Examining potential gaps in supportive medication use for US and foreign-born Hispanic women with breast cancer

  • Laura C. PinheiroEmail author
  • Devon K. Check
  • Donald Rosenstein
  • Katherine E. Reeder-Hayes
  • Stacie Dusetzina
Original Article



Compared to non-Hispanic Whites, Hispanic women are more likely to report pain, depression, and other mental health concerns. However, little is known about Hispanic women’s use of supportive medications, and whether use differs depending on nativity (US- vs. foreign-born). This study’s objectives were to examine patterns of supportive medication use and investigate potential differences by ethnicity/nativity among women with breast cancer.


We used the Surveillance, Epidemiology, and End Results data linked with Medicare claims to identify women diagnosed with incident breast cancer between July 1, 2007, and December 31, 2011. Supportive medication use (opioid pain and non-opioid psychotropic medications) in the 90 days after diagnosis was the primary outcome. We categorized ethnicity/nativity as US-Born non-Hispanic, US-born Hispanic, foreign-born non-Hispanic, and foreign-born Hispanic. Modified Poisson models examined associations between ethnicity/nativity and medication use, adjusting for tumor, treatment, and demographic characteristics.


We included 23,091 women, of whom 88% were US-born non-Hispanics, 4% US-born Hispanics, 6% foreign-born non-Hispanics, and 2% foreign-born Hispanics. Supportive medication use varied by ethnicity/nativity. Compared to US-born non-Hispanics, foreign-born Hispanics and non-Hispanics were 5% (95% CI 0.92–0.98) and 10% (95% CI 0.85–0.96) less likely to receive supportive medications, respectively. US-born Hispanics were 5% (95% CI 1.02–1.09) more likely to receive supportive medications. Observed differences persisted when analyses were limited to stage I–III breast cancer cases.


This work highlights potential disparities in the pharmacologic treatment of psychosocial needs of foreign-born breast cancer patients. Future studies should explore if differences observed here are reflective of health disparities or differential patient preferences.


Hispanic Latina Supportive care Breast cancer Disparities 



The database infrastructure used for this project was funded by the CER Strategic Initiative of UNC’s Clinical &Translational Science Award (UL1TR001111), and the UNC School of Medicine. Additional funding for the SEER-Medicare data was provided by the UNC Lineberger Comprehensive Cancer Center’s University Cancer Research Fund (UCRF) via the State of North Carolina.

Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflicts of interest

The authors declare that they have no conflicts of interest or financial disclosures.


This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the National Cancer Institute; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.

Human and animal rights and informed consent

This article does not contain any studies with animals performed by any of the authors. Informed consent from study subjects was not needed as the University of North Carolina at Chapel Hill IRB granted this research exemption from review. All authors have read and approved the manuscript for submission to Supportive Care in Cancer. This manuscript has not been published elsewhere and is not under consideration by another journal.

Supplementary material

520_2018_4406_MOESM1_ESM.docx (21 kb)
ESM 1 (DOCX 20 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of General Internal Medicine, Department of MedicineWeill Cornell MedicineNew YorkUSA
  2. 2.Duke UniversityDurhamUSA
  3. 3.University of North Carolina at Chapel HillChapel HillUSA
  4. 4.Vanderbilt UniversityNashvilleUSA

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