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. Author manuscript; available in PMC: 2020 Jan 14.
Published in final edited form as: Breast Cancer Res Treat. 2018 Aug 9;172(2):247–263. doi: 10.1007/s10549-018-4909-5

Table 2.

Studies examining association between race and delays to treatment initiation

First Author Population Baseline Timepoint Outcome Event Sample Characteristics Unit of measurement Insurance Status Covariates Results
McLaughlin 201225 North Carolina Medicaid System linked to the North Carolina Central Cancer Registry–Medicaid Claims database Diagnosis Any treatment N=1786
Any Stage
Age ≥18
Jan 2000– Dec 2002
≥ 60 days versus < 60 days Medicaid Age
Race
Marital status
Year at diagnosis
County-level metropolitan and HPSA status
Stage
Tumor size
Hormone receptor status
CCI
Disability status
Assisted living and home health
Surgery Type
Treatment Type
Unadjusted: Treatment delay ≥6 months (nonwhite v white): OR: 1.37, 95% CI 1.01–1.86
Gwyn 200426 Residents of metropolitan area of Atlanta, Georgia, SEER for case ascertainment with data abstracted from records and surveys Diagnosis Any treatment: Definitive surgery, initial neoadjuvant chemotherapy, or the initiation of chemotherapy or hormonal therapy for metastatic disease. N=950
Any Stage
Age 20–54
May 1990– Dec 1992
< 1 month v ≥ 1 month Whites:
95.6% Private
2.1% Medicare or Medicaid
2.3% None

Blacks:
79.4% Private
9.8% Medicare or Medicaid
10.7% None
Age
Insurance status
Poverty Index
Marital Status
BMI
Education level
Insurance type
Mammography history
Method of detection
Number of comorbidities
Smoking status
Breast self-exam
Bra cup size
LN status
Tumor size
Disease stage
Treatment delay ≥1 month (black v white) OR 2.34; 95% CI: 1.25–4.38
Gorin 200627 SEER-Medicare Diagnosis Any treatment: Definitive surgery, neoadjuvant chemotherapy, radiation, chemotherapy or hormonal therapy for metastatic disease. N=49,865
Any Stage
Age ≥65
Jan 1992–Dec 1999
<1 month, 1–2 months, > 2 months Medicare Age
Marital status
Population of city of residency
Stage
Hormone receptor status
Tumor size
Lymph node involvement
Cormorbid conditions
Method of cancer detection
Member of HMO
Year of diagnosis
Physician visits per year
Census tract percentage in poverty
Treatment delays ≥1 month (black v white) OR 1.64; 95% CI: 1.40–1.94
Simon 201222 Henry Ford Health System, SEER Diagnosis Adjuvant chemotherapy N=2,234
Stage I–III
Any Age
Jan 1996-Dec2005
0–60 days, >60 days Whites:
95.6% Private
2.1% Medicare or Medicaid
2.3% None

Blacks
79.4% Private
9.8% Medicare of Medicaid
10.7% None

Total:
61.3% Private
34.9% Medicare
3.8% Other
Age
Insurance status
CCI
Deprivation index
Treatment delay > 60 days v ≤ 60 days (black v white) OR 1.18, 95% CI: 0.80–1.74
Vandergrift 201328 National Comprehensive Cancer Network Outcomes Database Diagnosis Adjuvant chemotherapy N=6222
Stages I–III
Any Age
January 2003–December 2009
Weeks Total:
79% Commercial
11% Medicare
8% Medicaid
3% Other
CCI
BMI
Age
Stage
Lymph node status
Hormone receptor status
HER2 status
Grade
LVI
Pathologic upstage
Number of excisional procedures
Reconstruction before adjuvant therapy
Received ALND
Diagnostic breast US
Diagnostic breast MRI
21 gene RT PCR assay
Type of Diagnostic biopsy
Treating institution
Type of initial surgery
Time to chemotherapy (black v white) +1.5 weeks, P < .001
Chavez-Macgregor 20163 California Cancer Registry Definitive Surgery Adjuvant chemotherapy Stage I–III
Any Age
January 1,2005–December31,2010
91 days or more Total: 24,843
Private: 17772
Medicare: 1651
Military: 223
Medicaid: 4259
Not insured/self pay: 208
Unknown: 70
Age
Sex
Year of diagnosis
SES, breast cancer stage,
Breast cancer subtype,
Marital status
Type of breast surgery,
whether reconstructive surgery was performed,
Primary payer,

Treatment at an NCI–designated cancer center
Time to chemotherapy 91 days or more (black v white) OR, 1.38; 95% CI, 1.19–1.60
Hershman 200629 SEER-Medicare Definitive Surgery Adjuvant chemotherapy Stage I, II
Age ≥65
1992–1999
<1 month, 1–2 months, 2–3 months, > 3 months Medicare Age
Live in metropolitan area
Stage
Hormone receptor status
Tumor Grade
Comorbid conditions
SES score
Marital status
Teaching hospital
Surgery performed
Radiation received
Treatment delay ≥3 months v < 3 months (black v white) OR 1.2, 95% CI: 0.7 to 1.8
Fedewa 201030 National Cancer Database Definitive surgery Adjuvant chemotherapy N=107,587
Stage I–III
Any Age
Jan 2004 – Dec 2006
60 days, 90 days Whites:
63.2% Private
33.6% Medicare
3.3% Other

Blacks:
57.6% Private
37.7% Medicare
4.8% Other
Age
CCI
Population without high school diploma
Treatment facility type
Volume of patients with breast cancer at facility
Census region
Insurance status
Stage
Hormone receptor status
Year diagnosis Year diagnosis
Treatment delay > 90 days v ≤ 90 days (black v white) RR: 1.56; 95% CI: 1.44–1.89
Nurgalieva 201331 SEER-Medicare Definitive surgery Adjuvant chemotherapy N= 14,380
Stages I–III
January 1, 1992–Dec 31,2005
> 90 days Medicare Age
Marriage status
Tumor stage, size, grade
Hormone receptor status
Comorbidity
Year of diagnosis
SEER region
Primary surgery and radiotherapy, and chemotherapy
Unadjusted: Treatment delay > 60 days v ≤ 60 days (black v white) 1.07; 95% CI 0.89–1.29

Treatment delay > 90 days v ≤ 90 days (black v white) 1.05; 95% CI 0.81–1.36
Gagliato201432 Breast Medical Oncology Institutional database at The University of Texas MD Anderson Cancer Center Definitive surgery Adjuvant chemotherapy N=6827
Stages I–III
1997–2011
≤ 30 days, 31 to 60 days, and ≥ 61 days Unknown Age
Race/ethnicity
Pathologic tumor size according to TNM classification
Pathologic nodal status according to TNM classification
Histologic grade
LVI
Type of surgery
Number of comorbidities (0, 1 to 2, 3 to 4, or 5+)
Unadjusted: Treatment delay > 60 days v ≤ 60 days (black v white) 0.79; 95% CI 0.62–1.00