Geography Affects Racial Health Disparities in Cancer Treatment Delays

How long does it take to begin cancer treatment? It may depend on where you live, according to new data showing that geography can compound or mitigate racial disparities in cancer treatment delays.

The study, published in ACS Journals, showed that the magnitude of racial differences in cancer treatment delays can vary by geographic region.

Delays in cancer treatment can result in poorer outcomes, the researchers said. Zooming in on breast cancer specifically, treatment delays between 30 and 50 days can result in disease-specific and overall survival, the researchers said. Patients who see delays between surgery and adjuvant chemotherapy, and in completion of all therapy, are also more likely to see their breast cancer recur, the research team added.

Black patients are more likely to see these delays than their White counterparts, carving out racial health disparities in treatment access and, consequently, outcomes.

“It is likely that racial and ethnic disparities in timely access to cancer care are influenced by the characteristics of the health system and communities within which individuals seek cancer care,” the researchers posited. “Black and Hispanic patients with breast cancer receive surgical care at different hospitals than non-Hispanic White peers, are less involved with selection of their surgeon and treatment facility, and rely less on reputation when selecting care.”

That hypothesis bore out, with an analysis of 32,000 breast cancer patients in North Carolina between 2004 and 2015 showing that geography makes a difference.

Statewide, Black patients were more likely to see a 60-day gap in breast cancer care access than people of other races (15 versus 8 percent, respectively).

But geography played a critical role in determining the scale of that racial health disparity. Depending on where in North Carolina patients lived, the racial gap in treatment delays ranged from 0 to 9.4 percent, the researchers said.

In fact, geography was such a strong predictor of timely care access that it impacted patients of any race. In certain parts of North Carolina, patients of any race could be up to twice as likely to face a 60-day breast cancer treatment delay.

The researchers acknowledged the role that sociodemographics and social determinants of health may play in these disparities, including differences in cancer care outcomes. But they also emphasized the problems that remained even after controlling for sociodemographics.

“These findings suggest that structural features of local health care systems, rather than variation in patient characteristics, may be key explanatory factors for geographic disparities in treatment delays and other cancer outcomes,” the research team wrote.

Services like patient navigation and care coordination will also be essential, particularly for the areas with the greatest disparities in treatment delays. The researchers noted that those areas also had the highest risk of treatment delay for Black patients and were located near large urban centers.

“Although this requires confirmation, these findings suggest that interventions to facilitate access for Black patients and those with high clinical risk in complex urban health systems, such as patient navigation, should be prioritized to combat treatment disparities and improve outcomes at the state level,” the team wrote.

Further research should look at how the healthcare industry can modify these problems, the team said. Studies may focus on health system characteristics associated with treatment delays, delays in treatments for other types of cancers, and assessment of tailored interventions.