Racial/ethnic Differences in Treatment Delay in a Multi-ethnic Sample of Women with Breast Cancer

1. 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

2. Acknowledgements Sarah T. Hawley, PhD Nancy K. Janz, PhD Jennifer J. Griggs, PhD Ann Hamilton, PhD John Graff, PhD Steven J. Katz, MD University of Michigan Los Angeles and Detroit Metropolitan Area SEER Registries University of Southern California and Wayne State University Funded by the National Cancer Institute (R01CA109696; R01 CA088370)

3. 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

4. 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

5. Research Aims • To describe the prevalence of treatment delay in in a population-based sample • To examine racial/ethnic differences in treatment delay • To determine the sociodemographic, clinical/treatment, and access barriers that may account for racial/ethnic differences in treatment delay

6. 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

7. Study Variables Study 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

8. Sociodemographic 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

9. Additional Variables (2) Access Barriers Difficulty (yes/no): • Finding a doctor • Scheduling surgical procedure • Getting to doctors’ office • Financial cost (office visits, treatments)

10. Statistical Analyses • Multinomial Logistic Regression Models • Three level dependent variable • < 1 month • 1-3 months • > 3 months Significant Delay Point estimates adjusted by weights to account for differential selection by race/ethnicity and non-response

11. Patient Characteristics *Restricted to women who had a surgical procedure

12. Prevalence of Treatment Delay

13. Prevalence of Treatment Delay by Race/ethnicity p<0.001 percent

14. Sociodemographic Factors by Race/ethnicity all p’s <0.001 percent

15. Clinical/Treatment Factors by Race/ethnicity all p’s <0.05 percent

16. Access Barriers by Race/ethnicity all p’s <0.05 percent

17. Adjusted Odds of Treatment Delay (>3mo vs. < 1mo) by Race/Ethnicity Latina vs. White African American vs. White odds ratios Model adjusts for sociodemographic, clinical/treatment, and access barriers

18. Other Significant Correlates of Treatment Delay (> 3months*) • Sociodemographic • Married* • Clinical/Treatment • More co-morbidities • Higher cancer stage* • Chemotherapy • Breast reconstruction* • Access Barriers • Scheduling surgical procedure*

19. 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

20. 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

21. Thank you!!!