Social determinants of health and timely chemotherapy initiation.

Abstract

e13580 Background: Timely initiation of chemotherapy is critical for optimizing outcomes in gynecologic cancers. This study aimed to evaluate the effect of social determinants of health (SDOH) on delays in chemotherapy initiation in gynecologic cancer, to identify modifiable barriers to care, and inform targeted interventions. Methods: A retrospective cohort study was conducted at a single academic institution after IRB approval, analyzing data from patients diagnosed with cervical, endometrial, or ovarian cancer between 05/2021–02/2024 and initiated on chemotherapy. Patient data was abstracted from electronic medical records. Individual-level SDOH factors, including insurance type, language, race, and ethnicity, were evaluated. X 2 and Poisson regression models were used to assess associations between SDOH variables and treatment delays. Results: A total of 170 patients were diagnosed and initiated chemotherapy for ovarian (28.8%), uterine (43.5%), and cervical (27.6%) cancers. The mean age was 59 years. The mean days to chemotherapy initiation varied by cancer type: ovarian 33.3, uterine 47.6, and cervical 67.2. The median days to chemotherapy was 40 for patients receiving chemotherapy after a surgery (46.5% of cohort) and 41 for patients receiving chemotherapy without surgery (53.5%). Patients were 37.1% Hispanic, 27.6% non-Hispanic White, 26.5% Black, and 8.2% Asian. After multivariable analysis, compared to non-Hispanic Whites, Black patients experienced longer delays (IRR 1.21, 95% CI 1.13-1.29, p < 0.01). Spanish-speaking patients represented 21.2% of the population and were significantly more likely to receive timely chemotherapy compared to English-speaking patients (IRR 0.82, 95% CI 0.77–0.87, p < 0.01). Insurance status was also a significant factor in treatment delays: patients with Medicaid (IRR 1.12, 95% CI 1.03–1.22, p < 0.01) and Medicare (IRR 1.16, 95% CI 1.10–1.23, p < 0.01) were significantly more likely to have delays in starting chemotherapy compared to patients with private insurance. Patients with advanced-stage disease (Stage III/IV, 70.6%) initiated chemotherapy faster compared to those with early-stage disease (IRR 0.93, 95% CI 0.88–0.98, p < 0.01). Inpatient diagnosis of cancer was associated with faster chemotherapy initiation (IRR 0.85, 95% CI 0.80–0.89, p < 0.01). Patients with cervical cancer (IRR 1.84, 95% CI 1.73–1.97, p < 0.01) and uterine cancer (IRR 1.38, 95% CI 1.29–1.47, p < 0.01) experienced longer delays compared to those with ovarian cancer. Conclusions: Delays in chemotherapy initiation are strongly associated with SDOH factors, including race/ethnicity and insurance type. These findings highlight the need for targeted interventions, such as enhanced patient navigation and streamlined insurance approval processes to ensure timely access to care and reduce health disparities in vulnerable populations.