title: Cancer Treatment Delays in American Indians and Alaska Natives Enrolled in Medicare.
abstract: To assess whether timing of initial post-diagnosis cancer care differs between American Indian and Alaska Native (AI/AN) and non-Hispanic White (NHW) patients, we accessed SEER-Medicare data for breast, colorectal, lung, and prostate cancers (2001-2007). Medicare claims data were examined for initiation of cancer-directed treatment. Overall, AI/ANs experienced longer median times to starting treatment than NHWs (45 and 39 days, p &lt; .001) and lower rates of treatment initiation (HR[95%CI]: 0.86[0.79-0.93]). Differences were largest for prostate (HR: 0.80[0.71-0.89]) and smallest for breast cancer (HR: 0.96[0.83-1.11]). American Indians / Alaska Natives also had elevated odds of greater than 10 weeks between diagnosis and treatment compared with NHWs (OR[95% CI]: 1.37[1.16-1.63]), especially for prostate cancer (OR: 1.41[1.14-1.76]). Adjustment for comorbidity and socio-demographic factors attenuated associations except for prostate cancer. In this insured population, we observed evidence that AI/ANs start cancer therapy later than NHWs. The modest magnitude of delays suggests that they are unlikely to be a determinant of survival disparities.
authors.forename: Scott V
authors.initials: SV
authors.lastname: Adams
authors.forename: Aasthaa
authors.initials: A
authors.lastname: Bansal
authors.forename: Andrea N
authors.initials: AN
authors.lastname: Burnett-Hartman
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Cohen
authors.forename: Andrew
authors.initials: A
authors.lastname: Karnopp
authors.forename: Victoria
authors.initials: V
authors.lastname: Warren-Mears
authors.forename: Scott D
authors.initials: SD
authors.lastname: Ramsey
mesh_terms: D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000413:Alaska / Q000453:epidemiology; D000072957:Alaska Natives / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000208:ethnology / Q000628:therapy; D015179:Colorectal Neoplasms / Q000208:ethnology / Q000628:therapy; D015897:Comorbidity; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D008175:Lung Neoplasms / Q000208:ethnology / Q000628:therapy; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D060787:Neoplasm Grading; D009369:Neoplasms / Q000208:ethnology / Q000628:therapy*; D011471:Prostatic Neoplasms / Q000208:ethnology / Q000628:therapy; D012111:Residence Characteristics; D018426:SEER Program; D012723:Sex; D012959:Socioeconomic Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014481:United States; D016549:United States Indian Health Service / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data