University of Maryland Greenebaum Comprehensive Cancer Center to Reduce Disparities in Care for Black Women with Breast Cancer

Susan G. Komen^® American Society of Clinical Oncology Provide Funding and Training

The University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center (UMGCCC) is working to reduce disparities in patient care for Black women diagnosed with breast cancer – a group at significantly higher risk of dying from breast cancer than White women.

The academic cancer center is one of eight oncology practices nationwide selected to take part in a quality improvement and training initiative supported by the American Society of Clinical Oncology (ASCO) and Susan G. Komen^®. The clinical practices are located in metropolitan areas that Komen has targeted in its African American Health Equity Initiative, which aims to reduce breast cancer disparities in urban areas where disparities are the greatest.

Black women are 40 percent more likely to die of breast cancer than White women in the United States, according to the Centers for Disease Control and Prevention. Breast cancer is also the second-leading cause of death among Black women nationally. In Maryland, the mortality rate in Black females increased at a rate of 0.4 percent per year between 2012 and 2016 while it decreased at a rate of 3.5 percent per year among White females during the same time period, a Maryland Department of Health report shows.

"We welcome this opportunity to work with ASCO and Susan G. Komen to help eliminate barriers and improve access to care for Black women diagnosed with breast cancer," said Kevin J. Cullen, MD, the Marlene and Stewart Greenebaum Distinguished Professor in Oncology at the University of Maryland School of Medicine (UMSOM) and UMGCCC's director. "Breast cancer affects many women in the communities we serve, and Black women are often diagnosed at a later stage and experience poorer outcomes."

As part of the three-year program, UMGCCC and the other clinical practices will receive help to identify and solve problems they face in delivering care by participating in ASCO quality improvement programs, including the Quality Oncology Practice Initiative (QOPI^®) as well as the Quality Training Program (QTP). Komen is providing funding through the Fund II Foundation; Conquer Cancer, the ASCO Foundation, is administering the program.

A key focus for UMGCCC is reducing the number of patients who miss appointments. A review of the data showed the rate of Black patients missing appointments is 13 percent, compared to 6 percent for White patients, according to Paula Y. Rosenblatt, MD, an assistant professor of medicine at UMSOM and a medical oncologist in the cancer center's Breast Evaluation and Treatment Program.

"We know that there are a lot of barriers in regard to transportation, child care, getting time off from work and other societal influences that prevent patients from keeping scheduled appointments and these barriers may affect Black patients at UMGCCC to a greater degree," Dr. Rosenblatt said. "This can lead to untimely treatment, delays in care, increased cost of care and a negative effect on clinical outcomes for patients."

"We don't want patients to have adverse outcomes due to missing appointments," Dr. Rosenblatt said. "The team is preparing to tackle the issue using a multidisciplinary and multifaceted approach. Through improved communication with scheduling, early identification of high-risk patients, and involvement of social work and navigators, we believe we will see improvement in this disparity."

Dr. Rosenblatt said the goal is to reduce the rate of Black patients missing appointments to 11 percent or less by December and to 9.5 percent or less by June 2022.

Members of the breast clinical care team are now in the process of mapping out the problem and identifying other barriers to care. As part of the initiative, they will also collect data on quality measures that will help inform future quality improvement initiatives.

In announcing the collaboration earlier this year, Kim Johnson, the Senior Director of Komen's African-American Health Equity Initiative, said, "It is unconscionable that Black Women are 40 percent more likely to die from breast cancer than White women. Where you live and what you look like should not determine whether you live, yet we know that for too many this is the case. We know that we can significantly close those gaps in outcomes without a single new discovery, if we just ensure that everyone is getting high-quality care. We are excited about this collaboration because it gets us a step closer to achieving health equity in these communities."

"The collaboration with Susan G. Komen aligns with ASCO's efforts to achieve health equity for every patient, every day, everywhere," said ASCO President Lori J. Pierce, MD, FASTRO, FASCO. "These practices now will be able to measure their quality of care and develop process improvement strategies and techniques to best serve patients with cancer in their communities."

About the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center

The University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center (UMGCCC) is a National Cancer Institute-designated Comprehensive Cancer Center in Baltimore. The center is a joint entity of the University of Maryland Medical Center and University of Maryland School of Medicine. It offers a multidisciplinary approach to treating all types of cancer and has an active cancer research program. It is ranked among the top cancer programs in the nation by U.S. News & World Report. www.umgccc.org.

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