Disparities in Time to Treatment in Breast Cancer Patients in the National Cancer Database, 2004-2013

Authors: Arroyo NA, Hampton JM, Gangnon RE, Sprague BL, Stout NK, Alagoz O, Greenberg CC, Burnside ES, Trentham-Dietz A

Category: Cancer Health Disparities, Cancer Health Disparities
Conference Year: 2018

Abstract Body:
Purpose: Time to treatment after breast cancer diagnosis can influence survival and other health outcomes. This study aims to examine patient factors related to increased time to treatment in a national surveillance study. Methods: We used data from the National Cancer Database for breast cancer patients from 2004 — 2013 and included female patients >18 years old with in situ or invasive breast cancer (n=2,013,590). We examined time from initial diagnosis to treatment in relation to covariates including age, race/ethnicity, health insurance, geographic region, treatment, and stage at diagnosis. Multivariable analysis of variance was used to estimate the mean number of days to treatment after diagnosis. We evaluated potential interactions between race/ethnicity and insurance. Results: Overall, the mean time to treatment was 28.6 days (median 24.0). After adjusting for covariates, the time to treatment was longer for older women (40-49, 28.9; 50-59, 29.0; 60-69, 28.8; 70-79, 28.2) compared to younger women (ages 18-29, 25.5; ages 30-39, 27.6); longer for women with Medicaid or no insurance (35.9 and 35.4 days, respectively) compared to private insurance (27.7); and longer for women treated with mastectomy and reconstruction (35.3 days) compared to lumpectomy w/ or w/o radiation (26.5). Mean time to treatment varied by race/ethnicity: white, 27.4 days; black, 34.8; and Hispanic, 36.3. For those with private insurance, white women, on average, received initial treatment in 26.9 days, while black and Hispanic women, on average, received initial treatment in 32.7 and 32.8 days, respectively. White women with Medicaid or no insurance received initial treatment on average in 32.7 and 29.7 days, respectively, whereas treatment was first received after a longer time period, on average, among black women (39.3 and 40.8) and Hispanic women (41.8 and 43.9) with Medicaid or no insurance, respectively. Conclusions: After adjusting for multiple factors including stage, treatment, and insurance, minority women were more likely to have a longer time before initiating treatment. Interventions focused on decreasing time to treatment may be necessary to eliminate racial and ethnic disparities in breast cancer outcomes.

Keywords: disparities, breast cancer, time to treatment