Pilot Project Begun in LDI’s CICADA Program is Published by JAMA Network

LDI Senior Fellow and Former CICADA Scholar Yehoda Martei Investigated Guideline-Concordant Cancer Care in Older Adults with Cancer

January 14, 2025

By:

Hoag Levins

Print:

A study by Yehoda Martei, MD, MSCE, that began as a pilot project in the Leonard Davis Institute of Health Economics’ (LDI) Center for Improving Care Delivery for the Aging (CICADA) was recently published in the Journal of the American Medical Association’s (JAMA) Network Open. It found that among older adults with breast cancer, identifying as non-Hispanic Black was associated with increased odds of not receiving guideline-concordant care (GCC).

GCC refers to medical treatment that adheres to established clinical practice guidelines developed by expert panels and professional organizations based on the best available evidence and research.

CICADA is an LDI program funded by the National Institute on Aging (NIA) that is a Resource Center for Minority Aging Research (RCMAR). Each year, it selects three new postdoctoral and junior faculty members to be CICADA scholars receiving training and mentorship in health services research.

CICADA Pilot Project

In 2022 as a new CICADA Scholar, LDI Senior Fellow, Martei, an Attending Physician in the Division of Hematology and Oncology at the Hospital of the University of Pennsylvania Hospital, was funded for a CICADA pilot research project entitled “Disparities in Guideline-Concordant Care Delivery and Survival Outcomes in Elderly Patients with Stage I-III Breast Cancer.”

In October 2024, the final version of the work was published in JAMA Network Open as an original investigation entitled, “Racial Disparities in Receipt of Guideline-Concordant Care in Older Adults with Early Breast Cancer.” Martei’s co-authors were Brenda S. Castillo, Taussia Boadi, Xiaoyan Han, and Lawrence N. Shulman.

The study subsequently received prominent coverage in Black Enterprise, a national media company with print, digital, TV, and social media platforms that reach large African American business and entrepreneurial audiences across the country.

Different GCC Rates

The studied cohort of people with breast cancer included 258,531 participants that consisted of 25,174 non-Hispanic Black participants (9.7%) and 233,357 non-Hispanic white participants (90.3%). It found that 18.1 % of non-Hispanic Black patients and 15.2% of non-Hispanic white patients did not receive GCC and that that Black patients faced delays in treatment initiation and had higher all-cause mortality rates.

The authors suggested that “optimizing timely receipt of GCC and addressing social determinants of health may represent a modifiable pathway to improving inferior survival outcomes among older non-Hispanic Black patients with breast cancer.”