Impact of patient demographics, tumor characteristics, and treatment type on treatment delay throughout breast cancer care at a diverse academic medical center

Abstract

Purpose and objectiveThe aim of this study was to examine the impact of patient demographics, tumor characteristics, and treatment type on time to treatment (TTT) in patients with breast cancer treated at a safety net medical center with a diverse patient population.Patients and methodsA total of 1,130 patients were diagnosed and treated for breast cancer between 2004 and 2014 at our institution. We retrospectively collected data on patient age at diagnosis, race/ethnicity, primary language spoken, marital status, insurance coverage, American Joint Committee on Cancer (AJCC) stage, hormone receptor status, and treatment dates. TTT was determined from the date of breast cancer biopsy to treatment start date. Nonparametric Mann–Whitney U-test (or Kruskal–Wallis test when appropriate) and multivariable quantile regression models were employed to assess for significant differences in TTT associated with each factor.ResultsLonger median TTT was noted for Black (P=0.002) and single (P=0.002) patients. AJCC stage IV patients had shorter TTT (27.5 days) compared to earlier AJCC patients (36, 35, 37, 37 days for stage 0, I, II, III, respectively), P=0.028. Age, primary language spoken, insurance coverage, and hormone receptor status had no significant impact on TTT. On multivariate analysis, race/ethnicity remained the only significant factor with Black reporting longer TTT, P=0.025. However, race was not a significant factor for time from first to second treatment. More Black patients were noted to be single (P<0.0001) and received chemotherapy as first treatment (P=0.008) compared to White, Hispanic, or other race/ethnicity patients.ConclusionIn this retrospective analysis, Black patients had longer TTT, were more likely to receive chemotherapy as first treatment, and have a single marital status. These patient factors will help identify vulnerable patients and guide further research to understand the barriers to care and the impact of treatment delays on outcomes.

Locally advanced breast cancer in young women in Latin America

“…As for the reviews that reported no association between young age and delay, two of them found significant crude associations that then disappeared when controlling by symptom presentation [6, 47], menstrual status [47] and history of benign breast conditions [47], which are all related with young age. The remaining negative studies defined young age as < 50 years, had a small sample size (n = 380) or focused on women identified through screening mammography [48], which could be the reasons they did not find a significant association between age and delay. It could also be that this relationship is different in diverse health system contexts.…”

“…On the other hand, only three quality studies have analysed the effect of young age on the treatment interval (time between diagnosis confirmation and cancer treatment initiation) and also showed contradictory results. One found an increased risk of delayed treatment among younger women [49], another reported a decreased risk in this group [46] and the last one found no association [48].…”

Incentivizing Physician Diversity in Radiology

“…The landmark 2003 Institute of Medicine report Unequal Treatment noted that racial and ethnic minorities continue to receive lower quality health care in comparison with nonminorities, even when controlling for factors relating to access [1]. For example, although African American women have a lower overall incidence of breast cancer than white women, they are more likely than white women to be diagnosed with cancer at a more advanced stage, have a more aggressive form of cancer, and have higher rates of mortality from breast cancer [16,17]. Here, radiologists can have an active role in recognizing barriers to care in vulnerable populations and acting as agents of change.…”

Delays in Care Associated With Non–English-Speaking Patients With Breast Cancer

“…Race/Ethnicity disparities have been shown to impact delays in diagnosis and treatment. 12,13 In women aged ,50 years, Black women experienced greater delays than White women. 14 Similar findings have been seen in patients of older age, those who are unmarried, or those from a lower socioeconomic background.…”