Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Room C-308, Philadelphia, PA, 19111, USA.
Department of Surgery, NorthShore University Health System, Evanston, IL, USA.
Breast Cancer Res Treat. 2022 Feb;191(3):513-522. doi: 10.1007/s10549-021-06460-9. Epub 2022 Jan 11.
Breast cancer outcomes are impaired by both delays and disparities in treatment. This study was performed to assess their relationship and to provide a tool to predict patient socioeconomic factors associated with risk for delay.
The National Cancer Database was reviewed between 2004 and 2017 for patients with non-metastatic breast cancer managed with upfront surgery. Times to treatment were measured from the date of diagnosis. Patient, tumor, and treatment factors were assessed with attention paid to sociodemographic variables.
514,187 patients remained after exclusions, with 84.3% White, 10.8% Black, 3.7% Asian, and Hispanics comprising 5.6% of the cohort. Medicaid and uninsured patients had longer mean adjusted time to surgery (≥ 46 days) versus private (36.7 days), Medicare (35.9 days), or other governmental insurance (39.8 days). After adjustment, Black race and Hispanic ethnicity were most impactful, adding 6.0 and 6.4 preoperative days, 10.9 and 11.5 days to chemotherapy, 11.1 and 9.1 days to radiation, and 12.5 and 8.9 days to endocrine therapy, respectively. Income, education, and insurance, among other factors, also affected delay. A nomogram, including race and sociodemographic factors, was created to predict the risk of preoperative delay.
Significant disparities exist in timeliness of care for factors, including but not limited to, race and ethnicity. Although exact causes cannot be discerned, these data indicate population subsets whose intervals of care risk being longer than those specified by national quality standards. The nomogram created here may help direct resources to those at highest risk of incurring a treatment delay.
乳腺癌的治疗效果受到治疗延误和差异的影响。本研究旨在评估它们之间的关系，并提供一种工具来预测与患者延迟风险相关的社会经济因素。
在 2004 年至 2017 年间，对接受初始手术治疗的非转移性乳腺癌患者的国家癌症数据库进行了回顾性分析。从诊断日期开始测量治疗时间。评估患者、肿瘤和治疗因素，并特别注意社会人口统计学变量。
排除后，514187 名患者仍保留，其中 84.3%为白人，10.8%为黑人，3.7%为亚洲人，5.6%为西班牙裔。医疗补助和无保险患者的手术平均调整后时间（≥46 天）长于私人保险（36.7 天）、医疗保险（35.9 天）或其他政府保险（39.8 天）。调整后，黑人种族和西班牙裔血统的影响最大，分别增加了 6.0 和 6.4 个术前天、10.9 和 11.5 个化疗天、11.1 和 9.1 个放疗天以及 12.5 和 8.9 个内分泌治疗天。收入、教育和保险等其他因素也影响了延迟。创建了一个包含种族和社会人口统计学因素的诺莫图，以预测术前延迟的风险。
在包括种族和族裔在内的多种因素方面，护理及时性存在显著差异。尽管无法确定确切的原因，但这些数据表明，某些人群的护理间隔可能比国家质量标准规定的更长。这里创建的诺莫图可能有助于将资源引导至那些面临治疗延迟风险最高的人群。
