title: Delayed radiotherapy for breast cancer patients in integrated delivery systems.
abstract: OBJECTIVE
  To identify factors associated with delayed radiotherapy (RT) in older women with early-stage breast cancer.
  
  
  METHODS
  We studied 541 women age >or=65 years diagnosed with early-stage breast cancer in 1990-1994 at 5 integrated healthcare delivery systems and treated with breast-conserving surgery and RT, but not chemotherapy. We examined whether demographic, tumor, or treatment characteristics were associated with RT delays of >8 weeks postsurgery using chi(2) tests and multivariable logistic regression.
  
  
  RESULTS
  Seventy-six women (14%) had delayed RT, with a median delay of 14 weeks. Even though they had insurance and access to care, nonwhite and Hispanic women were much more likely than white women to have delayed RT (odds ratio = 3.3; 95% confidence interval = 1.7, 10) in multivariable analyses that controlled for demographic and clinical variables.
  
  
  CONCLUSIONS
  Timely RT should be facilitated through physician and patient education, navigation, and notification programs to improve quality of care. Queues for RT appointments should be evaluated on an ongoing basis to ensure adequate access. Future research should examine modifiable barriers to RT timeliness and whether delays impact long-term outcomes.
authors.affiliation: Department of Public Health, Weill Cornell Medical College, New York, NY 10065-6304, USA. heg2001@med.cornell.edu
authors.forename: Heather Taffet
authors.initials: HT
authors.lastname: Gold
authors.forename: Soe Soe
authors.initials: SS
authors.lastname: Thwin
authors.forename: Diana S M
authors.initials: DS
authors.lastname: Buist
authors.forename: Terry S
authors.initials: TS
authors.lastname: Field
authors.forename: Feifei
authors.initials: F
authors.lastname: Wei
authors.forename: Marianne Ulcickas
authors.initials: MU
authors.lastname: Yood
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Lash
authors.forename: Virginia P
authors.initials: VP
authors.lastname: Quinn
authors.forename: Ann M
authors.initials: AM
authors.lastname: Geiger
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Silliman
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D019033:Delivery of Health Care, Integrated; D005260:Female; D006801:Humans; D015999:Multivariate Analysis; D044469:Racial Groups; D013997:Time Factors; D014481:United States