Khanna Shivani, Kim Kristine N, Qureshi Muhammad M, Agarwal Ankit, Parikh Divya, Ko Naomi Y, Rand Alexander E, Hirsch Ariel E
Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine.
Department of Hematology Oncology, Boston Medical Center, Boston MA, USA.
Int J Womens Health. 2017 Dec 6;9:887-896. doi: 10.2147/IJWH.S150064. eCollection 2017.
The aim of this study was to examine the impact of patient demographics, tumor characteristics, and treatment type on time to treatment (TTT) in patients with breast cancer treated at a safety net medical center with a diverse patient population.
A total of 1,130 patients were diagnosed and treated for breast cancer between 2004 and 2014 at our institution. We retrospectively collected data on patient age at diagnosis, race/ethnicity, primary language spoken, marital status, insurance coverage, American Joint Committee on Cancer (AJCC) stage, hormone receptor status, and treatment dates. TTT was determined from the date of breast cancer biopsy to treatment start date. Nonparametric Mann-Whitney -test (or Kruskal-Wallis test when appropriate) and multivariable quantile regression models were employed to assess for significant differences in TTT associated with each factor.
Longer median TTT was noted for Black (=0.002) and single (=0.002) patients. AJCC stage IV patients had shorter TTT (27.5 days) compared to earlier AJCC patients (36, 35, 37, 37 days for stage 0, I, II, III, respectively), =0.028. Age, primary language spoken, insurance coverage, and hormone receptor status had no significant impact on TTT. On multivariate analysis, race/ethnicity remained the only significant factor with Black reporting longer TTT, =0.025. However, race was not a significant factor for time from first to second treatment. More Black patients were noted to be single (<0.0001) and received chemotherapy as first treatment (=0.008) compared to White, Hispanic, or other race/ethnicity patients.
In this retrospective analysis, Black patients had longer TTT, were more likely to receive chemotherapy as first treatment, and have a single marital status. These patient factors will help identify vulnerable patients and guide further research to understand the barriers to care and the impact of treatment delays on outcomes.
本研究旨在探讨患者人口统计学特征、肿瘤特征及治疗类型对在一家拥有多样化患者群体的安全网医疗中心接受治疗的乳腺癌患者治疗时间（TTT）的影响。
2004年至2014年间，共有1130例患者在我院被诊断并接受乳腺癌治疗。我们回顾性收集了患者诊断时的年龄、种族/民族、主要语言、婚姻状况、保险覆盖情况、美国癌症联合委员会（AJCC）分期、激素受体状态及治疗日期等数据。TTT从乳腺癌活检日期计算至治疗开始日期。采用非参数曼-惠特尼检验（或在适当情况下采用克鲁斯卡尔-沃利斯检验）及多变量分位数回归模型评估与各因素相关的TTT的显著差异。
黑人患者（P = 0.002）和单身患者（P = 0.002）的TTT中位数较长。与早期AJCC分期患者（0期、I期、II期、III期的TTT分别为36天、35天、37天、37天）相比，AJCC IV期患者的TTT较短（27.5天），P = 0.028。年龄、主要语言、保险覆盖情况及激素受体状态对TTT无显著影响。多变量分析显示，种族/民族仍然是唯一的显著因素，黑人患者的TTT较长，P = 0.025。然而，种族对于从首次治疗到第二次治疗的时间并非显著因素。与白人、西班牙裔或其他种族/民族患者相比，更多黑人患者为单身（P < 0.0001）且接受化疗作为首次治疗（P = 0.008）。
在这项回顾性分析中，黑人患者的TTT较长，更有可能接受化疗作为首次治疗，且婚姻状况为单身。这些患者因素将有助于识别脆弱患者，并指导进一步研究以了解护理障碍及治疗延迟对结局的影响。
