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Racial/ethnic Differences in Treatment Delay in a Multi-ethnic Sample of Women with Breast Cancer. Mahasin S. Mujahid, PhD RWJ Health and Society Scholar Harvard University School of Public Health. Acknowledgements. Sarah T. Hawley, PhD Nancy K. Janz, PhD Jennifer J. Griggs, PhD - PowerPoint PPT Presentation
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Racial/ethnic Differences in Treatment Delay
in a Multi-ethnic Sample of Women with Breast Cancer
Mahasin S. Mujahid, PhDRWJ Health and Society Scholar
Harvard University School of Public Health
AcknowledgementsSarah T. Hawley, PhD
Nancy K. Janz, PhDJennifer J. Griggs, PhD
Ann Hamilton, PhDJohn Graff, PhD
Steven J. Katz, MDUniversity of Michigan
Los Angeles and Detroit Metropolitan Area SEER RegistriesUniversity of Southern California and Wayne State University
Funded by the National Cancer Institute (R01CA109696; R01 CA088370)
Background• There are persistent racial/ethnic differences in
breast cancer survival in the US
• Differences have been attributed to:•Tumor biology and pathogenesis•Socioeconomic characteristics•Co-morbidities•Access to and quality of medical care
•Breast cancer screening•Timely receipt of appropriate treatment
Background (2)
• Treatment delay is an important area of study• Longer delays associated with worse
survival rates
• Few studies have examined racial/ethnic differences in treatment delay• population-based multi-ethnic studies• underlying factors contributing to
differences
Research Aims
1. To describe the prevalence of treatment delay in in a population-based sample
2. To examine racial/ethnic differences in treatment delay
3. To determine the sociodemographic, clinical/treatment, and access barriers that may account for racial/ethnic differences in treatment delay
Study Population• Population-based sample (8/05-2/07)
• Detroit and Los Angeles Metropolitan areas• Rapid case ascertainment (9 months post diagnosis)
• Accrued and Eligible Sample (N=3133)• 20-79 years of age• Stage 0-III disease• Able to complete self-administered questionnaire• African American and Latina women were over-
sampled
• Final Sample (N=2268); 72% response rate
Study VariablesStudy Outcome (Treatment Delay)Time between diagnosis and first surgical
procedure• <1month• 1-3 months moderate delay• >3 months significant delay
Key Covariate (Race/ethnicity)• White (non-Latina)• African American (non-Latina)• Latina
Additional VariablesSociodemographic Factors• Age at diagnosis
• Married/partner
• Education
• Income
• Employed
• Insurance
Clinical /Treatment Factors
• Number of co-morbidities
• Cancer stage
• Chemotherapy
• Breast reconstruction at time of surgery
Additional Variables (2)Access BarriersDifficulty (yes/no):
1. Finding a doctor
2. Scheduling surgical procedure
1. Getting to doctors’ office
2. Financial cost (office visits, treatments)
Statistical Analyses
• Multinomial Logistic Regression Models• Three level dependent variable
•< 1 month •1-3 months•> 3 months
Point estimates adjusted by weights to account for differential selection by race/ethnicity and non-response
Significant Delay
Patient Characteristics
N=2195*
Weighted %
Age Mean =58 years
Race/ethnicityLatinaAfrican AmericanWhite
562585994
171568
Education≤ H.S diplomaH.S diploma> H.S diploma
401461
1292
132067
*Restricted to women who had a surgical procedure
Prevalence of Treatment Delay
43
7
50
0
10
20
30
40
50
60
<1 month 1-3 months >3 months
pe
rce
nt
Prevalence of Treatment Delay
by Race/ethnicity
40
5
43
48
9
39
51
10
54
0
10
20
30
40
50
60
< 1month 1-3 months >3 months
White African American Latina
p<0.001
perc
ent
Sociodemographic Factors by Race/ethnicity
6
18
42
2
63
1513
34
42
6
38
19
48
41
47
18
61
11
0
10
20
30
40
50
60
70
< 45 years < H.S <$30,000 unemployed uninusured married
White African American Latina
all p’s <0.001
perc
ent
Clinical/Treatment Factors by Race/ethnicity
10
54
12
42
12
52
9
28
13
45
8
29
0
10
20
30
40
50
60
2+ comorbidities stage III chemotherapy reconstruction
White African American Latina
all p’s <0.05
perc
ent
Access Barriers by Race/ethnicity
1211
24
4
12
7
17
8
16
9
14
6
0
5
10
15
20
25
30
finding doctor getting to office schedulingsurgery
financial cost
White African American Latina
all p’s <0.05
perc
ent
Adjusted Odds of Treatment Delay (>3mo vs. < 1mo) by
Race/Ethnicity
2.1
1.7
2.6
2.1
1
10
unadjusted adjusted unadjusted adjusted
Latina vs. White African American vs. White
Model adjusts for sociodemographic, clinical/treatment, and access barriers
od
ds
rati
os
• Sociodemographic • Married*
• Clinical/Treatment • More co-morbidities• Higher cancer stage*• Chemotherapy• Breast reconstruction*
• Access Barriers • Scheduling surgical procedure*
Other Significant Correlates of Treatment Delay (> 3months*)
Conclusion
• Overall few women experienced significant treatment delay
• However, we found racial/ethnic differences in delay that are concerning
• These differences were partially explained by social, clinical/treatment, and access barriers
Implications• Providers should be aware of the potential for
treatment delay among race/ethnic minorities, and work to assist patients with navigating the health care system
• Further efforts are needed to ensure support for treatment decision making
• Ensuring information is culturally appropriate and available in different languages may improve the timely use of cancer treatment services
Thank you!!!
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