Study highlights racial and geographic disparities in timely breast cancer care

Race and geographic region were significantly associated with delays in breast cancer treatment in a to study Posted in Cancersuggesting that high-risk patients and high-risk regions should be prioritized in clinical and policy strategies to improve care disparities.

Delays in breast cancer diagnosis and treatment have been associated with worse disease-specific and overall survival in previous research, and black patients are at a disproportionately high risk for breast cancer treatment delays.

The large population-based cohort study explored variations in time from breast cancer diagnosis to treatment in North Carolina between 2004 and 2017 based on 2 distinct patient characteristics: race and geographic region in which patients reside. The analysis showed that black patients were more likely to experience treatment delays, as were patients of any race or ethnicity who lived in certain areas.

A total of 32,626 patients were included in the study, of whom 6,190 (19%) were black. These patients were younger than the rest of the cohort (64 years versus 68 years), were more likely to receive chemotherapy before any other treatment (14.8% versus 7.6%), and their tumors were more likely to be hormone receptor negative (29.3% vs. 15.6%) compared to the non-black cohort.

Black patients were also more likely to have Medicaid insurance (46.7% versus 14.9%) and more often lived within 5 miles of their treatment site (30.6% versus 25.2%) than non-black patients. They were also more likely to live in a census tract in the highest social deprivation category (52% versus 18.6%) compared to non-black patients in the cohort.

Treatment delays of more than 60 days, a threshold consistently linked to poorer outcomes, were more common among black patients, 15% of whom experienced such delays. In the non-black cohort, 8% of patients faced a delay greater than 60 days. The median time to treatment for black patients was 30 days versus 26 days for non-black patients.

For black and non-black patients, the likelihood of treatment delays varied between regions of the state. In the region with the highest risk of delay, patients were twice as likely to experience a delay as patients in the region with the lowest risk of delay. The extent of racial disparity also varied by region, with one region showing no significant difference – despite only 2.7% of patients in that region being black – and the most significant disparity being 9.4%.

“Importantly, regional differences in speed were not explained by clinical or sociodemographic characteristics. [of] patients,” the authors wrote. “The substantial geographic variation we observed in the provision of timely and equitable breast cancer care suggests that these outcomes are modifiable and should be a clinical and policy priority for intervention in high-risk regions.”

Overall, the results highlight multiple factors that may affect disparities in the timeliness of breast cancer care. Identifying areas where delays are common and exploring various aspects of care delivery in these areas will be a crucial area of ​​future research, the authors wrote. Further research into delays in other types of cancer is also warranted.

“On average, about 1 in 7 black women in our study experienced a long delay, but this risk varied depending on where the woman lives in the state. These delays were not explained by the patient’s distance from cancer treatment facilities, their specific cancer stage or type of treatment, or the insurance they had,” the study author said. , Katherine E. Reeder-Hayes, MD, MBA, MS, of UNC. Lineberger Comprehensive Cancer Center, said in a statement. “These results suggest that the structure of local health care systems, rather than the characteristics of the patients themselves, may better explain why some patients experience treatment delays and other adverse cancer-related outcomes.”

Reference

Reeder-Hayes KE, Jackson BE, Baggett CD, et al. Race, geography, and risk of breast cancer treatment delays: a population-based study 2004-2015. Cancer. Published online January 23, 2023. doi:10.1002/cncr.34573