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Race, ethnicity, other factors delay chemo after breast cancer surgery

August 19, 2010

Last Updated: 2010-08-17 18:48:03 -0400 (Reuters Health)

By Scott Baltic

NEW YORK (Reuters Health) - The vast majority of U.S. women who have chemotherapy after breast cancer surgery receive it in time to maximize their survival. But those whose chemotherapy is delayed are significantly more likely to be African-American or Hispanic, according to registry data from the American Cancer Society and the American College of Surgeons.

Insurance status, age, comorbidities, and the type of facility were also factors in delayed chemotherapy.

The findings, drawn from data on more than 100,000 women, appeared online August 9th in the Journal of Clinical Oncology.

Lead author Stacey Fedewa, an epidemiologist with the American Cancer Society in Atlanta, and her colleagues say previous research shows that breast cancer survival drops if chemotherapy starts more than 90 days after surgery.

One earlier study did look at chemotherapy delay and race, but it was limited to patients 65 years and older, Fedewa told Reuters Health by e-mail.

The current study, she said, "extends previous findings by examining adjuvant chemotherapy among a national sample of women aged 18-99, with diverse insurance (uninsured, Medicaid, private, etc.) and race/ethnic groups."

Overall, only 4.2% of the 107,587 patients studied had a delay of more than 90 days in the initiation of chemotherapy after their surgery. The average delay was just 41 days.

The authors noted a 90-day or greater delay in 3.59% of white patients, 6.78% of black patients, and 6.91% of Hispanic patients.

The report says the increased risk of delayed adjuvant chemotherapy among Hispanics and African-Americans "may be attributable to lack of access to care, geographic distance to the treatment facility, and availability of transportation. Difficulty navigating the health system and language barriers may also contribute to the disparities in treatment delay."

Patients with long delays were more likely to be uninsured or insured by Medicaid, to have other medical conditions, and to be older.

Women who were treated at low- and medium-volume facilities or at teaching/research hospitals or National Cancer Institute cancer centers were also at increased risk of delays.

Fedewa noted that the clinical effects of the chemotherapy delays in the current study group won't be known until five-year follow-up data are released next summer.

SOURCE: http://link.reuters.com/zeb65n

J Clin Oncol 2010.

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