Barriers to Immunotherapy Use Among Patients with Triple-Negative Breast Cancer: A Qualitative Analysis

Background Individuals who are Black or Hispanic are disproportionately more likely to be diagnosed with triple-negative breast cancer (TNBC) than non-Hispanic White (NHW) individuals. Immune checkpoint inhibitors (ICIs) increase survival across different cancers, including TNBC. However, disparities in the use of ICIs exist across racial and socioeconomic (SES) groups, particularly among patients who are Black or of low SES in comparison to NHW and higher SES counterparts. The mechanisms underlying these disparities remain poorly understood, prompting this qualitative study to explore potential patient-reported factors in the use of ICIs, from the perspective of Black, Hispanic and low SES patients with TNBC. Methods Between April 2022 and December 2023, 45 English- and Spanish-speaking Black, Hispanic, and low SES patients with TNBC from cancer clinics in the NYC metropolitan area eligible for, being treated with, or formerly treated with ICIs participated in semi-structured in-depth interviews exploring ICI use. The interviews were analyzed using rapid matrix analysis. Results Five themes emerged: 1) Healthcare system factors preclude and delay accessibility of immunotherapy; 2) Deference to physicians in treatment decision-making; 3) The role of social support in treatment decision-making; 4) Preconceptions and perceptions about immunotherapy prompt hesitancy in treatment initiation; and 5) Unmet psychosocial needs inform continued immunotherapy use. Conclusion Findings identify potential mechanisms to inform future quantitative studies that could establish causal relationships between barriers to and facilitators of immunotherapy use and ultimately the development of scalable, effective interventions tailored to Black, Hispanic, and low SES patients with TNBC who are candidates for immunotherapy.