Song Julia H, Kantor Olga, Mittendorf Elizabeth A, King Tari A, Minami Christina A
Harvard Medical School, Boston, MA, USA.
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.
Ann Surg Oncol. 2022 Mar 30. doi: 10.1245/s10434-022-11543-y.
Women ≥ 65 years of age are less likely to receive guideline-concordant breast cancer care. Given existing racial/ethnic disparities, older minority breast cancer patients may be especially prone to inequalities in care. How site of care impacts older breast cancer patients is not well defined. We sought to evaluate the association between race/ethnicity and breast cancer treatment delays in older women treated at minority-serving hospitals (MSHs) versus non-MSHs.
Women ≥ 65 years of age treated for non-metastatic breast cancer were identified in the National Cancer Database (2010-2017). Treatment delay was defined as > 90 days from diagnosis to initial treatment. MSHs were defined as the top decile of hospitals serving predominantly Black or Hispanic patients. Multivariable logistic regression models adjusted for patient, tumor, and hospital characteristics were used to determine the odds of treatment delay for women at MSHs versus non-MSHs across racial/ethnic groups.
Overall, 557,816 women were identified among 41 MSHs and 1146 non-MSHs. Average time to treatment was 33.71 days (standard deviation 26.92 days). Older women at MSHs were more likely to experience treatment delays than those at non-MSHs (odds ratio 1.28, 95% confidence interval 1.21-1.36). Regardless of where they received care, minorities were more likely to experience treatment delays than non-Hispanic White women.
Although 97% of older women treated at Commission on Cancer-accredited hospitals received timely breast cancer care, minorities and those treated at MSHs were more likely to experience treatment delays. Interventions addressing barriers to timely breast cancer care at MSHs may be an effective approach to reducing racial/ethnic disparities.
65岁及以上的女性接受符合指南的乳腺癌护理的可能性较小。鉴于现有的种族/族裔差异，老年少数族裔乳腺癌患者可能特别容易在护理方面面临不平等。护理地点如何影响老年乳腺癌患者尚不清楚。我们试图评估在为少数族裔服务的医院（MSH）与非MSH接受治疗的老年女性中，种族/族裔与乳腺癌治疗延迟之间的关联。
在国家癌症数据库（2010 - 2017年）中识别出65岁及以上接受非转移性乳腺癌治疗的女性。治疗延迟定义为从诊断到初始治疗超过90天。MSH被定义为主要为黑人或西班牙裔患者服务的医院中排名前十分之一的医院。使用针对患者、肿瘤和医院特征进行调整的多变量逻辑回归模型来确定不同种族/族裔群体中，MSH与非MSH的女性出现治疗延迟的几率。
总体而言，在41家MSH和1146家非MSH中识别出557,816名女性。平均治疗时间为33.71天（标准差26.92天）。与非MSH的老年女性相比，MSH的老年女性更有可能经历治疗延迟（优势比1.28，95%置信区间1.21 - 1.36）。无论在哪里接受治疗，少数族裔比非西班牙裔白人女性更有可能经历治疗延迟。
尽管在获得癌症委员会认证的医院接受治疗的97%的老年女性得到了及时的乳腺癌护理，但少数族裔和在MSH接受治疗的女性更有可能经历治疗延迟。解决MSH中及时乳腺癌护理障碍的干预措施可能是减少种族/族裔差异的有效方法。
