Department of Surgery, Riverside University Health System, Moreno Valley, California.
Department of Radiology, Loma Linda University Health, Loma Linda, California.
J Surg Res. 2023 Nov;291:367-373. doi: 10.1016/j.jss.2023.06.023. Epub 2023 Jul 27.
Because limited data exist, we sought to evaluate timeliness of multimodal treatments in a safety net breast cancer population.
Breast cancer patients treated at a safety net hospital from 2016 to 2020 were analyzed retrospectively. Time intervals were defined as primary time (PT) from diagnosis to initiation of primary intervention, secondary time (ST) from completion of primary to initiation of secondary intervention, and tertiary time (TT) from completion of secondary to initiation of tertiary intervention. Variables included primary language, insurance type, and race.
Of 223 patients, 99 (44.4%) primarily spoke Spanish, 29 (13.0%) were of Black race, and 184 (82.5%) had Medicaid or uninsured status. Median (IQR) age at diagnosis was 55 (48-62) years. Primary intervention was surgical in 127/216 (58.8%); secondary intervention was systemic in 38/169 (22.5%); and tertiary intervention was radiation in 67/80 (83.8%). Overall, median days (IQR) for PT were 69 (53, 98), ST were 65 (42, 95), and TT were 69 (43, 88). PT was significantly longer in Black [105 (76, 142) days] patients compared to non-Hispanic White patients [68 (51, 107) days, P = 0.031)] and White Hispanic patients [65 (53,91) days, P = 0.014]. There were no significant differences in PT, ST, or TT by spoken language or insurance type.
Black patients remain at risk due to prolonged time to intervention. Spanish-speaking status was not associated with inferior timeliness or completion of multimodal care at a safety net hospital. Identifying safety net hospital barriers to achieving benchmarks for timely completion of all phases of multimodal care warrants further attention.
由于数据有限，我们试图评估安全网乳腺癌人群中多模式治疗的及时性。
回顾性分析 2016 年至 2020 年在一家安全网医院治疗的乳腺癌患者。时间间隔定义为从诊断到开始主要干预的主要时间 (PT)、从完成主要干预到开始次要干预的次要时间 (ST) 和从完成次要干预到开始次要干预的次要时间 (TT) 。三级干预。变量包括主要语言、保险类型和种族。
在 223 名患者中，99 名（44.4%）主要讲西班牙语，29 名（13.0%）为黑人，184 名（82.5%）拥有医疗补助或无保险。诊断时的中位（IQR）年龄为 55（48-62）岁。127/216（58.8%）例患者接受手术主要干预；38/169（22.5%）例患者接受系统辅助治疗；67/80（83.8%）例患者接受放射治疗。总体而言，PT 的中位天数（IQR）为 69（53，98）天，ST 为 65（42，95）天，TT 为 69（43，88）天。与非西班牙裔白人患者[68（51，107）天，P=0.031]和白西班牙裔患者[65（53，91）天，P=0.014]相比，黑人患者[105（76，142）天]PT 明显更长。PT、ST 或 TT 无明显差异语言或保险类型。
黑人患者由于干预时间延长仍面临风险。西班牙语患者在安全网医院接受多模式治疗的及时性或完成情况没有差异。需要进一步关注安全网医院在实现多模式治疗所有阶段及时完成的基准方面存在的障碍。
