SAN FRANCISCO-African-American breast cancer patients routinely experience changes in their treatment plans when they receive second opinions from a NCI-designated Comprehensive Cancer Center (CCC), according to results of a new study.
Research has shown that African-Americans and other ethnic minorities are underrepresented as patients in CCCs due to factors such as geographic distance, insufficient insurance, and perceptions that academic medical centers are less welcoming to diverse patients.
"Emerging research shows that NCI-designated Comprehensive Care Centers have the best cancer outcomes compared with all other clinical settings," said lead author Rena J. Pasick, DrPH, Professor at the University of California, San Francisco (UCSF) Division of General Internal Medicine and a member of the UCSF Helen Diller Family Comprehensive Cancer Center. Aside from providing patient care, these centers receive support from the NCI to conduct research, including clinical trials.
Pasick presented the results of the study at the 12th AACR Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved.
Research Details
Pasick and colleagues examined the feasibility of offering consultations by CCC physicians to African-American women with breast cancer, and evaluated whether the second opinions made a difference in their treatment plan. African-American women have well-documented disparities in breast cancer mortality, she noted.
The researchers recruited 14 patients from the San Francisco Bay Area, and physicians from UCSF conducted consultations at no charge to the patients. Most consultations were conducted in person, with a few video sessions. Patients received coaching on how to ask questions and seek clarification. Patients were interviewed 3 weeks after the consultation, and again 1 year later to gauge the impact of the consultation.
The results show that all 14 patients received recommendations that ultimately changed their treatment plan. Some recommendations were for moderate changes, such as different ways to monitor the patients or manage side effects. Others were more significant, such as adding or changing medications, modification of monitoring plans, and recurrence prevention protocols.
Pasick cited one case in which a patient at a public hospital was being treated unsuccessfully with carboplatin and paclitaxel for a stage III tumor associated with a p53 mutation. The CCC physician recommended a change to doxorubicin and cyclophosphamide. Two years later, the patient is in remission.
This small study indicates that adding a second opinion from a CCC has the potential to improve patient outcomes and is worthy of future study in larger trials, she said.
Possible Outcomes
"CCC second opinion consultations are feasible and can lead to improvements in treatment, monitoring, and management of side effects. For a relatively small cost to the CCC for each consultation, the institution can directly serve high-risk communities in a unique and potentially high-impact way," Pasick said. "That is a message to CCCs and to the highest level of the National Cancer Institute regarding an important opportunity for service."
She added that this study reinforces that patients should always consider a second opinion and, when possible, should seek it from an institution that conducts research and has access to the latest treatments. Future research should examine cost-effectiveness and whether certain patient groups are most likely to benefit from second opinions, she suggested.
Pasick cautioned that patients' trust in their treating clinicians is important and should not be undermined. Ideally, she said, experts from the CCCs and the other health facilities would work together, sharing expertise and working together for the patient's benefit.
Conference chair Laura Fejerman, PhD, Associate Professor in the Department of Medicine at UCSF, stated: "A huge challenge is availability of data on minority populations. As of today, we don't have as much data available for ethnic minorities as we do for other populations. This significantly limits what we can learn about their disease and circumstances.
"I can give my personal research experience as an example. I am part of a large collaborative effort that put together the first genome-wide association study of breast cancer in Latino patients. But we could still only put together about a tenth of the number of samples of what studies on European populations could put together. This translates into slower progress in learning and developing, for example, a risk prediction model for that underserved population. It takes more time and money to catch up."
Fejerman added: "Recently, Comprehensive Cancer Centers have been urged to address cancer health disparities, particularly to look into their catchment areas and aim to serve all populations equally. There's a lot more to be done, but there definitely has been progress and we are heading in the right direction."
Mark L. Fuerst is a contributing writer.