Applying a Novel Measure of Community-Level Healthcare Access to Assess Breast Cancer Care Timeliness
Year: 2025
Type: article
Abstract: BACKGROUND: Geographic disparities in breast cancer outcomes exist. Few studies have examined community- and health system-level factors associated with care timeliness, an important measure of care quality. METHODS: The Carolina Breast Cancer Study is a population-based cohort of 2,998 women with invasive breast cancer (2008-2013). Using latent class modeling, patients' census tracts of residence were characterized by healthcare accessibility and affordability. Centers for Medicare and Medicaid Services ratings were used to classify hospitals as low- or high-quality. Six timeliness outcomes were assessed: (i) lacking prediagnostic regular care, (ii) being underscreened, (iii) late-stage diagnosis, (iv) delayed treatment initiation, (v) prolonged treatment duration, and (vi) lacking receipt of Oncotype DX genomic testing. Associations of geographic accessibility, healthcare affordability, and hospital-level quality with care timeliness were evaluated with relative frequency differences (RFD) and 95% confidence intervals (CI). RESULTS: Compared with "high-accessibility, high-affordability" census tracts, patients residing in "low-accessibility, low-affordability" areas were more likely to be underscreened (RFD = 18.7%, CI, 13.0, 24.3), have late-stage diagnosis (RFD = 6.2%, CI, 2.4, 10.1), and experience prolonged treatment (RFD = 6.9%, CI, 1.4, 12.3). "High-accessibility, low-affordability" areas had the highest frequency of treatment delay (RFD = 9.3%, CI, 3.9, 14.7). Initial surgery at a high-quality facility was associated with less delayed treatment (RFD = -3.9%, CI, -7.5, -0.4) and prolonged treatment (RFD = -5.9%, CI, -9.9, -1.9). CONCLUSIONS: Community- and health system-level factors were associated with timely breast cancer care. IMPACT: Policy efforts to improve access in communities should consider multiple dimensions of access, including geospatial accessibility and affordability.
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funders: U.S. Department of Defense, Breast Cancer Research Foundation, Pfizer, Susan G. Komen, National Institutes of Health, University of North Carolina at Chapel Hill, Pfizer Foundation, National Cancer Institute, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
Awards: INTEGRATING MOLECULAR PATHOLOGY, RADIOLOGY, AND GENETICS TO IMPROVE BREAST CANCER RISK PREDICTION, G1084410269, G1569999668, G2245182356, G239801252, G2567120800, G2627953802, G5043494318, G534517478, G5766614609, G6207066558, G6243124407, G6753093058, G6896755501, G8389591173, G9000117861, G9000179697, G9000194218, Cancer Care Quality Training Program, Cancer Center Support Grant, G958207224
OpenAlex ID: W4409921579