title: Time to treatment for patients receiving BCS in a public and a private university hospital in Atlanta.
abstract: Delays in treatment for breast cancer can lead to poorer patient outcome. We analyzed time to treatment among female patients receiving breast-conserving surgery in two different hospital settings, public versus private. Retrospective chart review revealed 270 patients diagnosed during 2004-2008. Three consecutive time intervals were defined (Initial abnormal imaging [I] to core biopsy [II] to surgery /pathology staging [III] to oncology evaluation for adjuvant treatment). Multivariate analyses investigated hospital type and demographic factors. Overall median treatment time was 83 days, Interval II accounting for the longest (43 days). Only 55% of patients received the entire spectrum of care within 90 days; for each consecutive 30-day interval, percentages varied dramatically: 80.7%, 31.1%, and 68.9%.Public hospital patients experienced longer overall time to treatment than private patients (94 versus 77 days, p < 0.001); these differences persisted throughout the intervals. Longer wait times were experienced by African Americans versus Caucasians (89 versus 64 days, p = 0.003), unmarried versus married patients (93 versus 70 days, p < 0.001), and Medicaid-insured patients, p < 0.001. In multivariate analyses, hospital type, race, marital status, and insurance predicted timely treatment within one or more intervals. For patients undergoing breast-conserving therapy, time to treatment differs between private and public settings. However, barriers to timely treatment arise from both system-based issues and patient socio-demographic factors. Studies are needed to evaluate and intervene on this intricate connection.
authors.affiliation: Department of Pathology, Emory University, Atlanta, GA, USA. mmosunj@emory.edu
authors.forename: Marina
authors.initials: M
authors.lastname: Mosunjac
authors.forename: Jaemin
authors.initials: J
authors.lastname: Park
authors.forename: Alexandra
authors.initials: A
authors.lastname: Strauss
authors.forename: George
authors.initials: G
authors.lastname: Birdsong
authors.forename: Victor
authors.initials: V
authors.lastname: Du
authors.forename: Monica
authors.initials: M
authors.lastname: Rizzo
authors.forename: Sheryl G A
authors.initials: SG
authors.lastname: Gabram
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Lund
mesh_terms: D001741:Black or African American; D000368:Aged; D001706:Biopsy; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000601:surgery*; D005260:Female; D005845:Georgia; D054625:Healthcare Disparities; D016304:Hospitals, Private; D006779:Hospitals, Public; D006785:Hospitals, University; D006801:Humans; D017533:Marital Status; D015412:Mastectomy, Segmental; D008484:Medicaid; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States