Timeliness of breast cancer care: Real-world experience at a tertiary care and a public safety-net hospital.
Authors: Jeong Il Seok Daniel , Spector Kellie , Yu Tiffany , Cain Natalie , Sheshebor Niloofar , Yaghmai Nazanin , Sayre James , Rahbar Guita , Najmi Nooshin , Wu Phillis 
Published: May 2024

e13712

Background: Advances in breast cancer diagnostics and therapeutics have led to early cancer detection and an overall decrease in morbidity and mortality rates; nevertheless, cancer care disparity still exists and highlights areas of unmet need in cancer care delivery. Cancer navigator programs have been used as a strategy to reduce disparities arising from social determinants of health. We compared the timeliness of breast cancer care at UCLA Medical Center (UCLA), a tertiary care academic hospital, and at Olive View-UCLA Medical Center (OVMC), a safety-net hospital. This study highlights the benefits of cancer care navigation and streamlined workflow processes in bridging disparity gaps. Methods: In this retrospective cohort study, we examined patients diagnosed with breast cancer between 2018 and 2019 at UCLA and OVMC. A total of 100 patients were identified at each site. Demographics data, including age, race, ethnicity, pathology, and staging, were collected. For time interval analysis along the breast cancer care timeline, the mean number of days from the initial imaging date (i.e. either screening or diagnostic mammogram, with the latter if the patient presented with signs and symptoms of breast cancer) was compared with each diagnostic and therapeutic time point. These included time between screening and diagnostic mammograms (if available), time to biopsy, time to MRI, time to surgery, and time to treatment. Results: Mean age (years) at diagnosis was 62.0 and 57.5 at UCLA and OVMC, respectively (p=0.024). Racial distribution showed 60% White, 14% Asian, 7% Black, 7% Mixed, and 4% Other at UCLA, compared to 72%, 9%, 5%, 0%, and 0% at OVMC, respectively (p=0.01). Ethnicity comparison showed 11% Hispanic/Latino at UCLA versus 52% at OVMC (p<0.001). Breast cancer stage at diagnosis was not significantly different between sites. The time interval (days) from screening to diagnostic mammogram was significantly longer at OVMC compared to UCLA (35.1 versus 14.6, p=0.007); however, no statistically significant differences were observed from time to biopsy (27.3 versus 29.5, p=0.651), time to MRI (54.7 versus 49.9, p=0.703), time to neoadjuvant chemotherapy (73.4 versus 48.7, p=0.236), time to surgery (97.2 versus 106.2, p=0.523), time to adjuvant chemotherapy (158.6 versus 139.5, p=0.4), and time to radiation therapy (192.9 versus 198.6, p=0.796) between UCLA and OVMC, respectively. Conclusions: Our study shows that the timeliness of breast cancer care at UCLA and OVMC was overall comparable. This result can be attributed to the implementation of cancer navigator programs at OVMC as well as streamlined breast cancer detection workflow developed in multi-disciplinary collaboration across numerous departments. We believe this workflow can be expanded to all tumor types and be shared with other safety net facilities in order to bridge gaps in cancer care delivery for oncology patients.