Abstract D071: Impact of racial differences in financial burden on time to treatment
Authors: Elkins Wendi , Mbah Olive , Benson Jeannette T , Farnan Laura , Padilla Neda , Cykert Sam , Reeve Bryce B , Corbie-Smith Giselle , Samuel Cleo A. 
Published: September 2020

Abstract
Background Racial disparities in time-to-treatment exist among cancer patients, with patients of color being more likely to experience treatment delays. Such racial differences in treatment initiation are likely on the causal pathway to inequities in treatment outcomes. Emerging research has documented racial differences in financial burden, but little is known about the contribution of financial burden to disparities in treatment delays. In this study, we evaluated whether financial burden partly accounted for racial disparities in time to treatment initiation among a cohort of cancer survivors. Methods We used cross-sectional data of patients enrolled in the University of North Carolina Health Registry/Cancer Survivorship Cohort (HR/CSC) between 2010 and 2016. The sample for this study was limited to cancer patients and survivors who identified as non-Hispanic White or Black, received a diagnosis for breast, genitourinary, gastrointestinal, or head or neck cancer, and completed a questionnaire at least 30 days following their diagnosis (N=2,123). Time to treatment was measured in number of days from diagnosis to start of first course of treatment, ascertained from the medical record. Initial treatment was either surgery, chemotherapy, radiation, or hormonal therapy, depending on the clinical indication. Financial burden was assessed using the Patient Satisfaction Questionairre-18 on the self-reported satisfaction with the financial aspects of care (&gt;3.5 is satisfied; &lt;=3.5 is unsatisfied). To assess racial differences in time to treatment, we conducted both unadjusted and adjusted OLS regression analysis. Results In the first model predicting time to treatment as a function of race and clinical factors only, Black race was associated with a 11.4 day increase in the number of days between diagnosis and treatment (p&lt; 0.001). In a second model adjusting for race, clinical factors and financial burden, the absence of financial burden was associated with a decrease in the number of days between diagnosis and treatment (\beta=-3.2, p= 0.042). Results were similar in the final fully adjusted model accounting for the above covariates in addition to sociodemographic factors, with the absence of financial burden being associated with a minor decrease in the time to treatment initiation (\beta= -3.0, p= 0.044). There was only a minor attenuation in the Black-White disparity in the fully adjusted model, with Black race being associated with an increase of 10.6 days between diagnosis and treatment initiation (p=0.001). Conclusions In Black patients and patients who report experiencing financial burden a greater number of days elapse between diagnosis and treatment initiation. Decreases in the time from diagnosis to first treatment is a modifiable factor in treatment inequities whether both for related to financial burden and race.
Citation Format: Wendi Elkins, Olive Mbah, Jeannette T Benson, Laura Farnan, Neda Padilla, Sam Cykert, Bryce B Reeve, Giselle Corbie-Smith, Cleo A. Samuel. Impact of racial differences in financial burden on time to treatment [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D071.