Do Community-Based Patient Assistance Programs Affect the Treatment and Well-Being of Patients With Breast Cancer?

Copyright © 2013 by American Society of Clinical Oncology

Do Community-Based Patient Assistance Programs Affect the Treatment and Well-Being of Patients With Breast Cancer?

1. Nina A. Bickell, MD, MPH⇑,
2. Andrea N. Geduld, LCSW,
3. Kathie-Ann Joseph, MD, MPH,
4. Joseph A. Sparano, MD,
5. M. Margaret Kemeny, MD,
6. Soji Oluwole, MD,
7. Tehillah Menes, MD,
8. Anitha Srinivasan, MD,
9. Rebeca Franco, MPH,
10. Kezhen Fei, MS and
11. Howard Leventhal, PhD

+ Author Affiliations

1. Mount Sinai School of Medicine; Columbia University Medical Center; Bellevue Hospital Center; Harlem Hospital Center; Metropolitan Hospital Center; Montefiore Medical Center; Queens Hospital Center, New York; Elmhurst Hospital Center, Elmhurst, NY; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; and Rutgers, the State University of New Jersey, New Brunswick, NJ

1. Corresponding author: Nina A. Bickell, MD, MPH, 1 Gustave L. Levy Place, Box 1077, New York, NY 10029; e-mail: nina.bickell@mssm.edu.

Abstract

Purpose: Patients with breast cancer who need adjuvant treatments often fail to receive them. High-quality, community-based patient-assistance programs are an underused, inexpensive resource to help patients with cancer obtain needed therapy. We sought to determine whether connecting women to patient-assistance programs would reduce underuse of adjuvant therapies.

Methods: We conducted a randomized trial of 374 women (190 assigned intervention [INT], 184 to usual care [UC]) with early-stage breast cancer who underwent surgery between October 2006 and August 2009. After initial needs assessment, individualized action plans were created to connect INT patients with targeted patient-assistance programs; UC patients received an informational pamphlet. Main outcome measures were receiving adjuvant treatment and obtaining help.

Results: High rates of INT and UC patients received treatment: 87% INT versus 91% UC women who underwent lumpectomy received radiotherapy (P = .39); 93% INT versus 86% UC women with estrogen receptor (ER) –negative tumors ≥ 1 cm received chemotherapy (P = .42); 92% INT versus 93% UC women with ER-positive tumors ≥ 1 cm received hormonal therapy (P = .80). Many women reported needs: 63% had informational; 55%, psychosocial; and 53%, practical needs. High rates of INT patients with needs connected with a program within 2 weeks (92%). At 6 months, INT and UC women used patient-assistance programs at similar rates (75% v 76%; P = .54). Women with informational or psychosocial needs were more likely to receive help (relative risk [RR], 1.77; 95% CI, 1.51 to 1.90 and RR, 1.37; 95% CI, 1.06 to 1.61, respectively).

Conclusion: INT and UC patients received high rates of adjuvant treatment regardless of trial assignment. Patients with breast cancer who connect to relevant patient assistance programs receive useful informational and psychosocial but not practical help.