6589 Introduction: Treatment delay is commonly associated with reduced breast cancer survival. Inadequate or delayed follow-up for positive findings is the most common reason for breast cancer-related litigation in the U.S. The United Kingdom has made improvements in the delivery of breast cancer services a priority for resources with the aim of reducing delays. Yet, the evidence for the association of delay and breast cancer survival is mixed. Most studies rely on small, non-representative cohorts, treatment approaches have changed over the time since the the most widely-cited review. Studies cite wide variations in delay, and some research is subject to publication or lead time bias. Aims. The purpose of this study is to examine the influence of 3-month breast cancer treatment delay on survival using a large, longitudinal, population-based dataset to provide more definitive findings. Methods: Subjects were 43,359 female Medicare enrollees age 65 and older who were diagnosed with breast cancer between 1992 and 1999 and identified by the Surveillance, Epidemiology, and End Results (SEER) program for whom treatment delay information could be obtained. Billing claims from inpatient, outpatient and provider visits were used. Mortality from breast cancer was assessed through SEER linkage with death certificates. Using propensity scores to balance the comparison groups, the association between treatment delays of three months or more and cancer survival time were analyzed using Cox proportional hazards models with gamma frailty to account for the clustering effect due to census tract. To account for known predictors of breast cancer survival, in addition to the propensity scores, we adjusted for cancer stage, comorbidity, marital status, tumor characteristics, location, detection by screening or diagnostic mammography, and the average number of health provider visits during the study period. Results: Subjects who had over a three month delay in receiving any treatment had a 34% increased risk of breast cancer death by comparison to women with delays less than three months (adjusted Hazard ratio 1.34, 1.01–1.77). Discussion: Three-month delays in accessing breast cancer treatment have a clear relationship to survival. Rapid access to treatment is recommended for all women with breast cancer. No significant financial relationships to disclose.
The Impact of Neighborhood Economic and Racial Inequalities on the Spatial Variation of Breast Cancer Survival in New Jersey
