Journal article
Disparity in Timely Breast Cancer Treatment: Concordance with Commission on Cancer Quality Measures and the Influence of Socioeconomic Factors in the National Cancer Database
Journal of the American College of Surgeons, Vol.242(1), pp.79-89
01/2026
DOI: 10.1097/XCS.0000000000001649
PMID: 41100569
Abstract
Significant disparities persist in timely, guideline-concordant breast cancer treatment across the United States, impacting cancer outcomes. The influence of both patient-level and facility-level socioeconomic status (SES) on adherence to Commission on Cancer (CoC) quality measures remains incompletely understood.
We conducted a retrospective cohort study using the National Cancer Database (NCDB) to assess associations between patient and facility SES and concordance with timeliness of three CoC breast cancer quality measures: surgery, multi-agent chemotherapy, and radiotherapy, among patients diagnosed from 2018 to 2022. Multivariable logistic regression models were used to evaluate predictors of concordant care, including a composite measure of facility-level social risk.
The analytic cohorts included 471,425 patients for surgery, 82,734 for chemotherapy, and 311,523 for radiotherapy. Black race, uninsured status, and low educational attainment were each independently associated with lower odds of guideline-concordant care across all measures. Patients treated at low-SES facilities had higher odds of timely surgery (adjusted OR, 1.27; 95% CI, 1.24-1.31) but lower odds of timely chemotherapy (OR, 0.85; 95% CI, 0.79-0.91) and radiotherapy (OR, 0.95; 95% CI, 0.92-0.97) compared to those at other institutions. Facility type, fragmented care, and comorbidities also contributed to variation in concordance.
Significant disparities in guideline-concordant breast cancer care persist by race, insurance, education, and facility-level social risk, highlighting intervention opportunities to improve outcomes for these already vulnerable populations. These findings highlight the importance of policy and institutional strategies that address both patient- and facility-level barriers to ensure equitable access to high-quality multidisciplinary treatment.
Details
- Title: Subtitle
- Disparity in Timely Breast Cancer Treatment: Concordance with Commission on Cancer Quality Measures and the Influence of Socioeconomic Factors in the National Cancer Database
- Creators
- M Muska Nataliansyah - Medical College of WisconsinIngrid Marie Lizarraga - University of IowaYun Xing - Medical College of WisconsinJudy Caroline Boughey - Mayo Clinic in ArizonaRebecca Snyder - The University of Texas MD Anderson Cancer CenterErin Mobley - University of Florida
- Resource Type
- Journal article
- Publication Details
- Journal of the American College of Surgeons, Vol.242(1), pp.79-89
- DOI
- 10.1097/XCS.0000000000001649
- PMID
- 41100569
- NLM abbreviation
- J Am Coll Surg
- ISSN
- 1879-1190
- eISSN
- 1879-1190
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Grant note
- American College of Surgeons Cancer Research Program Standards Investigation and Validation CommitteeAmerican College of Surgeons NCDB Statistics and Analytics team
We thank the American College of Surgeons Cancer Research Program Standards Investigation and Validation Committee and the American College of Surgeons NCDB Statistics and Analytics team for their support and contributions to this work.
- Language
- English
- Electronic publication date
- 10/06/2025
- Date published
- 01/2026
- Academic Unit
- Health Management and Policy; Surgery
- Record Identifier
- 9985014801002771
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