Beyond the 5-year mark: adherence to and continuation of extended adjuvant endocrine therapy in non-metastatic breast cancer patients.

Purpose: Extended adjuvant endocrine therapy (AET) beyond 5 years (up to 10 years) has been shown to be beneficial for some women with non-metastatic, hormone-receptor positive breast cancer. Much of our current understanding of adherence to and continuation with AET is derived from examining the 5 years after AET initiation and is limited beyond the first 5 years. To address this limitation, we conducted a retrospective cohort study examining AET adherence and time of continuation beyond 5 years among a large, real-world population in Northern California.

Associations between social drivers of health and breast cancer stage at diagnosis among U.S. Black women.

U.S. Black women have disproportionately high breast cancer mortality, partly due to later-stage diagnoses.

Applying a Novel Measure of Community-Level Healthcare Access to Assess Breast Cancer Care Timeliness.

Background: Geographic disparities in breast cancer outcomes exist. Few studies have examined community- and health system-level factors associated with care timeliness, an important measure of care quality.

Methods: The Carolina Breast Cancer Study is a population-based cohort of 2,998 women with invasive breast cancer (2008-2013).

Patterns of Change in Emotional and Functional Well-Being Following Breast Cancer Diagnosis.

Background: Understanding the change in emotional well-being (EWB) and functional well-being (FWB) in breast cancer survivors can facilitate targeted support for unmet needs.

Methods: Among 2,767 women with breast cancer in the Carolina Breast Cancer Study Phase 3, we assessed EWB and FWB with the Functional Assessment of Cancer Therapy - Breast instrument at 5 (baseline), 25, and 84 months after diagnosis. We identified well-being trajectories using latent class growth analysis, and relative frequency differences (RFD) with 95% confidence intervals (CI) were estimated for associations between trajectory group membership and demographic or clinical characteristics.

End-of-life care quality for American Indians with cancer.

Background: American Indians experience disparities in cancer outcomes. Little is known about the quality of end-of-life care in American Indian patients with cancer.

Methods: We retrospectively analyzed end-of-life care for North Carolina patients who died (decedents) diagnosed with any cancer between 2003 and 2018 using the Cancer Information & Population Health Resource.

Evaluation of End-of-Life Quality Care Between American Indian and White North Carolina Decedents Diagnosed With Lung Cancer, 2003-2020.

Purpose: Lung cancer mortality rates for American Indians (AIs) are the highest among US race groups. End-of-life (EOL) care presents opportunities to limit aggressive and potentially unnecessary treatment. We evaluated differences in EOL quality of care between AI and White (WH) decedents with lung cancer.

Capturing Catchment Area Data Comprehensively: The North Carolina Cancer Health Assets and Needs Assessment (CHANA) Approach.

Background: A key requirement of community outreach and engagement offices within National Cancer Institute-designated cancer centers is to conduct a comprehensive examination of their catchment area's population, cancer burden, and assets. To accomplish this task, we describe the plan for implementing our initiative, the Cancer Health Assets and Needs Assessment (CHANA). CHANA compiles, into a single source, up-to-date data that describes the cancer landscape of North Carolina's 100 counties.

A latent class assessment of healthcare access factors and disparities in breast cancer care timeliness.

Background: Delays in breast cancer diagnosis and treatment lead to worse survival and quality of life. Racial disparities in care timeliness have been reported, but few studies have examined access at multiple points along the care continuum (diagnosis, treatment initiation, treatment duration, and genomic testing).

Methods And Findings: The Carolina Breast Cancer Study (CBCS) Phase 3 is a population-based, case-only cohort (n = 2,998, 50% black) of patients with invasive breast cancer diagnoses (2008 to 2013).

Emotional and functional well-being in long-term breast cancer survivorship.

Purpose: Emotional and functional well-being (EWB and FWB) are important components of mental health and quality of life. This study aims to evaluate long-term EWB and FWB in breast cancer (BC) survivors.

Methods: The Carolina Breast Cancer Study Phase 3 oversampled Black and younger (< 50 years in age) women so that they each represent approximately 50% of the study population and assessed participants' EWB and FWB with the Functional Assessment of Cancer Therapy-Breast (FACT-B) at 5- (baseline), 25-, and 84-months post diagnosis.

Characterizing Cancer Burden in the American Indian Population in North Carolina.

Background: The American Indian (AI) population in North Carolina has limited access to the Indian Health Service. Consequently, cancer burden and disparities may differ from national estimates. We describe the AI cancer population and examine AI-White disparities in cancer incidence and mortality.

Disparities in OncotypeDx Testing and Subsequent Chemotherapy Receipt by Geography and Socioeconomic Status.

Background: OncotypeDx is a prognostic and predictive genomic assay used in early-stage hormone receptor-positive, HER2- (HR+/HER2-) breast cancer. It is used to inform adjuvant chemotherapy decisions, but not all eligible women receive testing. We aimed to assess variation in testing by demographics and geography, and to determine whether testing was associated with chemotherapy.

Burden of lymphedema in long-term breast cancer survivors by race and age.

Background: Risk assessment for breast cancer-related lymphedema has emphasized upper-limb symptoms and treatment-related risk factors. This article examined breast cancer-related lymphedema after surgery, overall and in association with broader demographic and clinical features.

Methods: The Carolina Breast Cancer Study phase 3 followed participants for breast cancer-related lymphedema from baseline (on average, 5 months after breast cancer diagnosis) to 7 years after diagnosis.

Job loss, return to work, and multidimensional well-being after breast cancer treatment in working-age Black and White women.

Purpose: Breast cancer survivorship has improved in recent decades, but few studies have assessed the patterns of employment status following diagnosis and the impact of job loss on long-term well-being in ethnically diverse breast cancer survivors. We hypothesized that post-treatment employment status is an important determinant of survivor well-being and varies by race and age.

Methods: In the Carolina Breast Cancer Study, 1646 employed women with primary breast cancer were longitudinally evaluated for post-diagnosis job loss and overall well-being.

Hospitalization and Mortality Outcomes Among Childhood Cancer Survivors by Race, Ethnicity, and Time Since Diagnosis.

Importance: Cancer outcomes are relatively poor in adults who belong to minoritized racial and ethnic groups. Survival and long-term outcomes by race and ethnicity in individuals with childhood cancers are less studied.

Objective: To evaluate survival and hospitalization among American Indian and Alaska Native, Asian, Black, and Hispanic children compared with non-Hispanic White children with cancer.

Socioeconomic status, access to care, risk factor patterns, and stage at diagnosis for head and neck cancer among black and white patients.

Background: Little is known about how factors combine to influence progression of squamous cell carcinoma of the head and neck (HNSCC). We aimed to evaluate multidimensional influences of factors associated with HNSCC stage by race.

Methods: Using retrospective data, patients with similar socioeconomic status (SES), access to care (travel time/distance), and behavioral risk factors (tobacco/alcohol use and dental care) were grouped by latent class analysis.

Breast cancer treatment patterns by age and time since last pregnancy in the Carolina Breast Cancer Study Phase III.

Purpose: To describe breast cancer treatment patterns among premenopausal women by age and time since last pregnancy.

Methods: Data were analyzed from 1179 women diagnosed with premenopausal breast cancer in the Carolina Breast Cancer Study. Of these, 160 had a recent pregnancy (within 5 years of cancer diagnosis).

Integrating biology and access to care in addressing breast cancer disparities: 25 years' research experience in the Carolina Breast Cancer Study.

Purpose Of Review: To review research on breast cancer mortality disparities, emphasizing research conducted in the Carolina Breast Cancer Study, with a focus on challenges and opportunities for integration of tumor biology and access characteristics across the cancer care continuum.

Recent Findings: Black women experience higher mortality following breast cancer diagnosis, despite lower incidence compared to white women. Biological factors, such as stage at diagnosis and breast cancer subtypes, play a role in these disparities.

Initiation and adherence to adjuvant endocrine therapy among urban, insured American Indian/Alaska Native breast cancer survivors.

Background: It has been shown that racial/ethnic disparities exist with regard to initiation of and adherence to adjuvant endocrine therapy (AET). However, the relationship among American Indian/Alaska Native (AIAN) individuals is poorly understood, particularly among those who reside in urban areas. We evaluated whether AET initiation and adherence were lower among AIAN individuals than those of other races/ethnicities who were enrolled in the Kaiser Permanente of Northern California (KPNC) health system.

Breast cancer treatment delays by socioeconomic and health care access latent classes in Black and White women.

Background: Breast cancer mortality is higher for Black and younger women. This study evaluated 2 possible contributors to disparities-time to treatment and treatment duration-by race and age.

Methods: Among 2841 participants with stage I-III disease in the Carolina Breast Cancer Study, we identified groups of women with similar patterns of socioeconomic status (SES), access to care, and tumor characteristics using latent class analysis.

Integrating access to care and tumor patterns by race and age in the Carolina Breast Cancer Study, 2008-2013.

Purpose: Understanding breast cancer mortality disparities by race and age is complex due to disease heterogeneity, comorbid disease, and the range of factors influencing access to care. It is important to understand how these factors group together within patients.

Methods: We compared socioeconomic status (SES) and comorbidity factors in the Carolina Breast Cancer Study Phase 3 (CBCS3, 2008-2013) to those for North Carolina using the 2010 Behavioral Risk Factor Surveillance Study.

Correlates of Alcohol-Related Treatment Among American Indians and Alaska Natives with Lifetime Alcohol Use Disorder.

Background: To describe sociodemographic and selected psychiatric disorder patterns and estimate correlates of seeking alcohol treatment among American Indians and Alaska Natives (AIAN) and non-Hispanic Whites (NHW) with lifetime alcohol use disorder (AUD).

Methods: Data come from the 2012 to 2013 U.S.

Patterns of medication adherence in a multi-ethnic cohort of prevalent statin users diagnosed with breast, prostate, or colorectal cancer.

Purpose: To investigate the implications of a cancer diagnosis on medication adherence for pre-existing comorbid conditions, we explored statin adherence patterns prior to and following a new diagnosis of breast, colorectal, or prostate cancer among a multi-ethnic cohort.

Methods: We identified adults enrolled at Kaiser Permanente Northern California who were prevalent statin medication users, newly diagnosed with breast, colorectal, or prostate cancer between 2000 and 2012. Statin adherence was measured using the proportion of days covered (PDC) during the 2-year pre-cancer diagnosis and the 2-year post-cancer diagnosis.

Disparities in Prostate, Lung, Breast, and Colorectal Cancer Survival and Comorbidity Status among Urban American Indians and Alaskan Natives.

Cancer is the second leading cause of death among American Indians and Alaskan Natives (AIAN), although cancer survival information in this population is limited, particularly among urban AIAN. In this retrospective cohort study, we compared all-cause and prostate, breast, lung, and colorectal cancer-specific mortality among AIAN ( = 582) and non-Hispanic white (NHW; = 82,696) enrollees of Kaiser Permanente Northern California (KPNC) diagnosed with primary invasive breast, prostate, lung, or colorectal cancer from 1997 to 2015. Tumor registry and other electronic health records provided information on sociodemographic, comorbidity, tumor, clinical, and treatment characteristics.