Longer waits for breast cancer patients on Medicare

NEW YORK Thu Nov 22, 2012 3:37am IST

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NEW YORK (Reuters Health) - 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: bit.ly/10tpzc9 and bit.ly/10tpIMu Journal of Clinical Oncology, online November 19, 2012.

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