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Cancer Care Access Wait Times Fuel Racial Disparities for Minorities

Minorities have notably longer wait times for cancer care access than their White counterparts, which researchers said could lead to increased risk of death, a new study finds.

Many minorities face racial disparities in wait times for cancer care access; in some cases, access to radiation therapy can take up to seven days longer than for White patients, a study published in the scientific journal Health Equity revealed.

While patients wait for cancer treatment, cancer can progress, early treatment options get missed and mortality risk increases. A one-week delay in treatment can increase mortality risk by one to three percent depending on the cancer stage, the researchers said, citing prior studies.

This latest study showed that some patients are more likely to experience those delays than others.

UVA Cancer Center researchers reviewed data from more than 222,700 patients with non-small cell lung cancer across the United States and found that the average wait time for radiation initiation was 61.7 days.

On average, Black patients waited slightly longer, with the average wait time to access cancer radiation therapy taking 65.9 days. For Asian patients, wait times were 71.9 days. Meanwhile, White patients had a wait time of fewer than 62 days.

The findings, which were collected before the pandemic, provide insight into racial disparities that occur as patients move from initial evaluations to treatment design and implementation.

“Our results suggest that non-white lung cancer patients have delayed time to cancer treatment compared with white patients, and this is not limited to a particular type of treatment facility," senior researcher Rajesh Balkrishnan, PhD, of UVA Cancer Center and the University of Virginia School of Medicine’s Department of Public Health Sciences, said in a press release. “Collaboration among providers and community stakeholders and organizations is much needed to increase accessibility and patient knowledge of cancer and to overcome existing disparities in timely care for lung cancer patients."

Patients treated at academic hospitals had the longest waits for treatment initiation, regardless of race. Researchers hypothesize this may be because patients usually begin their treatment in community hospitals and then get referred to academic facilities that can offer more complex care.

This transfer from a community setting to an academic center is often accompanied by delays in referrals and long waiting lists for appointments, the researchers stated.

Despite the variation in average wait time among treatment facilities, racial disparities were found across all types of hospitals, with Asian patients consistently having the largest wait.

The study suggests several barriers are contributing to racial disparities in cancer treatment access, including prior research that shows minority patients are more likely to face socioeconomic barriers to care, be uninsured, experience less satisfaction with physician-patient encounters, and be perceived by providers as at-risk for noncompliance.

However, researchers said further investigation is needed to understand the underlying reason for the disparities.

“These findings shed light on the potential presence of and impact of structural racism on patients seeking cancer treatment,” the researchers wrote. “Further investigation into the societal determinants that perpetuate disparity in time to radiation therapy, and potential interventions in the clinical setting to improve cultural and racial sensitivity among healthcare professionals, is recommended.”

Despite the data being from a pre-COVID era, prior research shows that during COVID, minority patients experienced the greatest delays in cancer care access. The COVID-19 pandemic delayed cancer screening, surgical procedures, and treatments, with unknown implications for cancer mortality rates.

Past studies show that Black and Latinx respondents were three times more likely to experience modifications in cancer care, including delayed clinic visits, laboratory tests, and imaging, and a change in location of care, compared to White participants.

As more patients lack care access early in COVID-19, telehealth use for cancer care increased and emerged as a strategy to facilitate some treatment.

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