Socioeconomic- and Insurance-Based Inequities in Oncotype DX Testing and Score-Guided Treatment

Area of Science:

• Oncology
• Health Services Research
• Genomic Medicine

Background:

• Personalized breast cancer treatment increasingly relies on genomic tests like Oncotype DX (ODX).
• Limited data exists on how socioeconomic status and insurance affect ODX testing and subsequent treatment decisions.
• Understanding these disparities is crucial for equitable cancer care.

Purpose of the Study:

• To investigate the impact of socioeconomic status and insurance on the utilization of ODX testing.
• To examine how these factors influence ODX score-guided adjuvant chemotherapy treatment decisions.
• To identify potential inequities in early-stage breast cancer management.

Main Methods:

• Retrospective cohort study using a US-based electronic health record (EHR) database (2011-2023).
• Included women with early-stage, HR+/HER2- breast cancer eligible for ODX testing.
• Socioeconomic status assessed by neighborhood deprivation; insurance status captured at diagnosis. Utilized Poisson models to estimate treatment likelihood.

Main Results:

• Nearly half of eligible patients (47%) underwent ODX testing; those with commercial insurance and affluent backgrounds were more likely to be tested.
• Patients in affluent neighborhoods received adjuvant chemotherapy more often than those in impoverished neighborhoods, even with low recurrence risk (potential overtreatment).
• Publicly insured patients had double the probability of receiving chemotherapy compared to privately insured patients (potential overtreatment); Medicare beneficiaries received less chemotherapy than privately insured patients (potential undertreatment).

Conclusions:

• Socioeconomic and insurance-based disparities contribute to both overtreatment and undertreatment in early-stage breast cancer patients eligible for ODX testing.
• These findings highlight significant care quality opportunities.
• Addressing these inequities is essential for ensuring equitable and appropriate personalized cancer treatment.