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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

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

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