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Patient-reported causes of distress predict disparities in time to evaluation and time to treatment after breast cancer diagnosis.

Publication ,  Journal Article
Fayanju, OM; Ren, Y; Stashko, I; Power, S; Thornton, MJ; Marcom, PK; Hyslop, T; Hwang, ES
Published in: Cancer
March 1, 2021

BACKGROUND: We examined whether the National Comprehensive Cancer Network distress thermometer (DT), a patient-reported outcome measure, could be used to identify levels and causes of distress associated with racial/ethnic disparities in time to care among patients with breast cancer. METHODS: We identified women aged ≥18 years with stage 0-IV breast cancer who were diagnosed in a single health system between January 2014 and July 2016. The baseline visit was defined as the first postdiagnosis, pretreatment clinical evaluation. Zero-inflated negative binomial (ZINB) regression (modeling non-zero DT scores and DT scores = 0) and logistic regression (modeling DT score ≥ 4, threshold for social services referral) were used to examine associations between baseline score (0 = none to 10 = extreme) and types of stressors (emotional, familial, practical, physical, spiritual) after adjustment for race/ethnicity and other characteristics. Linear regression with log transformation was used to identify predictors of time to evaluation and time to treatment. RESULTS: A total of 1029 women were included (median baseline DT score = 4). Emotional, physical, and practical stressors were associated with distress in both the ZINB and logistic models (all P < .05). Black patients (n = 258) were more likely to report no distress than Whites (n = 675; ZINB zero model odds ratio, 2.72; 95% CI, 1.68-4.40; P < .001) despite reporting a similar number of stressors (P = .07). Higher DT scores were associated with shorter time to evaluation and time to treatment while being Black and having physical or practical stressors were associated with delays in both (all P < .05). CONCLUSIONS: Patient-reported stressors predicted delays in time to care, but patient-reported levels of distress did not, with Black patients having delayed time to care despite reporting low levels of distress. We describe anticipatory, culturally responsive strategies for using patient-reported outcomes to address observed disparities.

Duke Scholars

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Published In

Cancer

DOI

EISSN

1097-0142

Publication Date

March 1, 2021

Volume

127

Issue

5

Start / End Page

757 / 768

Location

United States

Related Subject Headings

  • Time-to-Treatment
  • Psychological Distress
  • Oncology & Carcinogenesis
  • Middle Aged
  • Humans
  • Female
  • Breast Neoplasms
  • Aged
  • Adult
  • 4206 Public health
 

Citation

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Chicago
ICMJE
MLA
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Fayanju, O. M., Ren, Y., Stashko, I., Power, S., Thornton, M. J., Marcom, P. K., … Hwang, E. S. (2021). Patient-reported causes of distress predict disparities in time to evaluation and time to treatment after breast cancer diagnosis. Cancer, 127(5), 757–768. https://doi.org/10.1002/cncr.33310
Fayanju, Oluwadamilola M., Yi Ren, Ilona Stashko, Steve Power, Madeline J. Thornton, P Kelly Marcom, Terry Hyslop, and E Shelley Hwang. “Patient-reported causes of distress predict disparities in time to evaluation and time to treatment after breast cancer diagnosis.Cancer 127, no. 5 (March 1, 2021): 757–68. https://doi.org/10.1002/cncr.33310.
Fayanju OM, Ren Y, Stashko I, Power S, Thornton MJ, Marcom PK, et al. Patient-reported causes of distress predict disparities in time to evaluation and time to treatment after breast cancer diagnosis. Cancer. 2021 Mar 1;127(5):757–68.
Fayanju, Oluwadamilola M., et al. “Patient-reported causes of distress predict disparities in time to evaluation and time to treatment after breast cancer diagnosis.Cancer, vol. 127, no. 5, Mar. 2021, pp. 757–68. Pubmed, doi:10.1002/cncr.33310.
Fayanju OM, Ren Y, Stashko I, Power S, Thornton MJ, Marcom PK, Hyslop T, Hwang ES. Patient-reported causes of distress predict disparities in time to evaluation and time to treatment after breast cancer diagnosis. Cancer. 2021 Mar 1;127(5):757–768.
Journal cover image

Published In

Cancer

DOI

EISSN

1097-0142

Publication Date

March 1, 2021

Volume

127

Issue

5

Start / End Page

757 / 768

Location

United States

Related Subject Headings

  • Time-to-Treatment
  • Psychological Distress
  • Oncology & Carcinogenesis
  • Middle Aged
  • Humans
  • Female
  • Breast Neoplasms
  • Aged
  • Adult
  • 4206 Public health