Abstract P6-12-03: Delays in diagnosis and treatment of breast cancer patients: A safety-net population profile
Authors: Jaiswal KR , Furniss A , Doyle R , Gayou N , Bayliss EA 
Published: May 2016

Background: Timely detection and treatment of breast cancer patients is important in survival and recurrence. Given disparities in breast cancer outcomes based on socioeconomic status, we examined the time to diagnosis and treatment in a safety net hospital.

Methods: We conducted a retrospective review of all breast cancer patients identified by cancer registry records from 7/1/2010 to 6/30/2012 (n=124). We excluded patients with primary stage IV (n=8) and those with recurrent breast cancer within 5 years of primary diagnosis (n=4). We determined intervals between presentation to diagnosis, diagnosis to first treatment, last surgery to chemotherapy start, and last surgery to radiation start. We used logistic regression to calculate unadjusted odds of receiving timely treatment (&lt; median time) versus more delayed treatment (≥ median time) as a function of age, language, ethnicity, insurance, Charlson co-morbidity index, cancer stage, method of first presentation (screening mammography vs. care provider), symptoms at presentation, and type of surgical treatment.

Results: Of 112 patients, the median age was 59. 42.9% were Hispanic, 29.5% were White, and 24.1% were African American. Clinical stage distribution was 20.0% stage 0, 31.8% stage I, 40.9% stage II, and 8% stage III. 83.9% of patients had surgery, of which 51.1% had breast conservation. The median time from presentation to diagnosis, time from diagnosis to first treatment, and time from surgery to chemotherapy start, fell within recommended intervals (Table 1). The time from last surgery to radiation start was greater than recommended intervals. Variables with significantly increased odds of taking longer than the median time include: stage, method of presentation, language, Charlson index, surgical treatment, ethnicity, symptoms at presentation (Table 2).

Conclusion: Acceptable diagnosis and treatment intervals were obtained for disadvantaged patients, except for time to radiation therapy. Room for improvement exists: focused interventions to facilitate access to radiation therapy, aid providers in accessing imaging more quickly, aid non-English speaking and Hispanic patients could lead to improved breast cancer care.

Table 1. Intervals of CareMeasure: Time From...Median (days)25th, 75th % (days)Recommended Intervals (days)Presentation to Diagnosis197, 4360Diagnosis to 1st Treatment3730, 4821-60Presentation to 1st Treatment6247, 83n/aLast Surgery to Chemo Start4831, 5928-90Last Surgery to Radiation Start*6853,7942-56* for patients needing surgery and radiation only

Table 2. Un-adjusted Odds Ratio of Taking Longer than Median TimeIntervalVariableReferenceO.R.p-valuePresentation to DiagnosisStage II or IIIStage 0 or I2.880.008 Method of Presentation: Care ProviderMethod of Presentation: Screening Mammogram4.270.0004Diagnosis to First TreatmentAge&lt; 55Age ≥ 552.180.070 English-speakingNon-English speaking0.220.005 Charlson Index ≥ 3Charlson Index &lt;30.420.040 Symptomatic PresentationAsymptomatic Presentation2.830.040 Breast ConservationMastectomy2.840.020Presentation to First TreatmentHispanicNon-Hispanic2.650.022 Charlson Index ≥ 3Charlson Index &lt;30.520.120 Method of Presentation: Care ProviderMethod of Presentation: Screening Mammogram3.160.008

Citation Format: Jaiswal KR, Furniss A, Doyle R, Gayou N, Bayliss EA. Delays in diagnosis and treatment of breast cancer patients: A safety-net population profile. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-12-03.