs JJ, Jagsi R, Hamilton AS, Graff JJ, Friese CR, Hofer TP.
Coordinating cancer care: patient and practice management processes among surgeons who treat breast cancer.
Med Care 2010 Jan;48(1):45-51.
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