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11.01.2022 | Preclinical study

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

verfasst von: Christopher G. Verdone, Jennifer A. Bayron, Cecilia Chang, Chihsiung E. Wang, Elin R. Sigurdson, Allison A. Aggon, Andrea Porpiglia, Maureen V. Hill, Mary T. Pronovost, Richard J. Bleicher

Erschienen in: Breast Cancer Research and Treatment | Ausgabe 3/2022

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Abstract

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.
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Literatur
1.
Zurück zum Zitat Bleicher RJ et al (2016) Time to surgery and breast cancer survival in the United States. JAMA Oncol 2(3):330–339CrossRef Bleicher RJ et al (2016) Time to surgery and breast cancer survival in the United States. JAMA Oncol 2(3):330–339CrossRef
2.
Zurück zum Zitat Coughlin SS (2019) Social determinants of breast cancer risk, stage, and survival. Breast Cancer Res Treat 177(3):537–548CrossRef Coughlin SS (2019) Social determinants of breast cancer risk, stage, and survival. Breast Cancer Res Treat 177(3):537–548CrossRef
3.
Zurück zum Zitat Smith EC, Ziogas A, Anton-Culver H (2013) Delay in surgical treatment and survival after breast cancer diagnosis in young women by race/ethnicity. JAMA Surg 148(6):516–523CrossRef Smith EC, Ziogas A, Anton-Culver H (2013) Delay in surgical treatment and survival after breast cancer diagnosis in young women by race/ethnicity. JAMA Surg 148(6):516–523CrossRef
4.
Zurück zum Zitat Eaglehouse YL et al (2019) Racial differences in time to breast cancer surgery and overall survival in the US military health system. JAMA Surg 154(3):e185113CrossRef Eaglehouse YL et al (2019) Racial differences in time to breast cancer surgery and overall survival in the US military health system. JAMA Surg 154(3):e185113CrossRef
5.
Zurück zum Zitat Iqbal J et al (2015) Differences in breast cancer stage at diagnosis and cancer-specific survival by race and ethnicity in the United States. JAMA 313(2):165–173CrossRef Iqbal J et al (2015) Differences in breast cancer stage at diagnosis and cancer-specific survival by race and ethnicity in the United States. JAMA 313(2):165–173CrossRef
6.
Zurück zum Zitat Reeder-Hayes KE et al (2019) Race and delays in breast cancer treatment across the care continuum in the Carolina breast cancer study. Cancer 125(22):3985–3992CrossRef Reeder-Hayes KE et al (2019) Race and delays in breast cancer treatment across the care continuum in the Carolina breast cancer study. Cancer 125(22):3985–3992CrossRef
8.
Zurück zum Zitat Hossain F et al (2019) Neighborhood social determinants of triple negative breast cancer. Front Public Health 7:18CrossRef Hossain F et al (2019) Neighborhood social determinants of triple negative breast cancer. Front Public Health 7:18CrossRef
9.
Zurück zum Zitat Roseland ME et al (2017) Influence of clinical, societal, and treatment variables on racial differences in ER-/PR- breast cancer survival. Breast Cancer Res Treat 165(1):163–168CrossRef Roseland ME et al (2017) Influence of clinical, societal, and treatment variables on racial differences in ER-/PR- breast cancer survival. Breast Cancer Res Treat 165(1):163–168CrossRef
10.
Zurück zum Zitat Newman LA, Kaljee LM (2017) Health disparities and triple-negative breast cancer in African American women: a review. JAMA Surg 152(5):485–493CrossRef Newman LA, Kaljee LM (2017) Health disparities and triple-negative breast cancer in African American women: a review. JAMA Surg 152(5):485–493CrossRef
11.
Zurück zum Zitat DeGuzman PB et al (2017) Impact of urban neighborhood disadvantage on late stage breast cancer diagnosis in Virginia. J Urban Health 94(2):199–210CrossRef DeGuzman PB et al (2017) Impact of urban neighborhood disadvantage on late stage breast cancer diagnosis in Virginia. J Urban Health 94(2):199–210CrossRef
12.
Zurück zum Zitat Polverini AC et al (2016) Time to treatment: measuring quality breast cancer care. Ann Surg Oncol 23(10):3392–3402CrossRef Polverini AC et al (2016) Time to treatment: measuring quality breast cancer care. Ann Surg Oncol 23(10):3392–3402CrossRef
13.
Zurück zum Zitat Bleicher RJ et al (2019) Treatment delays from transfers of care and their impact on breast cancer quality measures. Breast Cancer Res Treat 173(3):603–617CrossRef Bleicher RJ et al (2019) Treatment delays from transfers of care and their impact on breast cancer quality measures. Breast Cancer Res Treat 173(3):603–617CrossRef
14.
Zurück zum Zitat Bleicher RJ et al (2012) Preoperative delays in the US medicare population with breast cancer. J Clin Oncol 30(36):4485–4492CrossRef Bleicher RJ et al (2012) Preoperative delays in the US medicare population with breast cancer. J Clin Oncol 30(36):4485–4492CrossRef
15.
Zurück zum Zitat Bleicher RJ (2018) Timing and delays in breast cancer evaluation and treatment. Ann Surg Oncol 25(10):2829–2838CrossRef Bleicher RJ (2018) Timing and delays in breast cancer evaluation and treatment. Ann Surg Oncol 25(10):2829–2838CrossRef
18.
Zurück zum Zitat Bleicher RJ et al (2009) Association of routine pretreatment magnetic resonance imaging with time to surgery, mastectomy rate, and margin status. J Am Coll Surg 209(2):180–7 (quiz 294–5)CrossRef Bleicher RJ et al (2009) Association of routine pretreatment magnetic resonance imaging with time to surgery, mastectomy rate, and margin status. J Am Coll Surg 209(2):180–7 (quiz 294–5)CrossRef
19.
Zurück zum Zitat Hulvat M et al (2010) Time from diagnosis to definitive operative treatment of operable breast cancer in the era of multimodal imaging. Surgery 148(4):746–50 (discussion 750–1)CrossRef Hulvat M et al (2010) Time from diagnosis to definitive operative treatment of operable breast cancer in the era of multimodal imaging. Surgery 148(4):746–50 (discussion 750–1)CrossRef
20.
Zurück zum Zitat Ferrante JM, Chen PH, Kim S (2008) The effect of patient navigation on time to diagnosis, anxiety, and satisfaction in urban minority women with abnormal mammograms: a randomized controlled trial. J Urban Health 85(1):114–124CrossRef Ferrante JM, Chen PH, Kim S (2008) The effect of patient navigation on time to diagnosis, anxiety, and satisfaction in urban minority women with abnormal mammograms: a randomized controlled trial. J Urban Health 85(1):114–124CrossRef
21.
Zurück zum Zitat Dietz JR et al (2020) Recommendations for prioritization, treatment, and triage of breast cancer patients during the COVID-19 pandemic. The COVID-19 pandemic breast cancer consortium. Breast Cancer Res Treat 181(3):487–497CrossRef Dietz JR et al (2020) Recommendations for prioritization, treatment, and triage of breast cancer patients during the COVID-19 pandemic. The COVID-19 pandemic breast cancer consortium. Breast Cancer Res Treat 181(3):487–497CrossRef
Metadaten
Titel
A tool to predict disparities in the timeliness of surgical treatment for breast cancer patients in the USA
verfasst von
Christopher G. Verdone
Jennifer A. Bayron
Cecilia Chang
Chihsiung E. Wang
Elin R. Sigurdson
Allison A. Aggon
Andrea Porpiglia
Maureen V. Hill
Mary T. Pronovost
Richard J. Bleicher
Publikationsdatum
11.01.2022
Verlag
Springer US
Erschienen in
Breast Cancer Research and Treatment / Ausgabe 3/2022
Print ISSN: 0167-6806
Elektronische ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-021-06460-9

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