When you get diagnosed with breast cancer, time is of the essence.
If diagnosed and treated at an early stage, breast cancer has one of the highest survival rates, according to the American Cancer Society.
Timely treatment—including surgery to remove the tumor as well as chemotherapy and radiation therapy—not only gives patients the best chance for good outcomes, but it also relieves the stress of living with a cancer diagnosis.
However, outcomes still depend on external factors such as how much the cancer has spread, patient’s age, overall health, how well the cancer responds to treatment tumor grade and the time between diagnosis and surgery.
A recent study from Massachusetts General Hospital both confirmed time to surgery as a valid measure of healthcare outcomes. It also identified a worrying disparity in time to surgery (undergoing a lumpectomy or mastectomy) among Black and white patients.
Tawakalitu Oseni, MD, a physician-investigator in the Mass General Cancer Center and her team say the findings could serve as a way to assess patient access to healthcare services and measure the progress in reducing inequalities within healthcare systems.
"As healthcare providers, we should focus on the populations we serve,” Oseni says. “And the question is, ‘Is there a difference in the care we're giving?’ The answer to that question is yes. Ideally, the answer should be zero. There should be zero difference between the care we give Black and white patients."
Healthcare Disparities Within Time to Surgery
There is no current standard regarding the appropriate time to surgery for breast cancer, but there is support for including the difference in time to surgery (ΔTTS), as a breast cancer-specific quality metric.
It's a metric that is relatively easy to collect and can be standardized across health systems, Oseni says.
Delays in time to surgery have been associated with higher cancer related stress and reduced overall quality of life.
Previous research has also demonstrated a correlation between delayed surgery and poorer survival outcomes for breast cancer patients.
To expand on these findings, Oseni and her team analyzed a database of 866,840 patients diagnosed with breast cancer between 2010 and 2019, where they observed alarming differences between the white and Black patients.
The team found that Black women were more likely to be diagnosed at age 50 or younger, be on Medicaid, and diagnosed with stage II and III disease. They were also more likely to be treated at a minority-serving hospital.
The team also identified disparities in time to surgery—the median time to surgery was seven days longer for Black women (39 days) compared to White women (32 days).
Additionally, the team also found that Black patients were significantly less likely to receive surgery within 90 days compared to white patients (the team used 90 days from diagnosis as the cutoff point for their survey).
The gap between the median time to surgery (DTTS) between white and Black women increased between 2010 and 2019 as well, suggesting that the trend is heading in the wrong direction.
For lumpectomy, it increased from four days (25 vs. 29 days) to six days (35 vs. 41 days).
For mastectomy, it increased from eight days (30 vs. 38 days) to 10 days (44 vs. 54 days).
Where Do We Go from Here?
Moving forward, Oseni hopes to encourage other researchers and healthcare providers to use the difference in time to surgery for breast cancer as a way to assess the quality of cancer care, identify disparities and implement new solutions to address them.
"It could be that the minute they're diagnosed, we need to get them a patient navigator and assign them somebody who will walk them through the system,” she says.
“It may be that these patients may have extended family who they need to inform or who are going to play an integral part of their care, and we might want to immediately reach out and make sure that they have a multidisciplinary care team that includes their caregivers and everyone who's going to be involved in the procedure.”
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