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

Abstract

We examined whether the National Comprehensive Cancer Network Distress Thermometer (DT) and Problem List, a patient-reported outcome measure (PROM), could be used to identify levels and causes of distress among women presenting with breast cancer.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. Regression models were used to examine associations between baseline DT score (0 = none to 10 = extreme) and types of stressors (emotional, familial, practical, physical, spiritual) after adjustment for race/ethnicity and other characteristics and to identify predictors of time to evaluation (TTE) and time to treatment (TTT).A total of 1029 women were included (median baseline DT score = 4). Emotional, physical, and practical stressors were associated with distress (all P < .05). Black patients (n = 258) were >2.5x as likely to report no distress as Whites (n = 675; OR 2.72; 95% CI, 1.68-4.40; P < .001) despite reporting a similar number of stressors. Higher DT scores were associated with shorter TTE and TTT while being Black and having physical or practical stressors were associated with delays in both (all P < .05). Having physical or practical stressors particularly exacerbated delays in TTE and TTT, for Hispanic patients, who represented only a small proportion of our cohort but had the longest delays to evaluation (23 days) and treatment (71 days) of any group and some of the highest median self-reported distress levels.Early psychosocial evaluation could potentially address delays in time to care and mitigate disparities for vulnerable patients through targeted and culturally responsive interventions for modifiable barriers to care.