Improving Endocrine Therapy Utilization in Racially Diverse Populations

Project: Research project


Taking endocrine therapy (ET) for 5 years after a breast cancer diagnosis greatly reduces breast cancer recurrence and improves survival in most breast cancer patients. However, as many as 50% of women who are prescribed ET never take the first pill, and of those who start to take ET, about 50% discontinue the medication or are not taking it properly at 5 years. This is a problem in that it means women may not be receiving the full benefits of proven effective ET. The reasons women stop taking ET are unclear, and it is possible that differential rates of ET use contribute to observed disparities in breast cancer death rates for African American (AA) women, compared to non-AA women. Understanding why diverse groups of women do not take ET as prescribed is vitally important to improving breast cancer outcomes. This application proposes evaluating: (1) what barriers and motivators to ET use exist for AA and non-AA women; (2) whether differential rates of ET underuse exist in AA versus non-AA women and what factors predict ET underuse; and (3) whether a behavioral intervention can be adapted to improve ET use in diverse populations of women in a culturally acceptable and logistically feasible manner. To achieve these goals, the applicant will first analyze interview data from 48 breast cancer patients and 20 providers to better understand the processes that affect ET medication taking decisions. These data are currently being collected and will be available for analyses in year 1 of this ACS award. Then, the applicant will analyze surveys and clinical records data about ET underuse to understand whether racial differences in ET underuse exist and what factors predict ET underuse in a minority-enriched sample through the Carolina Breast Cancer Study (CBCS). CBCS is an ongoing study of 1,500 AA and 1,500 non-AA women with breast cancer, scheduled to complete recruitment and data collection in year 2 of this ACS award. Using information gathered from these formative analyses, the applicant, equipped with formal training and guided by her mentors and collaborators, will develop and test feasibility and acceptability of an intervention to improve ET use among 40 AA and non-AA women with breast cancer who are eligible to take ET. The intervention will likely consist of an initial educational and motivational session with a trained nurse navigator, who will help the patient understand the benefits and downsides of ET and ways to overcome key barriers; ongoing telephone support by the navigator; educational and motivational workbooks, and access to peer support and other resources. This project is important for patients with breast cancer in that it seeks to identify and begin to remedy key causes of less-than-optimal ET use. In addition, it may help explain and begin to remedy the higher death rate from breast cancer seen in AA women.
Effective start/end date1/1/1412/31/18


  • American Cancer Society (ACS)


Breast Neoplasms
African Americans