Breast cancer optimal care timeframes for culturally and linguistically diverse populations and First Nations People: A regional centre experience in Australia.

Abstract

1587 Background: Culturally and linguistically diverse (CALD) populations and First Nations People are at-risk communities who face unique challenges in cancer diagnosis and management resulting in inequities. Optimal Care Pathways (OCP) established by Cancer Council Australia aim to address these disparities. The Breast cancer OCP outlines an integrated model of care with optimal timeframes such as time from general practitioner (GP) referral to specialist surgical review, time from decision to treat to surgery or neoadjuvant chemotherapy (NAC), and time from completion of NAC to surgery. Methods: Retrospective data was collected for all CALD (migrant from non-English speaking country and/or primary language identified as not English) and First Nations patients diagnosed with breast cancer treated at a regional centre in Australia (Townsville University Hospital) from 2018 – 2022. A comparison cohort (control) of consecutive non-CALD, non-First Nations patients was included. Data collected included patient demographics, tumour characteristics, stage, and identified timeframes which were compared with OCP. Results: 133 patients were included with 43 CALD (32%), 41 First Nations (31%) and 50 control (37%). CALD and First Nations cohorts had higher rates of stage IV disease at diagnosis (12 v 15%) compared to control cohort (0%). They were also more likely to be diagnosed via emergency department admission (CALD 16 v First Nations 7%) compared to control cohort (0%) suggesting later presentation. Of those referred through OCP defined GP pathway, a similar percentage were reviewed by specialist surgeon within optimal 2-week timeframe in all groups (CALD 47%; First Nations 39%; control 44%). Median time from decision to treat to surgery were longer in CALD versus control groups (19 v 13 days; p = 0.03), and in First Nations versus control groups (22 v 13 days; p = 0.02). Less CALD (89%, n = 24) and First Nations (82%, n = 18) patients underwent surgery within optimal 5-week timeframe compared to control (98%, n = 40). Similarly, median time from decision to treat to NAC were longer in CALD versus control groups (19 v 14 days; p = 0.05), and First Nations versus control groups (20 v 14 days; p = 0.03). Most patients (91%, n = 29) commenced NAC within optimal 4-week timeframe; 2 CALD and 1 First Nations patients did not. Median time from completion of NAC to surgery was longer in CALD versus control groups (29 v 24 days; p = 0.15), and in First Nations versus control groups (35 v 24 days; p = 0.04). Of those who recieved NAC, 100% CALD (n = 9), 69% First Nations (n = 9), and 89% control (n = 8) patients underwent surgery within optimal 4-week timeframe. Conclusions: Achievement of key OCP timeframes was lower in both CALD populations and First Nations People. Strategies need to be further developed to address the delays and health outcome disparities in these vulnerable cohorts.