Abstract P5-14-13: Impact of race on time to treatment initiation and survival in breast cancer patients

Abstract

Abstract Background: Delays in cancer care can have a detrimental impact on breast cancer outcomes. Despite advances in breast cancer treatment and improvements in survival, disparities between racial groups persist. At our own institution, we observed worse breast cancer outcomes in Black versus White patients in spite of similar treatments received. Higher stage at diagnosis and differences in histology appeared to account for only part of the difference. In this study, we evaluate the impact of race on time to initiation of first oncology treatment and overall survival in a large cohort of breast cancer patients treated at our center. Methods: Women diagnosed with stage I-IV breast cancer between 2015 and 2020 at the Cleveland Clinic were identified from our local tumor registry. All women over the age of 18 who followed up at the Cleveland Clinic Main Campus and identified as either Black or White in the electronic medical record (EMR) were included in the initial query. Men and individuals who identified as a race other than Black or White were excluded due to small numbers. There were forty-nine patients in whom the date of first treatment was unknown. Clinical data were reviewed by author D.B. and data not available in the tumor registry were obtained from the EMR. Baseline characteristics, and time to first treatment initiation were reported. Time to treatment initiation was defined as the days from biopsy demonstrating cancer to the date of initiation of any breast cancer treatment modality (surgery, chemotherapy, endocrine therapy, or radiation therapy). Results: A total of 6095 patients were included in the analysis with a median follow-up of 2.7 years. Median age was 62 and Black patients were slightly older than White patients (63 years [range 21-98] versus 62 [range 21-99]; p=0.048). Fewer Black patients had private insurance (38% versus 51%) and more had Medicaid or Medicare compared to White patients (59% versus 45%) (p<0.001). Only 1% of patients had no insurance and this was similar for both Black and White patients. The time from diagnosis to treatment differed by race. Black patients had a median of 36 days from diagnosis to treatment and White patients had a median of 32 days from diagnosis to treatment (p<0.001). Three-year overall survival was 86% (95% CI: 83-89%) for Black patients and 92% (95%CI: 91%-93%) for White patients (p<0.0001). No difference was observed in breast cancer recurrence rates by race (p=0.56). Additional analyses will investigate the contribution of comorbidities, cancer stage, histology, and other patient related factors to racial disparities in overall survival and time to treatment. Conclusion:. Our study highlights real world data on racial disparities in breast cancer treatment initiation and overall survival. Further investigation will seek to identify the impact of patient related factors on these important outcomes. It is critically important for breast cancer treatment teams to be aware of these racial disparities to implement interventions that can attempt to limit them. Citation Format: Diana Basali, Emily C. Zabor, Narcissa Houston, Halle CF Moore. Impact of race on time to treatment initiation and survival in breast cancer patients [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-14-13.