Geographic region associated with risk of breast cancer treatment delays for Black and non-Black patients

Study finds that Black patients and patients living in certain regions experience greater delays.

For patients with cancer, lengthy delays in treatment can decrease their chances of survival. In an analysis of 2004–2017 information on patients with breast cancer in North Carolina, Black patients were more likely to experience such treatment delays than non-Black patients. Also, patients living in certain geographic regions of the state, regardless of race/ethnicity, tended to experience delays. The research is published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.

For the study, Katherine E. Reeder-Hayes, MD, MBA, MS, of the UNC Lineberger Comprehensive Cancer Center and her colleagues examined data on patients with stage I–III breast cancer who received surgery or chemotherapy as their first treatment and were listed in the Cancer Information and Population Health Resource, which links cancer registry and sociodemographic data to insurance claims. The research team defined a delay as >60 days from diagnosis to first treatment.

Among 32,626 patients, 19% were Black. Investigators found that 15% of Black patients experienced treatment delays compared with 8% of non-Black patients. Also, patients living in certain regions of the state were more likely to experience delays, with those in the highest-risk region being twice as likely to experience a delay as those in the lowest-risk region. This was the case for both Black and non-Black patients.

The magnitude of the racial gap in treatment delay varied by region, from 0.0% to 9.4%.

On average, about 1 in 7 Black women in our study experienced a lengthy delay, but this risk varied depending on where the woman lives in the state. These delays weren't explained by the patient's distance from cancer treatment facilities, their specific stage of cancer or type of treatment, or what insurance they had. These findings suggest that the structure of local health care systems, rather than characteristics of the patients themselves, may better explain why some patients experience treatment delays and other adverse cancer outcomes."

Dr. Katherine E. Reeder-Hayes, MD, MBA, MS, of the UNC Lineberger Comprehensive Cancer Center

The researchers are currently working on developing and testing tools for helping patients communicate about delays they're experiencing, and for alerting health care systems early when a patient's cancer treatment plan may be getting off track.