Race, geography associated with delays in breast cancer treatment
Click Here to Manage Email Alerts
Race and geographic location appeared significantly associated with increased risk for treatment delays among women with breast cancer in North Carolina, according to results of a retrospective study published in Cancer.
The extent of racial disparities in treatment delays varied considerably among regions, with age-adjusted relative risk for delay in the highest-risk region approximately double that of the lowest-risk region for both Black and non-Black patients, researchers wrote.
Background
Lengthy delays in breast cancer treatment can impact survival, with delays of 30 to 60 days associated with reductions in disease-specific and overall survival, according to study background.
With several state-specific and national studies having shown that Black patients are at disproportionate risk for breast cancer treatment delays, researchers sought to examine the potential relationship of geography with racial and ethnic differences in timely cancer care access.
“Black and Hispanic patients with breast cancer receive surgical care at different hospitals than non-Hispanic white peers, are less involved with selection of their surgeon and treatment facility, and rely less on reputation when selecting care,” researchers wrote.
Methodology
The population-based, retrospective study included 32,626 adults with stage I to stage III breast cancer (median age at diagnosis, 67 years; 19% Black) from 2004 to 2017 in the North Carolina Central Cancer Registry.
Study participants had previously received breast-conserving surgery (64%), mastectomy (27.1%) or chemotherapy (9%) as their first treatment.
Risk for treatment delay served as the primary outcome of interest. Researchers designated a delay in treatment as greater than 60 days from diagnosis to first treatment. They aggregated counties throughout North Carolina into nine Area Health Education Center regions, with race dichotomized as Black and non-Black.
Key findings
Researchers found Black patients with breast cancer experienced treatment delays more frequently than non-Black patients (15% vs. 8%).
Age-adjusted relative risk for delay in the highest-risk region was approximately twice that in the lowest-risk region among both Black (RR = 2.1; 95% CI, 1.6-2.6) and non-Black patients (RR = 1.9; 95% CI, 1.5-2.3).
Compared with non-Black patients, Black patients had a higher likelihood of having chemotherapy as their first treatment (14.8% vs. 7.6%), stage III disease (15.2% vs. 9.3%) and hormone receptor-negative tumors (29.3% vs. 15.6%) and of living within 5 miles of their treatment site (30.6% vs. 25.2%).
Black patients also experienced a higher median time to treatment than non-Black patients (30 days vs. 26 days).
The magnitude of the racial gap in treatment delay varied by the nine regions, from 0% to 9.4%.
“On average, about one in seven Black women in our study experienced a lengthy delay, but this risk varied depending on where the woman lives in the state,” Katherine E. Reeder-Hayes, MD, MBA, MS, associate professor of medicine at The University of North Carolina Lineberger Comprehensive Cancer Center, said in a press release. “These delays weren’t explained by the patient’s distance from cancer treatment facilities, their specific stage of cancer or type of treatment, or what insurance they had.”
Next steps
Researchers noted that future studies should consider both high-risk geographic regions and high-risk patient groups for intervention to prevent delays. Additionally, the investigators are now working on developing and testing tools that assist patients in communicating with health care systems about delays in care.
“These findings suggest that the structure of local health care systems, rather than characteristics of the patients themselves, may better explain why some patients experience treatment delays and other adverse cancer outcomes,” Reeder-Hayes said.
References:
- Race and geography linked to different risks of breast cancer treatment delays (press release). Available at: newsroom.wiley.com/press-releases/press-release-details/2023/Race-and-geography-linked-to-different-risks-of-breast-cancer-treatment-delays/default.aspx. Published Jan. 23, 2023. Accessed Jan. 23, 2023.
- Reeder-Hayes KE, et al. Cancer. 2023;doi:10.1002/cncr.34573.
Collapse
Reeder-Hayes KE, et al. Cancer. 2023;doi:10.1002/cncr.34573.
Read more about
Click Here to Manage Email Alerts