Abstract B12: Racial disparities in breast cancer treatment delay and type in three North Carolina counties

2010 ◽  
Author(s):  
Anissa I. Vines ◽  
Yonghong Nie ◽  
Keith Amos
Keyword(s):  
Breast Cancer ◽  
North Carolina ◽  
Cancer Treatment ◽  
Racial Disparities ◽  
Treatment Delay ◽  
Breast Cancer Treatment

Racial differences in impact of geography on breast cancer treatment delay.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 81-81
Author(s):  
Katherine Elizabeth Reeder-Hayes ◽  
Christopher Baggett ◽  
Bradford E. Jackson ◽  
Tzy-Mey Kuo ◽  
Jacquelyne Janean Gaddy ◽  
...  
Keyword(s):  
Breast Cancer ◽  
North Carolina ◽  
Black Women ◽  
Health System ◽  
Cancer Treatment ◽  
Racial Disparities ◽  
Treatment Delay ◽  
Breast Cancer Treatment ◽  
Black Patients ◽  
Region Of Residence

81 Background: Delays in breast cancer treatment > 60 days have been linked to decrements in outcome and constitute poor quality care. Black compared to non-Black patients are at greater risk of treatment delays across the cancer care delivery spectrum. The extent to which racial disparities in breast cancer timeliness are linked to the geographic areas where Black patients receive care is unclear. Methods: We assembled a cohort of 26,482 patients diagnosed with stage I-III breast cancer in North Carolina from 2004 to 2015 from the Cancer Information and Population Health Resource (CIPHR), a multi-payer linkage of insurance claims to cancer registry data, and enrolled for 1 year after diagnosis. We defined time to treatment (TTx) as days between diagnosis and the first claim for cancer-directed therapy (surgery or chemotherapy); patients receiving radiation before other treatments and those who did not receive cancer-directed surgery by 12 months were excluded. The main exposure was the patient’s Area Health Education Center (AHEC) region of residence. The outcome of clinically significant delay was dichotomized at 60 days. Modified Poisson regression was used to generate risk ratios for bivariate, race and age-adjusted, and fully-adjusted multivariable models including clinical characteristic. The interaction of race and AHEC region was significant; therefore all subsequent analyses were stratified by Black versus non-Black race. Results: Overall, 12.3% of Blacks were delayed > 60 days, compared to 6.8% of non-Blacks. Among non-Black patients, AHEC region of residence did not predict delay. Among Black patients, likelihood of delay varied significantly across the state’s nine AHEC regions, with a risk ratio of 1.91 (95% CI 1.30-2.79) for the lowest-performing region compared to the highest-performing region. The two highest-performing regions had the largest proportions of Black patients (25-38%), and did not contain any of the state’s five largest cities. Adjustment for age, disease stage, hormone receptor status and type of first treatment did not significantly attenuate regional differences in delay among Black patients. Conclusions: Significant racial disparities exist in timely breast cancer treatment among Black women in North Carolina. AHEC region of residence had a disproportionate impact on the likelihood of treatment delay among Black women, with higher-minority regions without large cities delivering more timely care to Black patients. Our findings suggest that local health system characteristics of AHEC regions, rather than patient-level factors, may be key determinants of care disparities among Black breast cancer patients in this context. Ongoing work includes additional multi-level modeling including AHEC-level health system factors, and stakeholder interviews in high and low performing areas to enhance understanding of patterns of care and identify intervention targets.

Killing time: Treatment delay and breast cancer survival

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6589-6589
Author(s):  
S. Sheinfeld Gorin ◽  
J. E. Heck ◽  
B. Cheng
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Propensity Scores ◽  
Cancer Survival ◽  
Treatment Delay ◽  
Breast Cancer Treatment ◽  
Breast Cancer Survival ◽  
Access To Treatment ◽  
Breast Cancer Death ◽  
Increased Risk

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.

scholarly journals Determinants of Breast Cancer Treatment Delay Differ for African American and White Women

2013 ◽  
Vol 22 (7) ◽  
pp. 1227-1238 ◽  
Author(s):  
Sasha A. McGee ◽  
Danielle D. Durham ◽  
Chiu-Kit Tse ◽  
Robert C. Millikan
Keyword(s):  
Breast Cancer ◽  
African American ◽  
Cancer Treatment ◽  
White Women ◽  
Treatment Delay ◽  
Breast Cancer Treatment

scholarly journals Factors Affecting Timely Breast Cancer Treatment Among Black Women in a High-risk Urban Community: a Qualitative Study

2021 ◽  
Author(s):  
Johnie Rose ◽  
Yvonne Oliver ◽  
Paulette Sage ◽  
Weichuan Dong ◽  
Siran M. Koroukian ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Black Women ◽  
High Risk ◽  
Cancer Treatment ◽  
Breast Cancer Survivors ◽  
Urban Community ◽  
Treatment Delay ◽  
Breast Cancer Treatment ◽  
Breast Cancer Patients ◽  
Structured Interviews

Abstract Background: Black women diagnosed with breast cancer in the U.S. tend to experience significantly longer waits to begin treatment than do their white counterparts, and such treatment delay has been associated with poorer survival. We sought to identify the factors driving or mitigating treatment delay among Black women in an urban community where treatment delay is common.Methods: Applying the SaTScan method to data from Ohio’s state cancer registry, we identified the community within Cuyahoga County, Ohio (home to Cleveland) with the highest degree of breast cancer treatment delay from 2010 through 2015. We then recruited breast cancer survivors living in the target community, their family caregivers, and professionals serving breast cancer patients in this community. Participants completed semi-structured interviews focused on identifying barriers to and facilitators of timely breast cancer treatment initiation after diagnosis.Results: Factors reported to impact timely treatment fell into three primary themes: informational, intrapersonal, and logistical. Informational barriers included erroneous beliefs and lack of information about processes of care; intrapersonal barriers centered on mistrust, fear, and denial; while logistical barriers involved transportation and financial access, as well as patients’ own caregiving obligations. An informational facilitator was the provision of objective and understandable disease information, and a common intrapersonal facilitator was faith. Logistical facilitators included financial counseling and mechanisms to assist with Medicaid enrollment. Crosscutting these themes, and mentioned frequently, was the centrality of both patient navigators and support networks (formal and, especially, informal) as critical lifelines for overcoming barriers and leveraging facilitating factors.Conclusions: The present study describes the numerous hurdles to timely breast cancer treatment faced by Black women in a high-risk urban community. These hurdles, as well as corresponding facilitators, can be classified as informational, intrapersonal, and logistical. Observing similar results on a larger scale could inform the design of interventions and policies to reduce race-based disparities in processes of cancer care.

Effect of race/ethnicity and treatment delay on breast cancer survival

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6063-6063
Author(s):  
S. Sheinfeld Gorin ◽  
J. E. Heck ◽  
B. Cheng ◽  
S. Smith
Keyword(s):  
Breast Cancer ◽  
Propensity Score ◽  
Cancer Treatment ◽  
Propensity Score Analysis ◽  
Large Population ◽  
Treatment Delay ◽  
Breast Cancer Treatment ◽  
Treatment Type ◽  
Increased Risk ◽  
Race Ethnicity

6063 Background: Several papers have examined the relationship between treatment delay and survival among patients who are diagnosed with cancer. None has yet relied on a large, population-based dataset to systematically examine survival among women within different ethnic/racial groups who delay breast cancer treatment. Methods: Subjects were 49,865 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. Dates of their health care visits were identified through the linkage of SEER with Medicare claims data. Mortality from breast cancer was assessed through linkage with death certificates. Propensity score analyses that compared patients matched according to their propensity to receive treatment were used to balance patient characteristics between treatment groups, as would occur in a randomized clinical trial. Results: A propensity score analysis and a Cox proportional hazards model of survival (with adjustments for ER/PR status, treatment type, race/ethnicity, stage, age, comorbidities, marital status, poverty status, geographic location, and average number of service contacts) revealed that subjects with 1-month delay in the start of treatment had a reduced likelihood of survival (adjusted HR=1.17, 95% CI, 1.06–1.30) relative to those with less delay. Blacks had significantly lessened survival than women in other races/ethnicities (adjusted HR=1.23, 95% CI, 1.00–1.52). Receipt of radiation (adjusted HR=1.45, 95% CI, 1.24–1.69), chemotherapy (adjusted HR=1.73, 95% CI, 1.51–1.99), stage three diagnosis (adjusted HR=1.35, 95% CI, 1.08–1.70), being age 70 or older (adjusted HR=1.24, 95% CI, 1.09–1.41), or having 2 or more comorbidities (adjusted HR=1.47, 95% CI, 1.12–1.92) also predicted reduced survival from breast cancer. Conclusions: One month delay in accessing breast cancer treatment has a clear relationship to reduced survival, particularly among older, later-stage, comorbid black women who receive chemotherapy or radiation. Mechanisms for rapid access to treatment, using both provider- and system-based strategies, are recommended for these women who are at increased risk for breast cancer-related mortality. No significant financial relationships to disclose.

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