Time to diagnosis and treatment initiation during the COVID-19 pandemic among rural patients with cancer.

Abstract

132 Background: Time to diagnosis (TTD) and treatment initiation (TTI) are important measures of access and quality of cancer care, but little is known about TTD and TTI for rural cancer patients. Rural residents experience disproportionate burdens of cancer including higher incidence and mortality, and many rural patients face challenges in health care access. Further understanding of TTD and TTI in rural areas is essential to improving the quality of cancer care delivery and cancer outcomes in rural areas. In this study, we describe TTD and TTI among rural cancer patients in Hawaii during the COVID-19 pandemic. Methods: Information about TTD and TTI was collected from 80 rural cancer patients enrolled on a care coordination study between Sept. 2020 and Dec. 2021. Participants were receiving active treatment for any cancer and residing in rural areas in Hawaii. We used descriptive statistics to describe TTD and TTI for the overall sample and specifically for those with breast and GI cancers, the two most common cancers in this study sample. Results: Participants were 56% female, with the mean age of 63 (SD = 12.1). 43% were White/Caucasian, 30% Native Hawaiian, and 25% two or more race. Reporting of symptoms to a healthcare provider led to diagnosis for 61.6% of the overall sample, whereas 38.4% received diagnosis following screening. For breast cancer, 36.8% indicated symptoms led to diagnosis, and 63.2% by screening. Among those with GI cancer, 76.5% reported symptoms led to diagnosis, and 23.5% by screening. Overall, 62.5% of participants reported TTD of within one month (< = 30 days) of screening or reporting symptoms to a healthcare provider (30-day TTD 62.5% for breast and 60.0% for GI). Median TTI for the overall sample was 60.6 days (IQR 30-62). For those with breast and GI cancers, median TTI was 61.0 (IQR 31-70) and 31.0 (IQR 0-61) days, respectively. Conclusions: Our results demonstrate that although TTD in this rural sample was comparable to other studies, TTI overall, and particularly for those with breast cancer, was nearly twice the TTI reported in other population-based studies. Delays in cancer treatment initiation have been associated with worse survival for breast and other cancers, especially among underserved populations. Our findings indicate that during the COVID-19 pandemic, rural residents in Hawaii experienced substantial delays in cancer treatment initiation. This study highlights the importance of addressing timely healthcare system access to minimize delays in treatment initiation and to improve health outcomes for rural cancer patients.