Factors associated with time to breast cancer treatment initiation at an urban safety net center.

Abstract

e13750 Background: Delays in cancer treatment initiation are associated with increased mortality and may disproportionately affect socioeconomically disadvantaged patients. We evaluated sociodemographic and clinicopathological factors associated with time to initial treatment (TT) − defined as days to first surgery, chemotherapy, or radiation − in patients with primary breast cancer at an urban safety net center in 2022. Methods: We conducted a retrospective analysis of 70 patients treated at our institution. Variables included age, race, insurance status, AJCC clinical stage, Ki-67 % scores, hormone receptor status, HER2 status, aerial distance to center, and Area Deprivation Index (ADI). TT was measured in days and was normally distributed. Untransformed values were used in analyses. Univariable analysis was followed by a multivariable regression analysis to identify factors associated with ± TT (- indicating shorter TT, + indicating longer TT). Results: 70 patients were included. Mean (SE) TT was 79.0 (4.4) days, mean distance to care was 9.0 (0.8), mean ADI was 74.0 (2.5), and mean Ki-67 was 41.2% (3.9). AJCC Clinical Stage distribution was: 57.1% (n = 40) stage I, 21.4% (n = 15) stage II, 10% (n = 7) stage III, and 2.9% (n = 2) stage IV. The cohort was 40.0% Black (n = 28), 37.1% White (n = 26), 12.9% Latino (n = 9), 7.1% Asian/Pacific Islander (n = 5), and 2.9% Native American (n = 2). Insurance status was Medicaid in 35.7% (n = 25), Medicare in 20.0% (n = 14), private in 30.0% (n = 21), and self-pay in 14.3% (n = 10). Hormone receptor–positive disease was present in 75.7% (n = 53) and HER2-positive disease in 22.9% (n = 16). Variables significant on univariable analysis and included in the multivariable model were distance, ADI, Ki-67, race, insurance status, AJCC stage, hormone receptor status, and HER2 status. The model was statistically significant (F = 2.23, p = 0.014) and explained 46.5% of the variance in TT (R² = 0.47, adjusted R² = 0.26). Compared with privately insured patients, Medicaid was associated with +41.1 days TT (p = 0.001, 95% CI 18.5, 63.7), and self-pay with +34.8 days TT (p = 0.039, 95% CI 1.8, 67.8). Medicare was associated with +27.0 days TT (p = 0.066, 95% CI −1.8, 55.8). AJCC stage IV disease was associated with −85.9 days TT (p = 0.023, 95% CI −159.5, −12.3). Hormone receptor positivity showed a trend towards increased TT at +25.1 days (p = 0.053, 95% CI −0.4, 50.6). Distance to care, ADI, race, HER2 status, and Ki-67 were not independently associated with TT (all p > 0.05). Conclusions: Self-pay and Medicaid status were associated with treatment delay, highlighting an underlying disparity in breast cancer care. Advanced-stage disease was associated with faster treatment initiation, consistent with appropriate clinical triage. A trend towards treatment delay for hormone-positive disease may highlight a need to balance prioritization of advanced breast cancer with ensuring timely management or referral for all cases.