Abstract P3-10-08: Socio-demographic predictors for delay of treatment among a racially diverse, urban breast cancer population

Abstract

Abstract Background: Racial and ethnic disparity in breast cancer outcomes is a long-standing problem that continues to worsen. Recent evidence has underscored the importance of timely care, as delays in treatment can lead to decreased survival. We sought to understand predictors of delay to first treatment among a racially diverse cancer population. Methods: This is a retrospective study of breast cancer cases diagnosed between the years 2000 to 2014. Data was extracted from the cancer registry at Boston Medical Center (BMC), an urban safety net hospital. Inclusion criteria were any breast cancer diagnosis from 2000-2014, receiving first treatment at BMC, and disease stage 0-III. Cox Proportional Hazards regression analysis was performed to identify predictors of time to first treatment, defined as days from date of diagnosis to date of first treatment with surgery or neo-adjuvant chemotherapy. Covariates included age, sex, race, type of insurance, marital status, US birth, disease stage and year of diagnosis. Results: Patients were 99% female and with a mean age of 58 years (range 23-96). Among a sample of 1545 breast cancer cases, 1372 (89%) had surgery as first treatment and 173 (11%) had neoadjuvant chemotherapy. Median days to treatment was 45 days (IQR 27, 71). In the multi-variable adjusted models for both treatment groups, race, and insurance were significantly associated with delay. In the surgical group, Black race, public or no insurance, non-US born, later stage and unmarried status were associated with increased risk of delay. For example, Blacks were at higher risk for delay (HR= 1.2; 95% CI 1.37-1.04) compared to the Hispanic or White (reference) groups. Public insurance (HR = 1.19; 95%CI 1.37-1.04) and no insurance (HR = 1.43; 95%CI 1.85-1.09) was significantly associated with increased delay when compared to private insurance (reference). In patients with neoadjuvant chemotherapy as first treatment, additional significant predictors of delay were age and year of diagnosis. Conclusion: Race and insurance status were significant predictors of delay to first treatment in a population of diverse breast cancer patients seeking care at a safety net hospital. Intervention efforts need to target patients at greatest risk for treatment delays. Citation Format: Ko NY, Patts G, Battaglia TA, Wang C, Denis GV, Hirsch A, Weinberg J. Socio-demographic predictors for delay of treatment among a racially diverse, urban breast cancer population [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-10-08.