Skip to main content

Advertisement

SpringerLink
Log in

Race and Site of Care Impact Treatment Delays in Older Women with Non-Metastatic Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Women ≥ 65 years of age are less likely to receive guideline-concordant breast cancer care. Given existing racial/ethnic disparities, older minority breast cancer patients may be especially prone to inequalities in care. How site of care impacts older breast cancer patients is not well defined. We sought to evaluate the association between race/ethnicity and breast cancer treatment delays in older women treated at minority-serving hospitals (MSHs) versus non-MSHs.

Methods

Women ≥ 65 years of age treated for non-metastatic breast cancer were identified in the National Cancer Database (2010–2017). Treatment delay was defined as > 90 days from diagnosis to initial treatment. MSHs were defined as the top decile of hospitals serving predominantly Black or Hispanic patients. Multivariable logistic regression models adjusted for patient, tumor, and hospital characteristics were used to determine the odds of treatment delay for women at MSHs versus non-MSHs across racial/ethnic groups.

Results

Overall, 557,816 women were identified among 41 MSHs and 1146 non-MSHs. Average time to treatment was 33.71 days (standard deviation 26.92 days). Older women at MSHs were more likely to experience treatment delays than those at non-MSHs (odds ratio 1.28, 95% confidence interval 1.21–1.36). Regardless of where they received care, minorities were more likely to experience treatment delays than non-Hispanic White women.

Conclusions

Although 97% of older women treated at Commission on Cancer-accredited hospitals received timely breast cancer care, minorities and those treated at MSHs were more likely to experience treatment delays. Interventions addressing barriers to timely breast cancer care at MSHs may be an effective approach to reducing racial/ethnic disparities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. DeSantis CE, Ma J, Gaudet MM, et al. Breast cancer statistics, 2019. CA Cancer J Clin. 2019;69:438–51. https://doi.org/10.3322/caac.21583.

    Article  PubMed  Google Scholar 

  2. Smith BD, Jiang J, McLaughlin SS, et al. Improvement in breast cancer outcomes over time: are older women missing out? J Clin Oncol. 2011;29:4647–53. https://doi.org/10.1200/JCO.2011.35.8408.

    Article  PubMed  Google Scholar 

  3. Freedman RA, Keating NL, Lin NU, et al. Breast cancer-specific survival by age: Worse outcomes for the oldest patients. Cancer. 2018;124(10):2184–91. https://doi.org/10.1002/cncr.31308.

    Article  CAS  PubMed  Google Scholar 

  4. Wheeler SB, Reeder-Hayes KE, Carey LA. Disparities in breast cancer treatment and outcomes: biological, social, and health system determinants and opportunities for research. Oncologist. 2013;18(9):986–93. https://doi.org/10.1634/theoncologist.2013-0243.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Yedjou CG, Sims JN, Miele L, et al. Health and racial disparity in breast cancer. Adv Exp Med Biol. 2019;1152:31–49. https://doi.org/10.1007/978-3-030-20301-6_3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Jemal A, Robbins AS, Lin CC, et al. Factors that contributed to black-white disparities in survival among nonelderly women with breast cancer between 2004 and 2013. J Clin Oncol. 2018;36:14–24. https://doi.org/10.1220/JCO.2017.73.7932.

    Article  PubMed  Google Scholar 

  7. Kantor O, Wang ML, Bertrand K, Pierce L, Freedman RA, Chavez-MacGregor M, King TA, Mittendorf EA. Racial and socioeconomic disparities in breast cancer outcomes within the AJCC pathologic prognostic staging system. Ann Surg Oncol. 2022;29(1):686–96. https://doi.org/10.1245/s10434-021-10527-8.

    Article  PubMed  Google Scholar 

  8. Krimphove MJ, Fletcher SA, Cole AP, et al. Quality of care in the treatment of localized intermediate and high risk prostate cancer at minority serving hospitals. J Urol. 2019;201(4):735–41. https://doi.org/10.1016/j.juro.2018.10.024.

    Article  PubMed  Google Scholar 

  9. Cole AP, Nguyen D-D, Meirkhanov A, et al. Association of care at minority-serving vs non–minority-serving hospitals with use of palliative care among racial/ethnic minorities with metastatic cancer in the United States. JAMA Netw Open. 2019;2(2):e187633. https://doi.org/10.1001/jamanetworkopen.2018.7633.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Joynt KE, Orav EJ, Jha AK. Patient race, site of care, and 30-day readmission rates among elderly Americans. JAMA. 2011;305(7):675–81. https://doi.org/10.1001/jama.2011.123.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Danziger J, de la Hoz MÁA, Li W, et al. Temporal trends in critical care outcomes in U.S. Minority-serving hospitals. Am J Respir Crit Care Med. 2020;201(6):681–7. https://doi.org/10.1164/rccm.201903-0623OC.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Jha AK, Orav EJ, Li Z, Epstein AM. Concentration and quality of hospitals that care for elderly black patients. Arch Intern Med. 2007;167(11):1177–82. https://doi.org/10.1001/archinte.167.11.1177.

    Article  PubMed  Google Scholar 

  13. Fletcher SA, Gild P, Cole AP, et al. The effect of treatment at minority-serving hospitals on outcomes for bladder cancer. Urol Oncol. 2018;36(5):238.e7-238.e17. https://doi.org/10.1016/j.urolonc.2018.01.010.

    Article  Google Scholar 

  14. Creanga AA, Bateman BT, Mhyre JM, Kuklina E, Shilkrut A, Callaghan WM. Performance of racial and ethnic minority-serving hospitals on delivery-related indicators. Am J Obstet Gynecol. 2014;211(6):647.e1-16. https://doi.org/10.1016/j.ajog.2014.06.006.

    Article  Google Scholar 

  15. Gaskin DJ, Spencer CS, Richard P, Anderson G, Powe NR, LaVeist TA. Do minority patients use lower quality hospitals? Inquiry. 2011;48(3):209–20. https://doi.org/10.5034/inquiryjrnl_48.03.06.

    Article  PubMed  Google Scholar 

  16. Bleicher RJ, Ruth K, Sigurdson ER, et al. Time to surgery and breast cancer survival in the United States [published erratum appears in JAMA Oncol. 2016. Sep; 2(9):1244]. JAMA Oncol. 2016;2(3):330–9. https://doi.org/10.1001/jamaoncol.2015.4508.

    Article  PubMed  PubMed Central  Google Scholar 

  17. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hershman DL, Wang X, McBride R, Jacobson JS, Grann VR, Neugut AI. Delay of adjuvant chemotherapy initiation following breast cancer surgery among elderly women. Breast Cancer Res Treat. 2006;99(3):313–21. https://doi.org/10.1007/s10549-006-9206-z.

    Article  CAS  PubMed  Google Scholar 

  19. de Melo Gagliato D, Lei X, Giordano SH, et al. Impact of delayed neoadjuvant systemic chemotherapy on overall survival among patients with breast cancer. Oncologist. 2020;25(9):749–57. https://doi.org/10.1634/theoncologist.2019-0744.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. National College of Surgeons. 2021. Available at: https://www.facs.org/quality-programs/cancer/ncdb. Accessed 8 Sep 2021.

  21. Facility Oncology Registry Data Standards (FORDS). 2016. Available at: https://www.facs.org/-/media/files/quality-programs/cancer/ncdb/fords-2016.ashx. Accessed 21 Dec 2021.

  22. Gorin SS, Heck JE, Cheng B, Smith SJ. Delays in breast cancer diagnosis and treatment by racial/ethnic group. Arch Intern Med. 2006;166(20):2244–52. https://doi.org/10.1001/archinte.166.20.2244.

    Article  PubMed  Google Scholar 

  23. Polverini AC, Nelson RA, Marcinkowski E, et al. Time to treatment: measuring quality breast cancer care. Ann Surg Oncol. 2016;23(10):3392–402. https://doi.org/10.1245/s10434-016-5486-7.

    Article  PubMed  Google Scholar 

  24. Navarro S, Yang Y, Ochoa C, et al. Breast cancer surgical delays in a racially and ethnically diverse California cancer registry cohort. J Clin Oncol. 2021;39(15 Suppl):e12589. https://doi.org/10.1200/JCO.2021.39.15_suppl.e12589.

    Article  Google Scholar 

  25. 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. 2020. https://doi.org/10.1200/OP.20.00381.

    Article  PubMed  Google Scholar 

  26. Adams SV, Bansal A, Burnett-Hartman AN, et al. Cancer treatment delays in American Indians and Alaska natives enrolled in medicare. J Health Care Poor Underserved. 2017;28(1):350–61. https://doi.org/10.1353/hpu.2017.0027.

    Article  PubMed  Google Scholar 

  27. Wilson RT, Adams-Cameron M, Burhansstipanov L, et al. Disparities in breast cancer treatment among American Indian, Hispanic and non-Hispanic white women enrolled in medicare. J Health Care Poor Underserved. 2007;18(3):648–64. https://doi.org/10.1353/hpu.2007.0071.

    Article  PubMed  Google Scholar 

  28. Jacobson JS, Grann VR, Hershman D, Troxel AB, Li H, Neugut AI. Breast biopsy and race/ethnicity among women without breast cancer. Cancer Detect Prev. 2006;30(2):129–33. https://doi.org/10.1016/j.cdp.2006.02.002.

    Article  PubMed  Google Scholar 

  29. Chagpar AB, Dupont E, Chiba A, et al; SHAVE2 authors. Are we choosing wisely? Drivers of preoperative MRI use in breast cancer patients. Am J Surg. 2021. https://doi.org/10.1016/j.amjsurg.2021.10.028

  30. Butler PD, Familusi O, Serletti JM, et al. Influence of race, insurance status, and geographic access to plastic surgeons on immediate breast reconstruction rates. Am J Surg. 2018;215(6):987–94. https://doi.org/10.1016/j.amjsurg.2017.09.037.

    Article  PubMed  Google Scholar 

  31. Chapman-Davis E, Zhou ZN, Fields JC, et al. Racial and ethnic disparities in genetic testing at a hereditary breast and ovarian cancer center. J Gen Intern Med. 2021;36(1):35–42. https://doi.org/10.1007/s11606-020-06064-x.

    Article  PubMed  Google Scholar 

  32. Santosa KB, Qi J, Kim HM, et al. Effect of patient age on outcomes in breast reconstruction: results from a multicenter prospective study. J Am Coll Surg. 2016;223(6):745–54. https://doi.org/10.1016/j.jamcollsurg.2016.09.003.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Boddicker NJ, Hu C, Weitzel JN, et al. Risk of late-onset breast cancer in genetically predisposed women. J Clin Oncol. 2021;39(31):3430–40. https://doi.org/10.1200/JCO.21.00531.

    Article  CAS  PubMed  Google Scholar 

  34. Thompson CA, Gomez SL, Hastings KG, et al. The burden of cancer in Asian Americans: a report of national mortality trends by Asian ethnicity. Cancer Epidemiol Biomark Prev. 2016;25(10):1371–82. https://doi.org/10.1158/1055-9965.EPI-16-0167.

    Article  Google Scholar 

  35. Trinh QD, Nguyen PL, Leow JJ, et al. Cancer-specific mortality of Asian Americans diagnosed with cancer: a nationwide population-based assessment. J Natl Cancer Inst. 2015;107(6):djv054. https://doi.org/10.1093/jnci/djv054.

    Article  PubMed  Google Scholar 

  36. Zamora SM, Pinheiro PS, Gomez SL, et al. Disaggregating Hispanic American cancer mortality burden by detailed ethnicity. Cancer Epidemiol Biomark Prev. 2019;28(8):1353. https://doi.org/10.1158/1055-9965.EPI-18-0872.

    Article  Google Scholar 

  37. National Quality Measures for Breast Centers. 2021. Available at: https://www.nqmbc.org/quality-measure-program/quality-measures.cms. Accessed 8 Sep 2021.

  38. Commission on Cancer. 2019. Available at: https://www.facs.org/-/media/files/quality-programs/cancer/ncdb/quality-measures.ashx. Accessed 22 Sep 2021.

  39. Mohanty S, Bilimoria KY. Comparing national cancer registries: the national cancer data base (NCDB) and the surveillance, epidemiology, and end results (SEER) program. J Surg Oncol. 2014;109(7):629–30. https://doi.org/10.1002/jso.23568.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Rachel Freedman, MD, MPH, for her advice and support.

Author information

Authors and Affiliations

  1. Harvard Medical School, Boston, MA, USA

    Julia H. Song BA

  2. Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA

    Julia H. Song BA & Christina A. Minami MD, MS

  3. Division of Breast Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Olga Kantor MD, MS, Elizabeth A. Mittendorf MD, PhD, Tari A. King MD & Christina A. Minami MD, MS

  4. Breast Oncology Program, Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA, USA

    Olga Kantor MD, MS, Elizabeth A. Mittendorf MD, PhD, Tari A. King MD & Christina A. Minami MD, MS

Authors
  1. Julia H. Song BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Olga Kantor MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elizabeth A. Mittendorf MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tari A. King MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christina A. Minami MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christina A. Minami MD, MS.

Ethics declarations

Disclosures

Tari A. King is a speaker and advisory board member for Exact Sciences, formerly Genomic Health, and has served as a faculty member of PrecisCA cancer information service. Elizabeth A. Mittendorf has no relevant disclosures for this work but reports compensated service on scientific advisory boards for AstraZeneca, Exact Sciences, Merck, Roche/Genentech; uncompensated service on steering committees for Bristol Myers Squibb, Lilly, and Roche/Genentech; and institutional research support from Roche/Genentech (via SU2C grant) and Gilead. Julia H. Song, Olga Kantor, and Christina A. Minami have no disclosures to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 23 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Song, J.H., Kantor, O., Mittendorf, E.A. et al. Race and Site of Care Impact Treatment Delays in Older Women with Non-Metastatic Breast Cancer. Ann Surg Oncol 29, 4103–4114 (2022). https://doi.org/10.1245/s10434-022-11543-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-022-11543-y

Search

Navigation