Delays in time to cancer treatment linked to demographic, socioeconomic disparities
Click Here to Manage Email Alerts
Key takeaways:
- Outpatient care led to increased delays in time to treatment initiation.
- Among patients with breast cancer, those without insurance or a Spanish language preference had higher risk for delays.
Certain clinical and socioeconomic factors appeared to predict delays in time to treatment initiation among patients with various cancer types, according to study results published in JCO Oncology Practice.
The findings indicate that existing disparities may be exacerbated due to delays that disproportionately affect patients who face care coordination/compliance issues and have multiple comorbidities and lower socioeconomic status, researchers concluded.
Rationale and methodology
Several studies have examined how delays in oncologic treatment initiation adversely impacts outcomes, Vikas Mehta, MD, MPH, FACS, vice chair and associate professor in the department of otolaryngology/head and neck surgery at Montefiore Medical Center, told Healio.
“We wanted to understand which factors were associated with delays in therapeutic treatment initiation so we could not only better understand why these delays were happening, but how best to predict which future patients would be at highest risk for delay and how best to address and avoid delays for cancer patients in the future,” Mehta said.
The retrospective cohort study included 2,543 patients (mean age, 63.4 years; 69% women; median time to treatment, 25 days) receiving care at an urban community-based academic center for breast, colorectal, head and neck, pancreatic, or non-small cell lung cancer between 2019 and 2021.
Charlson Comorbidity Index score, insurance type, language preference and inpatient admission 30 days before diagnosis served as variables of interest.
Researchers used multivariable logistic regression to assess factors associated with time to treatment initiation delay, defined as 30 days or longer.
Findings
Results of multivariable models showed patients treated in the outpatient setting and not admitted 30 days before diagnosis experienced statistically significant greater delays in treatment initiation for colorectal cancer (OR = 2.82; 95% CI, 1.71-4.66) and NSCLC (OR = 2.11; 95% CI, 1.31-3.39).
Researchers additionally found that higher Charlson Comorbidity Index score appeared associated with delays in treatment for head and neck cancer (OR = 2.63; 95% CI, 1.04-6.66) and NSCLC (OR = 1.75; 95% CI, 1.14-2.71).
Moreover, results showed increased odds of delays specifically for patients with breast cancer who did not have insurance and spoke Spanish (OR = 1.79; 95% CI, 1.21-2.67).
“Receiving strictly outpatient care, increased medical comorbidities, Spanish language preference, lack of insurance, former tobacco use, younger age at the time of diagnosis and residing in a ZIP code with a lower median household income were all associated with a higher risk for delayed care depending on tumor type,” Mehta said.
Implications
The findings implicate several socioeconomic and health literacy factors as predictors for delays in care and further elucidate how these factors lead to disparate oncologic outcomes, Mehta told Healio.
“By further understanding which factors are associated with delayed or incomplete care, our health system can direct more intensive care coordination for these at-risk patients and help address the disparity gap in oncologic outcomes,” he said. “Strategies, such as expanding navigation services, real-time patient tracking within the [electronic health record] to identify when cancer patients miss appointments, and value-based/bundled payment models that streamline the insurance approval process, thereby creating more efficiency with scheduling and reducing administrative burden, are all implicated as possible measures to help improve care delivery based on the factors associated with delayed care in the study.”
For more information:
Vikas Mehta, MD, MPH, FACS, can be reached at dr.vikasmehta@gmail.com.
Collapse
Click Here to Manage Email Alerts