Factors Mediating Racial/Ethnic Disparities in Delayed Treatment of Breast Cancer

Abstract

Background Despite improvements, disparities in breast cancer care have led to an inequitable distribution of treatment delays and worse outcomes among patients with breast cancer. This study aimed to quantify the contribution of mediators that may explain racial/ethnic disparities in breast cancer treatment delays. Patients and Methods We conducted a retrospective analysis of patients from the National Cancer Database with stage I–III breast cancer who underwent surgical resection. Mediation analyses estimated the extent to which racial/ethnic disparities in the distribution of patient characteristics account for racial/ethnic disparities in delayed treatment. Results Of the 1,349,715 patients with breast cancer included, 10%, 5%, and 4% were Black, Hispanic, and other non-white race/ethnicity, respectively. Multivariable models showed that patients in these racial/ethnic groups had 73%, 81%, and 24% increased odds of having a treatment delay relative to white patients. Mediation analyses suggested that 15%, 19%, and 15% of the treatment delays among Black, Hispanic, and other non-white race/ethnicity patients, respectively, are explained by disparities in education, comorbidities, insurance, and facility type. Therefore, if these mediators had been distributed equally among all races/ethnicities, a reduction of 15–19% in the delayed treatment disparities experienced by minority patients would have been observed. Academic facility type was the factor that could yield the largest reduction in time to treatment disparities, contributing to 8–13% of racial/ethnic disparities. Conclusions Patients with breast cancer who identified as Black, Hispanic, and other non-white races/ethnicities are exposed to longer treatment delays relative to white patients. Efforts to equalize mediators could remove substantial portions of racial/ethnic disparities in delayed treatment.

Neighborhood social vulnerability and disparities in time to kidney cancer surgical treatment and survival in Arizona

“…However, other factors that were not included in our study, such as comorbidities, transportation, clinical complexity, individual-level SES, cultural beliefs, institutional mistrust, health literacy, lack of financial and social support, and healthcare systems including poor care coordination and communication, may also delay the treatment of all patients. 18,27,41,42 A primary challenge for considering KCa disparities posed by time to surgery is the limited diversity of patients in large national databases. Racial and ethnic minority patients and some geographic areas in the United States are underrepresented in a national database commonly used for clinical quality assessment.…”

“…Addressing social determinants or drivers of health at the neighborhood level could improve timeliness of treatment and survival after treatment not only in racial and ethnic minority groups, but for all patients from any racial and ethnic backgrounds. However, other factors that were not included in our study, such as comorbidities, transportation, clinical complexity, individual‐level SES, cultural beliefs, institutional mistrust, health literacy, lack of financial and social support, and healthcare systems including poor care coordination and communication, may also delay the treatment of all patients 18,27,41,42 …”

“…For breast, 20,21 prostate, 22 lung, 23 cervical, 24 and liver 25,26 cancers, living in low socioeconomic status (SES) neighborhoods is linked to disease disparities. A suggested pathway shaping these disparities is the relationship between neighborhood‐level disadvantage and cancer treatment delay, which has been previously considered for breast, 18 colorectal, 16 and liver 19 cancers. The impacts of neighborhood‐level disadvantage on cancer treatment delay are particularly pronounced among individuals from racial and ethnic minority populations 16,27 .…”

“…Disparities in time to treatment initiation exist for many cancer types in racial and ethnic minority populations, including KCa. Racial and ethnic minority groups with high mortality rates often experience a longer gap between diagnosis to treatment initiation 15–19 . A better understanding of disparities in time to treatment initiation is necessary to develop programs or recommendations to reduce current patterns of KCa disparities.…”

“…Racial and ethnic minority groups with high mortality rates often experience a longer gap between diagnosis to treatment initiation. 15 , 16 , 17 , 18 , 19 A better understanding of disparities in time to treatment initiation is necessary to develop programs or recommendations to reduce current patterns of KCa disparities.…”