ASPO Abstracts
Social isolation, social support, and treatment delays in breast cancer patients treated within an integrated health care system
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2020
Abstract Body:
Purpose: Women diagnosed with breast cancer (BC) with greater social support have b
better survival but its relation to suboptimal treatment is unclear. We evaluated a
associations of social support and delays to initial surgery or to adjuvant chemotherapy in P
Pathways a large, BC cohort from Kaiser Permanente Northern California (KPNC).
Methods: 4,056 women were diagnosed with stages I-IV BC from 2005-2013, had s
surgery <1 year after diagnosis, and responded to questions about social integration (
(Kroenke, 2013), personal support using the Medical Outcomes Study Social Support s
survey, and clinician support from the Interpersonal Processes of Care survey a
approximately two months following diagnosis. The analysis of chemotherapy delays i
included a subset of patients who received adjuvant chemotherapy (N=1,721). Time to s
surgery was defined from the date of diagnosis to the date of definitive surgery. Time to c
chemotherapy was defined from the date of diagnosis or definitive surgery to the date of c
chemotherapy initiation. We used logistic regression to evaluate associations with >30 d
day surgery delays and >90 day (from diagnosis) or >60 day (from surgery) c
chemotherapy delays and linear regression to evaluate associations with continuous o
outcomes.
Results: Twenty-five percent had surgery delays and 18% had chemotherapy delays
(26% from surgery date) from time of diagnosis. Women in the lowest tertile of personal
social support had greater surgery (OR=1.35, 95% CI: 1.11-1.63, p-continuous=0.003)
and chemotherapy (OR=1.49, 95% CI: 1.08-2.04, p-continuous=0.04) delays compared
to women in the highest tertile. Women with low clinician support had greater surgery
(OR=1.28, 95% CI: 1.06-1.55, p-continuous=0.0006) but not chemotherapy
(p-continuous=0.73) delays. We noted suggestive, nonsignificant associations of social
integration with delays. Women in the lowest tertiles of all three sources of support had a
two-fold (OR=1.96, 95% CI: 1.30-2.95) higher odds of surgery delays (p-value, test for
three-way interaction=0.08). Associations with chemotherapy delays from the time of d
diagnosis were qualitatively similar but we noted no significant associations when delays w
were measured from the date of surgery.
Conclusion: Women with low social support had greater treatment delays.
Keywords: Social support, breast cancer, treatment delays