Abstract
Introduction
Initial treatment for nonmetastatic breast cancer is resection or neoadjuvant systemic therapy, depending on tumor biology and patient factors. Delays in treatment have been shown to impact survival and quality of life. Little has been published on the performance of safety-net hospitals in delivering timely care for all patients.
Methods
We conducted a retrospective study of patients with invasive ductal or lobular breast cancer, diagnosed and treated between 2009 and 2019 at an academic, safety-net hospital. Time to treatment initiation was calculated for all patients. Consistent with a recently published Committee on Cancer timeliness metric, a treatment delay was defined as time from tissue diagnosis to treatment of greater than 60 days.
Results
A total of 799 eligible women with stage 1–3 breast cancer met study criteria. Median age was 60 years, 55.7% were non-white, 35.5% were non-English-speaking, 18.9% were Hispanic, and 49.4% were Medicaid/uninsured. Median time to treatment was 41 days (IQR 27–56 days), while 81.1% of patients initiated treatment within 60 days. The frequency of treatment delays did not vary by race, ethnicity, insurance, or language. Diagnosis year was inversely associated with the occurrence of a treatment delay (OR: 0.944, 95% CI 0.893–0.997, p value: 0.039).
Conclusion
At our institution, race, ethnicity, insurance, and language were not associated with treatment delay. Additional research is needed to determine how our safety-net hospital delivered timely care to all patients with breast cancer, as reducing delays in care may be one mechanism by which health systems can mitigate disparities in the treatment of breast cancer.
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References
American Cancer Society. Cancer facts and figures 2022. American Cancer Society; 2022.
Howlander N, Noone A, Krapcho M, et al. SEER cancer statistics review (1975–2018). Bethesda: National Cancer Institute; 2018.
Chavez-MacGregor M, Clarke CA, Lichtensztajn DY, Giordano SH. Delayed initiation of adjuvant chemotherapy among patients with breast cancer. JAMA Oncol. 2016;2(3):322–9. https://doi.org/10.1001/JAMAONCOL.2015.3856.
Konieczny M, Cipora E, Roczniak W, Babuśka-Roczniak M, Wojtaszek M. Impact of time to initiation of treatment on the quality of life of women with breast cancer. Int J Environ Res Public Health. 2020;17(22):1–15. https://doi.org/10.3390/IJERPH17228325.
Richards MA, Westcombe AM, Love SB, Littlejohns P, Ramirez AJ. Influence of delay on survival in patients with breast cancer: a systematic review. Lancet. 1999;353(9159):1119–26. https://doi.org/10.1016/S0140-6736(99)02143-1.
Bleicher RJ. Timing and delays in breast cancer evaluation and treatment. Ann Surg Oncol. 2018;25(10):2829–38. https://doi.org/10.1245/S10434-018-6615-2.
Bleicher RJ, Ruth K, Sigurdson ER, et al. Time to surgery and breast cancer survival in the United States. JAMA Oncol. 2016;2(3):330–9. https://doi.org/10.1001/JAMAONCOL.2015.4508.
Commission on Cancer. NCDB Announces New Breast Quality Measure. https:\\www.facsorgfor-Med-Prof-Publ-Artic-Programs-News063022ncdb-Announc-New-Breast-Qual-Meas. Published online June 30, 2022.
Festa K, Hirsch AE, Cassidy MR, et al. Breast cancer treatment delays at an urban safety net hospital among women experiencing homelessness. J Community Health. 2020;45(3):452–7. https://doi.org/10.1007/s10900-019-00759-x.
Emerson MA, Golightly YM, Aiello AE, et al. Breast cancer treatment delays by socioeconomic and health care access latent classes in Black and White women. Cancer. 2020;126(22):4957–66. https://doi.org/10.1002/CNCR.33121.
Balazy KE, Benitez CM, Gutkin PM, Jacobson CE, von Eyben R, Horst KC. Delays in care associated with non-English-speaking patients with breast cancer. J Natl Compr Cancer Netw JNCCN. 2021;19(13):45–52. https://doi.org/10.6004/JNCCN.2020.7797.
Champion CD, Thomas SM, Plichta JK, et al. Disparities at the intersection of race and ethnicity: examining trends and outcomes in hispanic women with breast cancer. JCO Oncol Pract. 2022;18(5):e827–38. https://doi.org/10.1200/OP.20.00381.
Foy KC, Fisher JL, Lustberg MB, Gray DM, DeGraffinreid CR, Paskett ED. Disparities in breast cancer tumor characteristics, treatment, time to treatment, and survival probability among African American and white women. NPJ Breast Cancer. 2018. https://doi.org/10.1038/S41523-018-0059-5.
Fedewa SA, Edge SB, Stewart AK, Halpern MT, Marlow NM, Ward EM. Race and ethnicity are associated with delays in breast cancer treatment (2003–2006). J Health Care Poor Underserved. 2011;22(1):128–41. https://doi.org/10.1353/HPU.2011.0006.
Reeder-Hayes KE, Mayer SE, Olshan AF, et al. Race and delays in breast cancer treatment across the care continuum in the Carolina Breast Cancer Study. Cancer. 2019;125(22):3985–92. https://doi.org/10.1002/CNCR.32378.
Babatunde OA, Eberth JM, Felder TM, et al. Racial disparities and diagnosis-to-treatment time among patients diagnosed with breast cancer in South Carolina. J Racial Ethn Health Disparities. 2022;9(1):124–34. https://doi.org/10.1007/S40615-020-00935-Z.
Gwyn K, Bondy ML, Cohen DS, et al. Racial differences in diagnosis, treatment, and clinical delays in a population-based study of patients with newly diagnosed breast carcinoma. Cancer. 2004;100(8):1595–604. https://doi.org/10.1002/CNCR.20169.
Lund MJ, Brawley OP, Ward KC, Young JL, Gabram SSG, Eley JW. Parity and disparity in first course treatment of invasive breast cancer. Breast Cancer Res Treat. 2008;109(3):545–57. https://doi.org/10.1007/S10549-007-9675-8.
Katz SJ, Lantz PM, Paredes Y, et al. Breast cancer treatment experiences of Latinas in Los Angeles County. Am J Public Health. 2005;95(12):2225–30. https://doi.org/10.2105/AJPH.2004.057950.
Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017;67(2):93–9. https://doi.org/10.3322/CAAC.21388.
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Beaulieu-Jones, B.R., Ha, E.J., Fefferman, A. et al. Association of Race, Ethnicity, Language, and Insurance with Time to Treatment Initiation Among Women with Breast Cancer at an Urban, Academic, Safety-Net Hospital. Ann Surg Oncol 31, 1608–1614 (2024). https://doi.org/10.1245/s10434-023-14612-y
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DOI: https://doi.org/10.1245/s10434-023-14612-y