Racial Disparities in Chemotherapy for Breast Cancer: Are Delays Explained by Hospital Quality and Volume?

Abstract 6034 Background: Black women experience more delays to initiation of adjuvant chemotherapy for breast cancer than white women. Research also suggests that hospital quality and volume may influence receipt of cancer care. In a large population-based cohort, we examined racial differences in chemotherapy delay and whether hospital quality or volume explained any observed disparities. METHODS: We used Surveillance Epidemiology and End Results-Medicare data to examine time to chemotherapy for black and white women who were diagnosed with stage I-III breast cancer during 1992-2005 and received neo/adjuvant chemotherapy. We used multivariate logistic regression to assess the probability of chemotherapy delay (first dose of chemotherapy >90 days after surgery) by race, controlling for patient, tumor, and area-level characteristics. Sequential models included hospital quality (defined based on rates of recommended chemotherapy for eligible women), volume, or both. RESULTS: Among the 676 black and 5,905 white women who received adjuvant chemotherapy, 7% had a delay in treatment. Black women (vs. white) were less likely to be treated in higher quality hospitals (24% vs. 30%) and higher volume hospitals (62% vs. 73%) (both p