Patient‐reported causes of distress predict disparities in time to evaluation and time to treatment after breast cancer diagnosis

• Published in: Cancer Vol. 127; no. 5; pp. 757 - 768
• Main Authors: Fayanju, Oluwadamilola M., Ren, Yi, Stashko, Ilona, Power, Steve, Thornton, Madeline J., Marcom, P. Kelly, Hyslop, Terry, Hwang, E. Shelley
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.03.2021
• Subjects: Adult; Aged; Breast cancer; Breast Neoplasms - psychology; Breast Neoplasms - therapy; distress; Emotions; Evaluation; Female; health disparities; Humans; Medical diagnosis; Middle Aged; Minority & ethnic groups; Modelling; modifiable risk factors; Oncology; Patients; patient‐reported outcomes; Psychological Distress; race/ethnicity; Regression; Social services; Time-to-Treatment; distress; patient-reported outcomes; breast cancer; health disparities; modifiable risk factors; race/ethnicity
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.33310

Background We examined whether the National Comprehensive Cancer Network distress thermometer (DT), a patient‐reported outcome measure, could be used to identify levels and causes of distress associated with racial/ethnic disparities in time to care among patients with breast cancer. Methods We identified women aged ≥18 years with stage 0‐IV breast cancer who were diagnosed in a single health system between January 2014 and July 2016. The baseline visit was defined as the first postdiagnosis, pretreatment clinical evaluation. Zero‐inflated negative binomial (ZINB) regression (modeling non‐zero DT scores and DT scores = 0) and logistic regression (modeling DT score ≥ 4, threshold for social services referral) were used to examine associations between baseline score (0 = none to 10 = extreme) and types of stressors (emotional, familial, practical, physical, spiritual) after adjustment for race/ethnicity and other characteristics. Linear regression with log transformation was used to identify predictors of time to evaluation and time to treatment. Results A total of 1029 women were included (median baseline DT score = 4). Emotional, physical, and practical stressors were associated with distress in both the ZINB and logistic models (all P < .05). Black patients (n = 258) were more likely to report no distress than Whites (n = 675; ZINB zero model odds ratio, 2.72; 95% CI, 1.68‐4.40; P < .001) despite reporting a similar number of stressors (P = .07). Higher DT scores were associated with shorter time to evaluation and time to treatment while being Black and having physical or practical stressors were associated with delays in both (all P < .05). Conclusions Patient‐reported stressors predicted delays in time to care, but patient‐reported levels of distress did not, with Black patients having delayed time to care despite reporting low levels of distress. We describe anticipatory, culturally responsive strategies for using patient‐reported outcomes to address observed disparities. In a review of 1029 women with breast cancer at their first postdiagnosis oncology appointments, patient‐reported causes of distress were found to predict delays in time‐to‐evaluation and time‐to‐treatment, but summative levels of patient‐reported distress did not, with Black patients reporting lower levels of distress than White patients despite having longer time‐to‐evaluation and time‐to‐treatment. Disparities in time‐to‐care may be improved through early assessment of logistical and psychosocial challenges prior to patients' first oncologic appointments.