A tool to predict disparities in the timeliness of surgical treatment for breast cancer patients in the USA

Purpose Breast cancer outcomes are impaired by both delays and disparities in treatment. This study was performed to assess their relationship and to provide a tool to predict patient socioeconomic factors associated with risk for delay. Methods The National Cancer Database was reviewed between 2004...

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Bibliographic Details
Published in:Breast cancer research and treatment 2022-02, Vol.191 (3), p.513-522
Main Authors: Verdone, Christopher G., Bayron, Jennifer A., Chang, Cecilia, Wang, Chihsiung E., Sigurdson, Elin R., Aggon, Allison A., Porpiglia, Andrea, Hill, Maureen V., Pronovost, Mary T., Bleicher, Richard J.
Format: Article
Language:English
Subjects:
Aged
Breast cancer
Breast Neoplasms - epidemiology
Breast Neoplasms - surgery
Cancer
Cancer patients
Cancer research
Cancer therapies
Chemotherapy
Endocrine therapy
Ethnicity
Female
Health aspects
Healthcare Disparities
Humans
Medicaid
Medicare
Medicine
Medicine & Public Health
Metastases
Metastasis
Minority & ethnic groups
Nomograms
Oncology
Oncology, Experimental
Patients
Preclinical Study
Prognosis
Sociodemographics
Socioeconomic Factors
Surgery
Tumors
United States - epidemiology
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Summary:Purpose Breast cancer outcomes are impaired by both delays and disparities in treatment. This study was performed to assess their relationship and to provide a tool to predict patient socioeconomic factors associated with risk for delay. Methods The National Cancer Database was reviewed between 2004 and 2017 for patients with non-metastatic breast cancer managed with upfront surgery. Times to treatment were measured from the date of diagnosis. Patient, tumor, and treatment factors were assessed with attention paid to sociodemographic variables. Results 514,187 patients remained after exclusions, with 84.3% White, 10.8% Black, 3.7% Asian, and Hispanics comprising 5.6% of the cohort. Medicaid and uninsured patients had longer mean adjusted time to surgery (≥ 46 days) versus private (36.7 days), Medicare (35.9 days), or other governmental insurance (39.8 days). After adjustment, Black race and Hispanic ethnicity were most impactful, adding 6.0 and 6.4 preoperative days, 10.9 and 11.5 days to chemotherapy, 11.1 and 9.1 days to radiation, and 12.5 and 8.9 days to endocrine therapy, respectively. Income, education, and insurance, among other factors, also affected delay. A nomogram, including race and sociodemographic factors, was created to predict the risk of preoperative delay. Conclusion  Significant disparities exist in timeliness of care for factors, including but not limited to, race and ethnicity. Although exact causes cannot be discerned, these data indicate population subsets whose intervals of care risk being longer than those specified by national quality standards. The nomogram created here may help direct resources to those at highest risk of incurring a treatment delay.
ISSN:0167-6806
1573-7217
DOI:10.1007/s10549-021-06460-9