Racial ethnic differences in treatment delay in a multi ethnic sample of women with breast cancer
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Racial/ethnic Differences in Treatment Delay in a Multi-ethnic Sample of Women with Breast Cancer. Mahasin S. Mujahid, PhD RWJ Health and Society Scholar Harvard University School of Public Health. Acknowledgements. Sarah T. Hawley, PhD Nancy K. Janz, PhD Jennifer J. Griggs, PhD

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Racial/ethnic Differences in Treatment Delay in a Multi-ethnic Sample of Women with Breast Cancer

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Racial ethnic differences in treatment delay in a multi ethnic sample of women with breast cancer

Racial/ethnic Differences in Treatment Delay in a Multi-ethnic Sample of Women with Breast Cancer

Mahasin S. Mujahid, PhD

RWJ Health and Society Scholar

Harvard University

School of Public Health


Acknowledgements

Acknowledgements

Sarah T. Hawley, PhD

Nancy K. Janz, PhD

Jennifer J. Griggs, PhD

Ann Hamilton, PhD

John Graff, PhD

Steven J. Katz, MD

University of Michigan

Los Angeles and Detroit Metropolitan Area SEER Registries

University of Southern California and Wayne State University

Funded by the National Cancer Institute

(R01CA109696; R01 CA088370)


Background

Background

  • There are persistent racial/ethnic differences in breast cancer survival in the US

  • Differences have been attributed to:

    • Tumor biology and pathogenesis

    • Socioeconomic characteristics

    • Co-morbidities

    • Access to and quality of medical care

      • Breast cancer screening

      • Timely receipt of appropriate treatment


Background 2

Background (2)

  • Treatment delay is an important area of study

    • Longer delays associated with worse survival rates

  • Few studies have examined racial/ethnic differences in treatment delay

    • population-based multi-ethnic studies

    • underlying factors contributing to differences


Research aims

Research Aims

  • To describe the prevalence of treatment delay in in a population-based sample

  • To examine racial/ethnic differences in treatment delay

  • To determine the sociodemographic, clinical/treatment, and access barriers that may account for racial/ethnic differences in treatment delay


Study population

Study Population

  • Population-based sample (8/05-2/07)

    • Detroit and Los Angeles Metropolitan areas

    • Rapid case ascertainment (9 months post diagnosis)

  • Accrued and Eligible Sample (N=3133)

    • 20-79 years of age

    • Stage 0-III disease

    • Able to complete self-administered questionnaire

    • African American and Latina women were over-sampled

  • Final Sample (N=2268); 72% response rate


Study variables

Study Variables

Study Outcome (Treatment Delay)

Time between diagnosis and first surgical procedure

  • <1month

  • 1-3 months moderate delay

  • >3 months significant delay

    Key Covariate (Race/ethnicity)

  • White (non-Latina)

  • African American (non-Latina)

  • Latina


Additional variables

Sociodemographic Factors

Age at diagnosis

Married/partner

Education

Income

Employed

Insurance

Clinical /Treatment Factors

Number of co-morbidities

Cancer stage

Chemotherapy

Breast reconstruction at time of surgery

Additional Variables


Additional variables 2

Additional Variables (2)

Access Barriers

Difficulty (yes/no):

  • Finding a doctor

  • Scheduling surgical procedure

  • Getting to doctors’ office

  • Financial cost (office visits, treatments)


Statistical analyses

Statistical Analyses

  • Multinomial Logistic Regression Models

    • Three level dependent variable

      • < 1 month

      • 1-3 months

      • > 3 months

Significant Delay

Point estimates adjusted by weights to account for differential selection by race/ethnicity and non-response


Patient characteristics

Patient Characteristics

*Restricted to women who had a surgical procedure


Prevalence of treatment delay

Prevalence of Treatment Delay


Prevalence of treatment delay by race ethnicity

Prevalence of Treatment Delay by Race/ethnicity

p<0.001

percent


Sociodemographic factors by race ethnicity

Sociodemographic Factors by Race/ethnicity

all p’s <0.001

percent


Clinical treatment factors by race ethnicity

Clinical/Treatment Factors by Race/ethnicity

all p’s <0.05

percent


Access barriers by race ethnicity

Access Barriers by Race/ethnicity

all p’s <0.05

percent


Adjusted odds of treatment delay 3mo vs 1mo by race ethnicity

Adjusted Odds of Treatment Delay (>3mo vs. < 1mo) by Race/Ethnicity

Latina vs. White

African American vs. White

odds ratios

Model adjusts for sociodemographic, clinical/treatment, and access barriers


Other significant correlates of treatment delay 3months

Other Significant Correlates of Treatment Delay (> 3months*)

  • Sociodemographic

    • Married*

  • Clinical/Treatment

    • More co-morbidities

    • Higher cancer stage*

    • Chemotherapy

    • Breast reconstruction*

  • Access Barriers

    • Scheduling surgical procedure*


Conclusion

Conclusion

  • Overall few women experienced significant treatment delay

  • However, we found racial/ethnic differences in delay that are concerning

  • These differences were partially explained by social, clinical/treatment, and access barriers


Implications

Implications

  • Providers should be aware of the potential for treatment delay among race/ethnic minorities, and work to assist patients with navigating the health care system

  • Further efforts are needed to ensure support for treatment decision making

  • Ensuring information is culturally appropriate and available in different languages may improve the timely use of cancer treatment services


Thank you

Thank you!!!


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