Breast cancer treatment delays by socioeconomic and health care access latent classes in Black and White women

Abstract

BACKGROUND: Breast cancer mortality is higher for Black and younger women. This study evaluated 2 possible contributors to disparities-time to treatment and treatment duration-by race and age. METHODS: Among 2841 participants with stage I-III disease in the Carolina Breast Cancer Study, we identified groups of women with similar patterns of socioeconomic status (SES), access to care, and tumor characteristics using latent class analysis. We then evaluated latent classes in association with treatment delay (initiation >60 days after diagnosis) and treatment duration (in quartiles by treatment modality). RESULTS: Thirty-two percent of younger Black women were in the highest quartile of treatment duration (versus 22% of younger White women). Black women experienced a higher frequency of delayed treatment (adjusted relative frequency difference [RFD], 5.5% [95% CI, 3.2%-7.8%]) and prolonged treatment duration (RFD, 8.8% [95% CI, 5.7%-12.0%]). Low SES was significantly associated with treatment delay among White women (RFD, 3.5% [95% CI, 1.1%-5.9%]), but treatment delay was high at all levels of SES in Black women (eg, 11.7% in high SES Black women compared with 10.6% and 6.7% among low and high SES White women, respectively). Neither SES nor access to care classes were significantly associated with delayed initiation among Black women, but both low SES and more barriers were associated with treatment duration across both groups. CONCLUSIONS: Factors that influence treatment timeliness persist throughout the care continuum, with prolonged treatment duration being a sensitive indicator of differences by race, SES, and care barriers. Cancer 2020;126:4957-4966.

Differences in Emotional Distress Among Black and White Breast Cancer Survivors During the Covid-19 Pandemic: a National Survey

“…Racial inequities are found in time to diagnosis, surgery [9,10], and adjuvant chemotherapy [11,12]. Racial inequities have also been found in treatment duration; results from the Carolina Breast Cancer Study indicate that Black women experienced 1.73 times higher odds of significant delays in treatment initiation and 1.69 odds of longer treatment duration compared to White women [13]. Racial inequities in time to treatment have been linked to racial disparities in mortality [14][15][16].…”

Breast cancer treatment patterns by age and time since last pregnancy in the Carolina Breast Cancer Study Phase III

“…Our recent findings, in the Carolina Breast Cancer Study (CBCS), suggest that breast tumors of recently postpartum women were more frequently node positive and had unique immune microenvironments, but it is unknown how common treatment delay is among these women. Previous analyses from the CBCS indicated that younger (<50 years of age) women had fewer treatment delays compared to older (50-74 years of age) women [42,43], but comparisons in that study were not restricted to premenopausal women or to those with recent pregnancy. It is important to understand differences in treatment patterns for women with higher risk of aggressive cancers because delays and undertreatment are linked to worse overall and breast cancer-specific survival [44].…”

Boys Don't Cry: Examining Sex Disparities in Behavioral Oncology Referral Rates for AYA Cancer Patients

“…Access to psychosocial services is influenced by system, provider, and patient factors (Matthews et al, 2004 ) and a large body of research has documented disparities in oncology treatment and care based on various sociocultural identities, such as race (Emerson et al, 2020 ; Hardy and Du, 2021 ), SES (Dreyer et al, 2018 ; Karanth et al, 2019 ), and gender (Tabaac et al, 2018 ; Benchetrit et al, 2019 ). Access may also be subject to provider biases based on attitudes, socialized norms, as well as patients' perceived stigma around mental health services and varying communication styles and willingness to disclose emotional and psychosocial distress.…”

“…One understudied barrier to behavioral oncology care is gender/sex bias and disparities. A large body of research exists documenting disparities in oncology treatment and care based on various sociocultural identities, such as race (Emerson et al, 2020 ; Hardy and Du, 2021 ), socioeconomic status (SES) (Dreyer et al, 2018 ; Karanth et al, 2019 ), and gender (Tabaac et al, 2018 ; Benchetrit et al, 2019 ) however, less attention has been paid to sociocultural disparities, namely gender/sex disparities, in referral practices to behavioral oncology services. Given previous research documenting disparities in cancer care, and the need to increase utilization rates of behavioral oncology for cancer patients with psychosocial distress, this study aims to examine the presence of sex disparities in referral rates to psychosocial services (i.e., counseling and psychiatric services) for Adolescent and Young Adult (AYA) cancer patients.…”