Women with a new diagnosis of breast cancer who are covered by Medicare
are waiting longer and longer to get treatment, according to a new nationwide
study. Researchers found that between 1992 and 2005, the average waiting time
between being diagnosed and having surgery rose from 21 days to 32 days. The
delay was especially long for black and Hispanic women, and for those living in
large cities.
Still, the study team noted, it's unclear how big a difference the extra
week or two would make in women's long-term health. "I don't believe the
delays we're seeing here are problematic, (but) we're clearly going to need to
keep any eye on it because if those delays keep increasing, they may become
problematic," said the study's lead author, Dr. Richard Bleicher.
Bleicher, from Fox Chase Cancer Center in Philadelphia, and his
colleagues analyzed cancer registry data and Medicare claims for 72,586 older
adults diagnosed with breast cancer between 1992 and 2005, 99 percent of whom
were women. Over that period, both the time between a patient's first breast
cancer-related visit and her first biopsy increased, as did the time between
biopsies and surgery, according to findings published this week in the Journal
of Clinical Oncology.
When the researchers accounted for patient characteristics such as tumor
stage, as well as number and type of pre-surgery visits and screenings, the
relative delay shrank from 11 days to five days. Whether the extra waiting in
more recent years is "clinically meaningful" remains to be seen,
according to Bleicher's team.
Another report published in the same journal found that for women with
advanced cancer, waiting 60 days or more for treatment was tied to a greater
likelihood of dying in the five years after diagnosis. Shorter delays, however,
weren't associated with worse outcomes. Among 1,786 North Carolina women on
Medicaid, the average time between diagnosis and treatment - usually surgery -
was 22 days between 2000 and 2002, Dr. Electra Paskett from The Ohio State
University in Columbus and her team found.
The length of that interval didn't seem to affect a woman's chance of
surviving early-stage breast cancer. But for those with late-stage cancer,
women who waited 60 days or more between diagnosis and treatment were 66
percent more likely to die of any cause over the next five years and 85 percent
more likely to die of breast cancer, in particular. In Paskett's study, one in
10 women waited at least 60 days for treatment. She pointed out that people on
Medicaid, like those in her study, may have more problems getting timely
treatment compared to people with private insurance. "It could be that
they had problems finding a doctor who would accept them, because they're low
income, or (there were) scheduling problems with the clinic," Paskett told
Reuters Health.
She recommended health systems look into having "patient
navigators" to guide low-income people and others who may need help
through the treatment process. Bleicher said doctors and health systems can
start using the new data to figure out how to consolidate the biopsies, second
opinions and other visits that often happen between diagnosis and treatment. But
for now, he told Reuters Health that women with breast cancer shouldn't panic
if it takes them a few weeks to coordinate their surgery. "Getting to the
operating room for treatment is not something that's an emergency, even though
it feels like one," Bleicher said. Up to 60 days, Paskett said, should be
"plenty of time to get second opinions, plenty of time to get consults and
things like that."
Source: Chicago Tribune
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