ASPO Abstracts
Delays in breast cancer treatment associations with patterns of SES, access to care and tumor characteristics in the Carolina Breast Cancer Study Phase III
Category: Cancer Health Disparities
Conference Year: 2020
Abstract Body:
PURPOSE: Breast cancer mortality is higher for black and younger women. This study evaluated factors that
impact time to treatment and treatment duration by race and age.
METHODS: Among 2,841 participants with stage I-III disease in the Carolina Breast Cancer Study Phase III, we
identified groups of women with similar patterns of socioeconomic status (SES), access to care, and tumor
characteristics using latent class analysis. We evaluated latent classes in association with treatment delay
(initiation >60 days after diagnosis) and treatment duration (in quartiles by treatment modality).
RESULTS: Thirty-two percent of younger black women were in the highest quartile of treatment duration (versus
22% of younger whites). Black women were more likely to have a higher frequency of delayed treatment initiation
[adjusted relative frequency difference (RFD) = 5.5%; 95% confidence interval (CI): 3.2%, 7.8%)] and prolonged
treatment duration (RFD = 8.8%; 95% CI: 5.7%, 12.0%). Low SES was associated with treatment delay among
white women (RFD 3.5%; 95% CI: 1.1, 5.9), but baseline rates of treatment delay remained elevated among high
SES black women (e.g. 11.7% compared to 10.6% and 6.7% among low and high SES whites, respectively).
Neither SES nor access to care classes were significantly associated with delayed initiation among black women,
but both low SES and more barriers to care were associated with treatment duration in both races.
CONCLUSIONS: There are many dimensions of treatment delay, from diagnosis to completion of treatment and
social differences compound across the continuum. Delay in treatment duration may be a more sensitive indicator
of barriers to care, possibly more sensitive than delayed initiation. By developing an integrated view of where
delays happen and compound on the care continuum, and evaluating aggregated characteristics, appropriate
multidimensional interventions can be conceptualized.
Keywords: Breast cancer, racial health disparities, latent class analysis, treatment delay