Disparities in outcomes for vulnerable women is an ongoing problem. Homelessness and breast cancer treatment outcomes is understudied. This is a descriptive study exploring types of homelessness and treatment delays at an urban safety net hospital providing care to a vulnerable patient population.This study is a retrospective chart review of homeless female patients diagnosed with breast cancer between January 1, 2000 and December 31, 2014. Data for this study were acquired from the hospital cancer registry and electronic medical record. All demographic characteristics, time to treatment and factors related to delays to treatment were analyzed descriptively, reporting frequencies and proportions. The total number of individuals analyzed was 24. All except two subjects were delayed to treatment (≥ 30 days from diagnosis to treatment). Most women in this cohort were categorized as chronically homeless (46%) with the rest categorized as transitionally (29%) or episodically (12%) homeless. The majority of subjects (70%) were Black, non-Hispanic. All except one subject were publicly insured (71% Medicaid; 12% Medicare) or uninsured (8%). Regardless of type of homelessness, most subjects were either 30–60 or 60–90 days delayed. Those who were chronically homeless experienced significantly more delays to first treatment (56% of those who were delayed 30–60 days and 57% of those who were delayed 60–90 days; p value 0.006) than those who were episodically or transitionally homeless. Significant delays and barriers to breast cancer treatment exist among women experiencing homelessness. Further studies to improve breast cancer care for homeless women are warranted.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Siegel, R. L., Miller, K. D., & Jemal, A. (2018). Cancer statistics. 2018. CA: A Cancer Journal for Clinicians, 68(1), 7–30. https://doi.org/10.3322/caac.21442.
DeSantis, C. E., Ma, J., Goding Sauer, A., Newman, L. A., & Jemal, A. (2017). Breast cancer statistics, 2017, racial disparity in mortality by state. CA: A Cancer Journal for Clinicians, 67(6), 439–448. https://doi.org/10.3322/caac.21412.
Zhan, Q.-H., Fu, J.-Q., Fu, F.-M., Zhang, J., & Wang, C. (2018). Survival and time to initiation of adjuvant chemotherapy among breast cancer patients: a systematic review and meta-analysis. Oncotarget, 9(2), 2739–2751. https://doi.org/10.18632/oncotarget.23086.
Gagliato, DdeM., Gonzalez-Angulo, A. M., Lei, X., Theriault, R. L., Giordano, S. H., Valero, V., et al. (2014). Clinical impact of delaying initiation of adjuvant chemotherapy in patients with breast cancer. Journal of Clinical Oncology, 32(8), 735. https://doi.org/10.1200/JCO.2013.49.7693.
Baggett, T. P., Chang, Y., Porneala, B. C., Bharel, M., Singer, D. E., & Rigotti, N. A. (2015). Disparities in cancer incidence, stage, and mortality at Boston Health Care for the Homeless Program. American Journal of Preventive Medicine, 49(5), 694–702. https://doi.org/10.1016/j.amepre.2015.03.038.
Ending Homelessness. (2012). Retrieved from http://commonwealthlandtrust.org/values-and-impact/ending-homelessness/.
Bleicher, R. J. (2018). Timing and delays in breast cancer evaluation and treatment. Annals of Surgical Oncology, 25(10), 2829–2838. https://doi.org/10.1245/s10434-018-6615-2.
Bleicher, R. J., Ruth, K., Sigurdson, E. R., Beck, J. R., Ross, E., Wong, Y.-N., et al. (2016). time to surgery and breast cancer survival in the United States. JAMA Oncology, 2(3), 330–339. https://doi.org/10.1001/jamaoncol.2015.4508.
Jaiswal, K., Hull, M., Furniss, A. L., Doyle, R., Gayou, N., & Bayliss, E. (2018). Delays in diagnosis and treatment of breast cancer: A safety-net population profile. Journal of the National Comprehensive Cancer Network: JNCCN, 16(12), 1451–1457. https://doi.org/10.6004/jnccn.2018.7067.
Baggett, T. P., O’Connell, J. J., Singer, D. E., & Rigotti, N. A. (2010). The Unmet health care needs of homeless adults: A national study. American Journal of Public Health, 100(7), 1326–1333. https://doi.org/10.2105/AJPH.2009.180109.
The National Academies of Science Engineering and Medicine. (2018). Permanent supportive housing: evaluating the evidence for improving health outcomes among people experiencing chronic homelessness. Washington, D.C.: National Academies Press. https://doi.org/10.17226/25133.
Kowalczyk, L. (2018, December 29). A double diagnosis- cancer while poor. The Boston Globe. Retrieved from https://www.bostonglobe.com/metro/2018/12/29/double-diagnosis/6dlK3khlR6jrOBXpNIMiiI/story.html.
Conflict of interest
The authors declare that they have no conflict of interest.
About this article
Cite this article
Festa, K., Hirsch, A.E., Cassidy, M.R. et al. Breast Cancer Treatment Delays at an Urban Safety Net Hospital Among Women Experiencing Homelessness. J Community Health 45, 452–457 (2020). https://doi.org/10.1007/s10900-019-00759-x
- Breast cancer
- Treatment delay
- Safety net hospital