Both race and place of residence affect how soon a woman in North Carolina receives treatment for breast cancer, suggesting the need to target high-risk geographic regions and patient groups to ensure timely care, new research suggests.
Among nearly 33,000 women from North Carolina with stage I–III breast cancer, Black patients were nearly twice as likely has non-Black patients to experience treatment delays of more than 60 days, researchers found.
“Our findings suggest that treatment delays are alarmingly common in patients at high risk for breast cancer death, including young Black women and patients with Stage III disease,” the authors note in their article, which was published online January 23 in Cancer.
Research shows that breast cancer treatment delays of 30 to 60 days can lower survival, and Black patients face a “disproportionate risk of treatment delays across the breast cancer care delivery spectrum,” the authors explain.
However, studies exploring whether or how racial disparities in treatment delays relate to geography are more limited.
In the current analysis, researchers amassed a retrospective cohort of all patients with stage I–III breast cancer between 2004 and 2015 in the North Carolina Central Cancer Registry and explored the risk of treatment delay by race and geographic subregion.
The cohort included 32,626 women, 6190 (19.0%) of whom were Black. Counties were divided into the nine Area Health Education Center regions for North Carolina.
Compared with non‐Black patients, Black patients were more likely to have stage III disease (15.2% vs 9.3%), hormone receptor–negative tumors (29.3% vs 15.6%), Medicaid insurance (46.7% vs 14.9%), and to live within 5 miles of their treatment site (30.6% vs 25.2%).
Overall, Black patients were almost two times more likely to experience a treatment delay of more than 60 days (15% vs 8%).
On average, about 1 in 7 Black women experienced a lengthy delay, but the risk varied depending on geographic location. Patients living in certain regions of the state were more likely to experience delays; those in the highest-risk region were about twice as likely to experience a delay as those in the lowest-risk region (relative risk [RR], 2.1 among Black patients; and RR, 1.9 among non-Black patients).
The magnitude of the racial gap in treatment delay varied by region — from 0% to 9.4%. But overall, of patients who experienced treatment delays, a significantly greater proportion were Black patients in every region except region 2, where only 2.7% (93 of 3362) of patients were Black.
Notably, two regions with the greatest disparities in treatment delay, as well as the highest absolute risk of treatment delay for Black patients, surround large cities.
“These delays weren’t explained by the patients’ distance from cancer treatment facilities, their specific stage of cancer or type of treatment, or what insurance they had,” lead author Katherine Reeder-Hayes, MD, with the University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, said in a news release.
Instead, Reeder-Hayes said, the findings suggest that the structure of local healthcare systems, rather than patient characteristics, may better explain why some patients experience treatment delays.
In other words, “if cancer care teams in certain areas say, ‘Oh, it’s particularly hard to treat breast cancer in our area because people are poor or have really advanced stages of cancer when they come in,’ our research does not bear out that explanation,” Reeder-Hayes said in email to Medscape Medical News.
This study “highlights the persistent disparities in treatment delays Black women encounter, which often leads to worse outcomes,” said Kathie-Ann Joseph, MD, MPH, who was not involved in the research.
“Interestingly, the authors could not attribute these delays in treatment to patient-level factors,” said Joseph, breast cancer surgeon at NYU Langone Perlmutter Cancer Center. But the authors “did find substantial geographic variation, which suggests the need to address structural barriers contributing to treatment delays in Black women.”
Sara P. Cate, MD, who was not involved with the research, also noted that the study highlights a known issue — “that racial minorities have longer delays in cancer treatment.” And notably, she said, the findings reveal that this disparity persists in areas where access to care is better and more robust.
“The nuances of the delays to care are multifactorial,” said Cate, a breast cancer surgeon and director of the Breast Surgery Quality Program at Mount Sinai in New York City. “We need to do better with this population, and it is a multilevel solution of financial assistance, social work, and patient navigation.”
The study was supported in part by grants from the Susan G. Komen Foundation and the NC State Employees’ Credit Union. Reeder-Hayes, Cate, and Joseph have disclosed no relevant financial relationships.
Cancer. Published online January 23, 2023. Full text
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