Abstract P2-12-10: Examining diagnostic and therapeutic delays using patient reported outcomes
Authors: Fielder-Kimbrough Odicie , Serrano Mayra , Ashing Kimlin T 
Published: May 2015

Background: Diagnostic and treatment delays in cancer patients lead to poorer outcomes. African American and Latina women with breast cancer (BC) are more likely to experience delays. This study explores delays in African American and Latina breast cancer survivors (BCS) and association with physician-patient communication variables.

Methods: A total of 320 BCS (88 African-American and 232 Latina-American)diagnosed with stage 0-3 BC were recruited from the California Cancer Registry and Hospitals. BCS completed a questionnaire assessing patient reported time to diagnosis and initiating treatment, and quality of care variables pertaining to physician-patient interaction.

Results: The mean number of days waited after finding a lump or abnormality and seeking diagnostic care to obtaining a cancer diagnosis was 57.9 days in this cohort. Bivariate analysis revealed that Latina BCS were significantly more likely to wait longer to obtain diagnosis. ( p = .033). Once diagnosed, African-American BCS were more likely to report greater days delay to initiating treatment (p = .007). The mean number of days delayed for initiating treatment between African American and Latinas, however, was not significantly different, 35.3 v. 34.5 days (p=.107). We investigated the surgeon-patient dyad in influencing delays. The better patients rated the relationship, the fewer days in delayed treatment reported (p=0.038). Additionally, 11% of BCS (n=34) did not believe that their doctors gave them enough information regarding their treatment. The regression analysis showed that the patients’ evaluation of the adequacy of doctors’ information was a significant predictor of days delayed treatment (p&lt;0.0001). If the patient believed that enough information was provided, then the treatment was initiated within 6 days compared to the 40 days average reported by patients who endorse inadequate information.

However, the majority of patients (87%) reported a "good" or "very good" relationship with her surgeon. Although the majority of patients reported a "good" or "very good" relationship with her Oncologist (65%), the relationship was rated as "poor" or "very poor" by 23% of patients. There was no statistical difference in rating of relationship with providers between the ethnic groups (p=.865).

Conclusions: Our results suggest that poor patient-physician interactions are associated with BC diagnostic and therapeutic care delays in both African American and Latina BCS. As healthcare shifts towards improving variables of quality of care and patient satisfaction, attention to improving these interactions and further exploration will be warranted. Further, improving timely access to diagnostic and therapeutic care may reduce BC disparity and improve cancer equity.

Citation Format: Odicie Fielder-Kimbrough, Mayra Serrano, Kimlin T Ashing. Examining diagnostic and therapeutic delays using patient reported outcomes [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-12-10.