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. 2019 Nov 15;125(22):3985-3992.
doi: 10.1002/cncr.32378. Epub 2019 Aug 9.

Race and delays in breast cancer treatment across the care continuum in the Carolina Breast Cancer Study

Katherine E Reeder-Hayes  1   2 , Sophie E Mayer  3 , Andrew F Olshan  2   3 , Stephanie B Wheeler  2   3 , Lisa A Carey  1   2 , Chiu-Kit Tse  3 , Mary Elizabeth Bell  2 , Melissa A Troester  2   3
Affiliations

Race and delays in breast cancer treatment across the care continuum in the Carolina Breast Cancer Study

Katherine E Reeder-Hayes et al. Cancer. .

Abstract

Background: After controlling for baseline disease factors, researchers have found that black women have worse breast cancer survival, and this suggests that treatment differences may contribute to poorer outcomes. Delays in initiating and completing treatment are one proposed mechanism.

Methods: Phase 3 of the Carolina Breast Cancer Study involved a large, population-based cohort of women with incident breast cancer. For this analysis, we included black women (n = 1328) and white women (n = 1331) with stage I to III disease whose treatment included surgery with or without adjuvant therapies. A novel treatment pathway grouping was used to benchmark the treatment duration (surgery only, surgery plus chemotherapy, surgery plus radiation, or all 3). Models controlled for the treatment pathway, age, and tumor characteristics and for demographic factors related to health care access. Exploratory analyses of the association between delays and cancer recurrence were performed.

Results: In fully adjusted analyses, blacks had 1.73 times higher odds of treatment initiation more than 60 days after their diagnosis in comparison with whites (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.04-2.90). Black race was also associated with a longer treatment duration. Blacks were also more likely to be in the highest quartile of treatment duration (OR, 1.69; 95% CI, 1.41-2.02), even after adjustments for demographic and tumor characteristics (OR, 1.31; 95% CI, 1.04-1.64). A nonsignificant trend toward a higher recurrence risk was observed for patients with delayed initiation (hazard ratio, 1.44; 95% CI, 0.89-2.33) or the longest duration (hazard ratio, 1.17; 95% CI, 0.87-1.59).

Conclusions: Black women more often had delayed treatment initiation and a longer duration than whites receiving similar treatment. Interventions that target access barriers may be needed to improve timely delivery of care.

Keywords: breast cancer; health care disparities; minority health.

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Conflict of interest statement

Conflicts of Interest

The authors have no conflicts to report.

Figures

Figure 1:
Figure 1:
Distribution of Treatment Duration by Treatment Group
Figure 2:
Figure 2:
Unadjusted recurrence-free survival by timeliness of initiation (A) and treatment duration (B), beginning from 60-day (A) or 18 month (B) landmarks.
Figure 2:
Figure 2:
Unadjusted recurrence-free survival by timeliness of initiation (A) and treatment duration (B), beginning from 60-day (A) or 18 month (B) landmarks.
See this image and copyright information in PMC

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