Awareness of racial/ethnic inequities in time to treatment among breast cancer providers.

Abstract

584 Background: Cancer patients who self-identify as Black and Latinx are more likely to receive delays in care compared with Non-Latinx White patients. Research suggests that while providers are aware of racial/ethnic inequities in access to treatment at a national-level, they fail to recognize these differences at the hospital- or individual-level. This phenomenon is not well understood and has yet to be studied among oncologists. We sought to evaluate awareness of national and local time-to-treatment inequities in breast cancer providers. Methods: We conducted an educational intervention at the Smilow Cancer Hospital, the clinical arm of the Yale Cancer Center, in February 2023. Breast cancer providers (including breast surgeons, medical oncologists, radiation oncologists, breast radiologists, and advanced practice nurses) completed an online survey that assessed their understanding of treatment inequities at three levels (national, hospital, and individual) before and after they watched a 20-minute live presentation. The presentation included real-world national and breast-team specific data on differences in time-to-treatment metrics by race/ethnicity from the Flatiron electronic health record-derived de-identified database. Differences between surveys were evaluated with Fisher’s exact tests. Results: Among 18 providers, most were female (78%), Non-Latinx White (83%), had an average of 15 years of experience (SD=10), and half reported at least 10-25% of the patients they care for were non-White. Awareness of race/ethnicity as a factor in influencing differences in oncological care increased significantly (33% to 77 %, p = 0.02) pre-to-post intervention at the hospital-level but did not significantly change at the national- (78% to 83%, p > 0.05) or individual- (17% to 28%, p > 0.05) level. Providers identified adverse social determinants of health, such as housing insecurity, poor employment conditions, and food insecurity, as the main cause of inequities both nationally and within their disease team. On average, at the post-survey, most providers agreed that patient factors (62%) rather than provider factors (30%) were driving differences in oncological care metrics. However, they reported that larger systems, such as healthcare agencies, government, and providers (all 89%), rather than patients, were responsible for reducing these inequities. Conclusions: In this pilot study, a brief educational intervention increased awareness of local hospital-level factors, but not national- and individual-level factors, associated with racial/ethnic inequities in time to cancer treatment. As the oncology field continues to address inequities in care, it is crucial for providers to not only acknowledge the existence of these inequities but also to establish successful interventions to reduce these inequities within their own disease team.