Breast cancer treatment delays by socioeconomic and health care access latent classes in Black and White women
Background Breast cancer mortality is higher for Black and younger women. This study evaluated 2 possible contributors to disparities—time to treatment and treatment duration—by race and age. Methods Among 2841 participants with stage I‐III disease in the Carolina Breast Cancer Study, we identified...
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| Veröffentlicht in: | Cancer 2020-11, Vol.126 (22), p.4957-4966 |
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| creator | Emerson, Marc A. Golightly, Yvonne M. Aiello, Allison E. Reeder‐Hayes, Katherine E. Tan, Xianming Maduekwe, Ugwuji Johnson‐Thompson, Marian Olshan, Andrew F. Troester, Melissa A. |
| description | Background
Breast cancer mortality is higher for Black and younger women. This study evaluated 2 possible contributors to disparities—time to treatment and treatment duration—by race and age.
Methods
Among 2841 participants with stage I‐III disease in the Carolina Breast Cancer Study, we identified groups of women with similar patterns of socioeconomic status (SES), access to care, and tumor characteristics using latent class analysis. We then evaluated latent classes in association with treatment delay (initiation >60 days after diagnosis) and treatment duration (in quartiles by treatment modality).
Results
Thirty‐two percent of younger Black women were in the highest quartile of treatment duration (versus 22% of younger White women). Black women experienced a higher frequency of delayed treatment (adjusted relative frequency difference [RFD], 5.5% [95% CI, 3.2%‐7.8%]) and prolonged treatment duration (RFD, 8.8% [95% CI, 5.7%‐12.0%]). Low SES was significantly associated with treatment delay among White women (RFD, 3.5% [95% CI, 1.1%‐5.9%]), but treatment delay was high at all levels of SES in Black women (eg, 11.7% in high SES Black women compared with 10.6% and 6.7% among low and high SES White women, respectively). Neither SES nor access to care classes were significantly associated with delayed initiation among Black women, but both low SES and more barriers were associated with treatment duration across both groups.
Conclusions
Factors that influence treatment timeliness persist throughout the care continuum, with prolonged treatment duration being a sensitive indicator of differences by race, SES, and care barriers.
Economic and other barriers to care appear to compound across the continuum, with treatment duration representing a sensitive indicator of barriers to care. By developing an integrated view of multiple patient factors that contribute to duration, appropriate multidimensional interventions can be conceptualized to reduce racial mortality disparities. |
| doi_str_mv | 10.1002/cncr.33121 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_2444605501</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2453671558</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4481-497ad52ee2855f39405c77b352ec245960339130f9fd1fca60f9e38eb25e4a293</originalsourceid><addsrcrecordid>eNp9kV1rFDEUhkOxtGv1pj9AAt6IMDWfO5MbwS62FoqCKHoXsmfOdFMzSZvMWvbfm-3Wol54lZyT5zyc8BJyzNkJZ0y8gQj5REou-B6ZcWbahnElnpAZY6xrtJLfD8nTUq5r2QotD8ihFEYrZeSMxNOMrkwUXATMdKrVNGKcaI_BbQpdbmhJ4BNCimn0QF3s6QpdmFZ1JiN1AFgKDW7aTkFwpWChPtLT4ODHPf5t5Sekd6l6n5H9wYWCzx_OI_L17P2XxYfm8tP5xeLdZQNKdbxRpnW9Foii03qQRjENbbuUtQVCaTNnUhou2WCGng_g5vWGssOl0KicMPKIvN15b9bLEXuou2UX7E32o8sbm5y3f79Ev7JX6adt284Iyarg1YMgp9s1lsmOvgCG4CKmdbFCKTVnWjNe0Zf_oNdpnWP9XqW0nLdc665Sr3cU5FRKxuFxGc7sNka7jdHex1jhF3-u_4j-zq0CfAfc-YCb_6js4uPi8076CxcrqJw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2453671558</pqid></control><display><type>article</type><title>Breast cancer treatment delays by socioeconomic and health care access latent classes in Black and White women</title><source>Wiley Online Library Journals Frontfile Complete</source><source>Wiley Free Content</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Emerson, Marc A. ; Golightly, Yvonne M. ; Aiello, Allison E. ; Reeder‐Hayes, Katherine E. ; Tan, Xianming ; Maduekwe, Ugwuji ; Johnson‐Thompson, Marian ; Olshan, Andrew F. ; Troester, Melissa A.</creator><creatorcontrib>Emerson, Marc A. ; Golightly, Yvonne M. ; Aiello, Allison E. ; Reeder‐Hayes, Katherine E. ; Tan, Xianming ; Maduekwe, Ugwuji ; Johnson‐Thompson, Marian ; Olshan, Andrew F. ; Troester, Melissa A.</creatorcontrib><description>Background
Breast cancer mortality is higher for Black and younger women. This study evaluated 2 possible contributors to disparities—time to treatment and treatment duration—by race and age.
Methods
Among 2841 participants with stage I‐III disease in the Carolina Breast Cancer Study, we identified groups of women with similar patterns of socioeconomic status (SES), access to care, and tumor characteristics using latent class analysis. We then evaluated latent classes in association with treatment delay (initiation >60 days after diagnosis) and treatment duration (in quartiles by treatment modality).
Results
Thirty‐two percent of younger Black women were in the highest quartile of treatment duration (versus 22% of younger White women). Black women experienced a higher frequency of delayed treatment (adjusted relative frequency difference [RFD], 5.5% [95% CI, 3.2%‐7.8%]) and prolonged treatment duration (RFD, 8.8% [95% CI, 5.7%‐12.0%]). Low SES was significantly associated with treatment delay among White women (RFD, 3.5% [95% CI, 1.1%‐5.9%]), but treatment delay was high at all levels of SES in Black women (eg, 11.7% in high SES Black women compared with 10.6% and 6.7% among low and high SES White women, respectively). Neither SES nor access to care classes were significantly associated with delayed initiation among Black women, but both low SES and more barriers were associated with treatment duration across both groups.
Conclusions
Factors that influence treatment timeliness persist throughout the care continuum, with prolonged treatment duration being a sensitive indicator of differences by race, SES, and care barriers.
Economic and other barriers to care appear to compound across the continuum, with treatment duration representing a sensitive indicator of barriers to care. By developing an integrated view of multiple patient factors that contribute to duration, appropriate multidimensional interventions can be conceptualized to reduce racial mortality disparities.</description><identifier>ISSN: 0008-543X</identifier><identifier>EISSN: 1097-0142</identifier><identifier>DOI: 10.1002/cncr.33121</identifier><identifier>PMID: 32954493</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Breast cancer ; Cancer therapies ; Delay ; health care disparities ; Health services ; Latent class analysis ; Oncology ; Quartiles ; Race ; racial disparities ; Socioeconomic factors ; Socioeconomics ; treatment delay ; treatment duration ; White people</subject><ispartof>Cancer, 2020-11, Vol.126 (22), p.4957-4966</ispartof><rights>2020 American Cancer Society</rights><rights>2020 American Cancer Society.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4481-497ad52ee2855f39405c77b352ec245960339130f9fd1fca60f9e38eb25e4a293</citedby><cites>FETCH-LOGICAL-c4481-497ad52ee2855f39405c77b352ec245960339130f9fd1fca60f9e38eb25e4a293</cites><orcidid>0000-0002-1246-3235 ; 0000-0001-7535-1137 ; 0000-0001-6903-0177</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fcncr.33121$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fcncr.33121$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,777,781,882,1412,1428,27905,27906,45555,45556,46390,46814</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32954493$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Emerson, Marc A.</creatorcontrib><creatorcontrib>Golightly, Yvonne M.</creatorcontrib><creatorcontrib>Aiello, Allison E.</creatorcontrib><creatorcontrib>Reeder‐Hayes, Katherine E.</creatorcontrib><creatorcontrib>Tan, Xianming</creatorcontrib><creatorcontrib>Maduekwe, Ugwuji</creatorcontrib><creatorcontrib>Johnson‐Thompson, Marian</creatorcontrib><creatorcontrib>Olshan, Andrew F.</creatorcontrib><creatorcontrib>Troester, Melissa A.</creatorcontrib><title>Breast cancer treatment delays by socioeconomic and health care access latent classes in Black and White women</title><title>Cancer</title><addtitle>Cancer</addtitle><description>Background
Breast cancer mortality is higher for Black and younger women. This study evaluated 2 possible contributors to disparities—time to treatment and treatment duration—by race and age.
Methods
Among 2841 participants with stage I‐III disease in the Carolina Breast Cancer Study, we identified groups of women with similar patterns of socioeconomic status (SES), access to care, and tumor characteristics using latent class analysis. We then evaluated latent classes in association with treatment delay (initiation >60 days after diagnosis) and treatment duration (in quartiles by treatment modality).
Results
Thirty‐two percent of younger Black women were in the highest quartile of treatment duration (versus 22% of younger White women). Black women experienced a higher frequency of delayed treatment (adjusted relative frequency difference [RFD], 5.5% [95% CI, 3.2%‐7.8%]) and prolonged treatment duration (RFD, 8.8% [95% CI, 5.7%‐12.0%]). Low SES was significantly associated with treatment delay among White women (RFD, 3.5% [95% CI, 1.1%‐5.9%]), but treatment delay was high at all levels of SES in Black women (eg, 11.7% in high SES Black women compared with 10.6% and 6.7% among low and high SES White women, respectively). Neither SES nor access to care classes were significantly associated with delayed initiation among Black women, but both low SES and more barriers were associated with treatment duration across both groups.
Conclusions
Factors that influence treatment timeliness persist throughout the care continuum, with prolonged treatment duration being a sensitive indicator of differences by race, SES, and care barriers.
Economic and other barriers to care appear to compound across the continuum, with treatment duration representing a sensitive indicator of barriers to care. By developing an integrated view of multiple patient factors that contribute to duration, appropriate multidimensional interventions can be conceptualized to reduce racial mortality disparities.</description><subject>Breast cancer</subject><subject>Cancer therapies</subject><subject>Delay</subject><subject>health care disparities</subject><subject>Health services</subject><subject>Latent class analysis</subject><subject>Oncology</subject><subject>Quartiles</subject><subject>Race</subject><subject>racial disparities</subject><subject>Socioeconomic factors</subject><subject>Socioeconomics</subject><subject>treatment delay</subject><subject>treatment duration</subject><subject>White people</subject><issn>0008-543X</issn><issn>1097-0142</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kV1rFDEUhkOxtGv1pj9AAt6IMDWfO5MbwS62FoqCKHoXsmfOdFMzSZvMWvbfm-3Wol54lZyT5zyc8BJyzNkJZ0y8gQj5REou-B6ZcWbahnElnpAZY6xrtJLfD8nTUq5r2QotD8ihFEYrZeSMxNOMrkwUXATMdKrVNGKcaI_BbQpdbmhJ4BNCimn0QF3s6QpdmFZ1JiN1AFgKDW7aTkFwpWChPtLT4ODHPf5t5Sekd6l6n5H9wYWCzx_OI_L17P2XxYfm8tP5xeLdZQNKdbxRpnW9Foii03qQRjENbbuUtQVCaTNnUhou2WCGng_g5vWGssOl0KicMPKIvN15b9bLEXuou2UX7E32o8sbm5y3f79Ev7JX6adt284Iyarg1YMgp9s1lsmOvgCG4CKmdbFCKTVnWjNe0Zf_oNdpnWP9XqW0nLdc665Sr3cU5FRKxuFxGc7sNka7jdHex1jhF3-u_4j-zq0CfAfc-YCb_6js4uPi8076CxcrqJw</recordid><startdate>20201115</startdate><enddate>20201115</enddate><creator>Emerson, Marc A.</creator><creator>Golightly, Yvonne M.</creator><creator>Aiello, Allison E.</creator><creator>Reeder‐Hayes, Katherine E.</creator><creator>Tan, Xianming</creator><creator>Maduekwe, Ugwuji</creator><creator>Johnson‐Thompson, Marian</creator><creator>Olshan, Andrew F.</creator><creator>Troester, Melissa A.</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TO</scope><scope>7U7</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-1246-3235</orcidid><orcidid>https://orcid.org/0000-0001-7535-1137</orcidid><orcidid>https://orcid.org/0000-0001-6903-0177</orcidid></search><sort><creationdate>20201115</creationdate><title>Breast cancer treatment delays by socioeconomic and health care access latent classes in Black and White women</title><author>Emerson, Marc A. ; Golightly, Yvonne M. ; Aiello, Allison E. ; Reeder‐Hayes, Katherine E. ; Tan, Xianming ; Maduekwe, Ugwuji ; Johnson‐Thompson, Marian ; Olshan, Andrew F. ; Troester, Melissa A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4481-497ad52ee2855f39405c77b352ec245960339130f9fd1fca60f9e38eb25e4a293</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Breast cancer</topic><topic>Cancer therapies</topic><topic>Delay</topic><topic>health care disparities</topic><topic>Health services</topic><topic>Latent class analysis</topic><topic>Oncology</topic><topic>Quartiles</topic><topic>Race</topic><topic>racial disparities</topic><topic>Socioeconomic factors</topic><topic>Socioeconomics</topic><topic>treatment delay</topic><topic>treatment duration</topic><topic>White people</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Emerson, Marc A.</creatorcontrib><creatorcontrib>Golightly, Yvonne M.</creatorcontrib><creatorcontrib>Aiello, Allison E.</creatorcontrib><creatorcontrib>Reeder‐Hayes, Katherine E.</creatorcontrib><creatorcontrib>Tan, Xianming</creatorcontrib><creatorcontrib>Maduekwe, Ugwuji</creatorcontrib><creatorcontrib>Johnson‐Thompson, Marian</creatorcontrib><creatorcontrib>Olshan, Andrew F.</creatorcontrib><creatorcontrib>Troester, Melissa A.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Emerson, Marc A.</au><au>Golightly, Yvonne M.</au><au>Aiello, Allison E.</au><au>Reeder‐Hayes, Katherine E.</au><au>Tan, Xianming</au><au>Maduekwe, Ugwuji</au><au>Johnson‐Thompson, Marian</au><au>Olshan, Andrew F.</au><au>Troester, Melissa A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Breast cancer treatment delays by socioeconomic and health care access latent classes in Black and White women</atitle><jtitle>Cancer</jtitle><addtitle>Cancer</addtitle><date>2020-11-15</date><risdate>2020</risdate><volume>126</volume><issue>22</issue><spage>4957</spage><epage>4966</epage><pages>4957-4966</pages><issn>0008-543X</issn><eissn>1097-0142</eissn><abstract>Background
Breast cancer mortality is higher for Black and younger women. This study evaluated 2 possible contributors to disparities—time to treatment and treatment duration—by race and age.
Methods
Among 2841 participants with stage I‐III disease in the Carolina Breast Cancer Study, we identified groups of women with similar patterns of socioeconomic status (SES), access to care, and tumor characteristics using latent class analysis. We then evaluated latent classes in association with treatment delay (initiation >60 days after diagnosis) and treatment duration (in quartiles by treatment modality).
Results
Thirty‐two percent of younger Black women were in the highest quartile of treatment duration (versus 22% of younger White women). Black women experienced a higher frequency of delayed treatment (adjusted relative frequency difference [RFD], 5.5% [95% CI, 3.2%‐7.8%]) and prolonged treatment duration (RFD, 8.8% [95% CI, 5.7%‐12.0%]). Low SES was significantly associated with treatment delay among White women (RFD, 3.5% [95% CI, 1.1%‐5.9%]), but treatment delay was high at all levels of SES in Black women (eg, 11.7% in high SES Black women compared with 10.6% and 6.7% among low and high SES White women, respectively). Neither SES nor access to care classes were significantly associated with delayed initiation among Black women, but both low SES and more barriers were associated with treatment duration across both groups.
Conclusions
Factors that influence treatment timeliness persist throughout the care continuum, with prolonged treatment duration being a sensitive indicator of differences by race, SES, and care barriers.
Economic and other barriers to care appear to compound across the continuum, with treatment duration representing a sensitive indicator of barriers to care. By developing an integrated view of multiple patient factors that contribute to duration, appropriate multidimensional interventions can be conceptualized to reduce racial mortality disparities.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>32954493</pmid><doi>10.1002/cncr.33121</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-1246-3235</orcidid><orcidid>https://orcid.org/0000-0001-7535-1137</orcidid><orcidid>https://orcid.org/0000-0001-6903-0177</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Breast cancer Cancer therapies Delay health care disparities Health services Latent class analysis Oncology Quartiles Race racial disparities Socioeconomic factors Socioeconomics treatment delay treatment duration White people |
| title | Breast cancer treatment delays by socioeconomic and health care access latent classes in Black and White women |
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