New Perspectives on Breast Cancer Diagnosis and Treatment for Uninsured and Low-income Minority Women Addressed by Rutgers–Camden Nursing Scholars

CAMDEN — Two Rutgers University–Camden nursing scholars are performing research to better understand access to care and treatment choices made by women who have been diagnosed with breast cancer.

“In general, women have a one in eight chance of developing breast cancer over their lifetime,” says Patricia Suplee, an assistant professor at the Rutgers School of Nursing–Camden. “We also know that low-income and uninsured women have poorer outcomes from the disease even if they are no more likely to be diagnosed with breast cancer.”

In Camden, a city with many low-income and uninsured women, breast cancer remains a formidable challenge, the nursing scholar says. Suplee and research colleagues Bonnie Jerome-D’Emilia, an assistant professor of nursing at Rutgers–Camden, and Evelyn Robles-Rodriguez, director of outreach, prevention, and survivorship at MD Anderson Cancer Center at Cooper, are partnering to examine experiences African American and Hispanic women have had during diagnosis and treatment for breast cancer at Cooper.

The research team will analyze and compare 18 years of data, including screening, diagnosis, treatment, and outcome data  for women who enter the health care system through the New Jersey Cancer Education and Early Detection Program, as well as insured women who have received care at Cooper University Hospital.

“We have many unanswered questions, one being why minority and low-income women tend to face delays in care, which may ultimately lead to poorer prognoses in this population,” Jerome-D’Emila says.

“While studies have found that there are delays in the receipt of definitive care for this population, we do not know if the delays are occurring from screening to diagnosis or diagnosis to treatment,” she continues. “We also can’t say with any certainty whether these delays are due to patient related factors such as fear or perceived stigma, or if these delays are related to hospital and provider issues that may be a function of the women’s lack of insurance.”

“We have many unanswered questions, one being why minority and low-income women tend to face delays in care, which may ultimately lead to poorer prognoses in this population.”

In addition to this research, Suplee and Jerome-D’Emilia, along with Jen Boiler, a field education coordinator and instructor at the Rutgers School of Social Work, recently concluded a qualitative study exploring why women diagnosed with cancer in one breast decide to undergo surgery to remove both breasts.

The nursing scholars say this radical treatment has not been found to improve a woman’s breast cancer survival, yet the number of women who are choosing to have a double mastectomy has been increasing in recent years.

Suplee and Jerome-D’Emilia interviewed 23 women from New Jersey and southeastern Pennsylvania to determine their reasons for choosing to undergo the surgical procedure.

“We wanted to investigate how women make the decision for their treatment, who or what influences their decision, and what information they receive along the way to assist in the decision making process,” Suplee says.

The study will be the first published in the United States to include interviews with women who undergo this extensive surgical procedure.

“Providing women with the most up to date information and helping them process this information will help them make the best choice,” Jerome-D’Emilia says.

Future research, including a survey of a national sample of breast surgeons to determine what type of information is being given to women, will provide further evidence as to how women ultimately make their decision about breast cancer treatment.

To further support that research, Jerome-D’Emilia received a grant from the American Society of Breast Surgeons Foundation to analyze data from more than 17,000 breast cancer patients treated by a for-profit, physician-owned organization.

Jerome-D’Emilia received bachelor’s degrees from Brooklyn College and SUNY Downstate College of Nursing, her master’s degree from Columbia University School of Public Health, and her doctoral degree from Virginia Commonwealth University. She is mission chair for the Central and South Jersey affiliate of the Susan G. Komen Foundation.

Suplee earned her bachelor’s degree from Indiana University and her master’s and doctoral degrees from the University of Pennsylvania.

The two nursing scholars have collaborated on various research projects, including a series of studies on the health care needs of Hispanic women in urban, low income areas and self-efficacy and breast cancer in African American and Hispanic women.