- Black women are more likely to experience delays in the initiation of chemotherapy or radiation after surgery for breast cancer than Hispanic or white women.
- Delays in needed treatment after breast cancer surgery tended to occur more often in hospitals with higher populations of black breast cancer patients and in small, rural hospitals with relatively few breast cancer patients.
These delays, which can affect cancer outcomes, tended to occur more often in hospitals with higher proportions of black women treated for breast cancer. In addition, women at smaller, rural hospitals with relatively few breast cancer patients were more likely to have delays in needed radiation or chemotherapy compared with patients at larger urban hospitals areas with more cancer patients.
The researchers say this study helps explain the well-documented fact that black breast cancer patients have worse outcomes, including higher mortality rates, than do patients of other races. “Our study suggests that improving the ways that hospitals deliver timely, high-quality care will help to improve cancer-related outcomes,” said Rachel Freedman, M.D., MPH, a medical oncologist with the Dana Farber Cancer Center.
Freedman and her colleagues analyzed data from 54,592 female Medicare patients older than 66. All the women were diagnosed with stage 1 to stage 3 cancers during the years 1992 and 2007 and had either a mastectomy or a breast conserving operation. Overall, 8.1 percent of women experienced delays in post-surgical treatments. Delays occurred more often in black women (11.9 percent), as compared to Hispanic (9.9 percent) and white women (7.8 percent). The odds of a delay declined in the late 1990s and early 2000s but rose again in the years 2004 to 2007, despite increased attention to medical disparities.
Patient traits associated with delays included older age (above 70), having more coexisting medical problems and living in rural areas. The authors cited competing medical issues and long travel distances as likely contributors to treatment delays.
Tara Breslin, M.D., an associate professor of surgery and surgical oncology at the Northwestern University School of Medicine, points out that breast cancer care generally begins with surgery in a hospital but that afterwards, chemotherapy and radiation often take place elsewhere on an outpatient basis. “This paper highlights the hospital as a potential point of early intervention for improving coordination of care, for patient education and for minimizing barriers to care including difficulties accessing transportation to appointments.”
The authors suggest that interventions to address treatment delays might best be aimed at the kinds of resource-poor hospitals likeliest to be involved, rather than more broadly. Reminders or triggers might eventually be targeted to physicians and to patients to ensure timely initiation of needed treatments.
Breslin adds that this study demonstrates for patients the advantages to seeking treatment in a high-volume cancer center. The findings should remind physicians, she says, of the need to guide patients towards resources that will allow them to overcome “logistical barriers.” Such barriers can include lack of transportation or problems taking time off from work or from duties that the women themselves fulfill at home, caring for grandchildren or sick relatives. Chemotherapy or radiation therapy after breast cancer surgery generally demands many weeks or months of treatment.
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Rachel A. Freedman, Yulei He, Eric P. Winer and Nancy L. Keating. Article first published online: 13 MAY 2013 | DOI: 10.1111/1475-6773.12063