Black patients with breast cancer may face longer waits, treatment periods

Researchers identified using 2841 patients (about half black women and half whites) Carolina Breast Cancer Research Phase 3 (CBCS3) aims to investigate how the causes, treatments, and long-term outcomes of breast cancer in black and white women differ. They limited the analysis to participants with stage I to III breast cancer. Management of metastatic disease It occurs in a clinical pathway that is different from localized disease.

They found that black women were delayed in starting treatment more than white women, defined as starting 60 days or more after diagnosis (13.4% vs. 7.9%). The overall median before the start of treatment was 34 days.

Black women with both low and high SES levels (14.4% and 11.7%, respectively) saw delayed initiation of treatment. On the other hand, only 10.6% of white women in the low SES group and 6.7% of the high SES group had delays.

Dr. Mark Emerson, lead author of the University of North Carolina at Chapel Hill, said: statement.³

Black women also had a higher rate of extension of treatment (29.9% vs. 21.1%), which was defined differently depending on the treatment. For radiation, there were more than 56 days between the first and last treatment days. Radical surgery, 74 days or more; Chemotherapy, 119 days or more.

Both race and SES were significantly associated with longer treatment duration rather than delayed start of treatment, but there was still a disparity between black and white women. White women with low SES had a higher rate of prolongation of treatment than the high SES cohort (26.2% vs. 18.7%, respectively). In black women, 32.9% of the low SES group showed an extension of treatment, compared with 24.9% in the high SES cohort.

There were also significant disparities when groups were stratified by race and age. Young black women were more likely to face extended treatment periods than young white women (32% vs. 22.3%, respectively). Among older women, 27.9% of black patients had a longer treatment period, as opposed to 19.9% ​​of white patients.

Black women with high barriers to care also had a significant increase in treatment duration (42.6% compared to 28% for black women with low barriers to care). The authors state that longer treatment periods can be exacerbated throughout the course of care and can be a sensitive marker for accessing care disparities.

“It’s important to recognize that the causes of delays are complex and reflect both individual barriers and system-level factors,” said Dr. Melissa Trostar, a research author at the University of North Carolina at Chapel Hill. Stated.

The authors stated that the analysis had some limitations, including the inability to assess the long-term effects of long-term treatment on survival or recurrence. CBCS3 was also closed in 2013 and currently has a median follow-up of 7 years. This means that they are not mature enough to measure the association between treatment timeliness and long-term mortality.

They conclude that treatment delays are a complex and multifaceted problem, and both financially and logistically, the barriers to care appear to be exacerbated during the course of treatment. However, identifying specific factors that contribute to racial inequality helps researchers understand which interventions can reduce the breast cancer mortality inequality between black and white patients.

References

1. Emerson MA, Golightly YM, Aiello AE, etc. Delays in breast cancer treatment due to socio-economic and healthcare access potential classes in black and white women. cancer. Published online on September 21, 2020. doi: 10.1002 / cncr.33121

2. Breast cancer incidence in black and white women. CDC. Updated September 12, 2018. Accessed on November 2, 2020. https://www.cdc.gov/cancer/dcpc/research/articles/breast_cancer_rates_women.htm

3. Black women may be less likely to receive timely treatment for breast cancer. news release. Wiley. Accessed on November 2, 2020. https://newsroom.wiley.com/press-releases/press-release-details/2020/Black-Women-May-Be-Less-Likely-to-Receive-Timely-Treatment-for-Breast-Cancer/default. aspx