Race, Geography Associated with Breast Cancer Treatment Delays

According to the results of a retrospective study published in , race and geographic location appeared to be significantly associated with an increased risk of delayed treatment among women with breast cancer in North Carolina. C.cancer.

The degree of racial disparity in treatment delays varies widely by region, with the age-adjusted relative risk of delays in the highest-risk regions being approximately double that in the lowest-risk regions for both Black and non-Black patients. Yes, writes the researchers.

Background

Long delays in breast cancer treatment can affect survival. Associated with a 30–60 day delay associated with decreased disease-specific and overall survivalaccording to the research background.

Several state-specific and national studies have shown that black patients are disproportionately at risk of delayed breast cancer treatment, so researchers should consider geography and race in accessing timely cancer treatment. and attempted to examine potential relationships with ethnic differences.

“Black and Hispanic breast cancer patients receive surgical care in different hospitals than non-Hispanic white patients, are less involved in the selection of surgeons and treatment centers, and rely less on reputation in choosing treatment. No,” writes the researcher.

methodology

This population-based, retrospective study included 32,626 adults (median age at diagnosis, 67 years, 19% black) with stage I-III breast cancer from 2004 to 2017 in the North Carolina Central Cancer Registry. was included.

Study participants had previously undergone breast conservation surgery (64%), mastectomy (27.1%) or chemotherapy (9%) as initial treatment.

Risk of treatment delay served as the primary outcome of interest. The researchers specified a treatment delay of 60 days or more from diagnosis to first treatment.They grouped counties across North Carolina into his nine Area Health Education Center regions and divided race into black and non-black. dichotomy with blacks.

Main findings

Researchers found that black patients with breast cancer experienced treatment delays more frequently than non-black patients (15% vs. 8%).

Black patients (RR = 2.1; 95% CI, 1.6-2.6) and non-Black patients (RR = 1.9; 95%CI, 1.5-2.3).

Compared with non-black patients, black patients were more likely to receive chemotherapy as initial treatment (14.8% vs. 7.6%), stage III disease (15.2% vs. 9.3%) and hormone receptor-negative tumors (29.3%). % vs 9.3%). 15.6%) and he lives within 5 miles of the place of treatment (30.6% vs. 25.2%).

Black patients had a longer median time to treatment than non-Black patients (30 vs. 26 days).

The magnitude of racial differences in treatment delays varied from 0% to 9.4% across the nine regions.

“On average, about 1 in 7 black women who participated in our study experienced long delays, but this risk varies depending on where the woman lives within the state.,” Catherine E. Leader Hayes, MD, MBA, MS, An associate professor of medicine at the University of North Carolina Lineberger Comprehensive Cancer Center said in a press release: “These delays were not explained by the patient’s distance from the cancer treatment facility, the specific stage of cancer or type of treatment, or the insurance they had.”

next step

The researchers noted that future studies should consider both high-risk geographic regions and high-risk patient groups for interventions to prevent delays. We are working on developing and testing tools to help patients communicate with their healthcare system about treatment delays.

“These findings suggest that the structure of the local healthcare system, rather than the patient’s own characteristics, may better explain why some patients experience treatment delays and other adverse cancer outcomes. suggests that,” said Reeder-Hayes.

References:

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race and medicine