Identifying factors influencing delays in breast cancer treatment in Kentucky following the 2014 Medicaid expansion

Background and Objectives: A previous analysis of breast cancer care after the 2014 Medicaid expansion in Kentucky demonstrated delays in treatment despite a 12% increase in insurance coverage. This study sought to identify factors associated with treatment delays to better focus efforts for improved breast cancer care. Methods: The Kentucky Cancer Registry was queried for adult women diagnosed with invasive breast cancer between 2010 and 2016 who underwent up-front surgery. Demographic, tumor, and treatment characteristics were assessed to identify factors independently associated with treatment delays. Results: Among 6225 patients, treatment after Medicaid expansion (odds ratio [OR] = 2.18, 95% confidence interval [CI] = 1.874-2.535, P <.001), urban residence (OR = 1.362, 95% CI = 1.163-1.594, P <.001), treatment at an academic center (OR = 1.988, 95% CI = 1.610-2.455, P <.001), and breast reconstruction (OR = 3.748, 95% CI = 2.780-5.053, P <.001) were associated with delay from diagnosis to surgery. Delay in postoperative chemotherapy was associated with older age (OR = 1.155,95% CI = 1.002-1.332, P =.0469), low education level (OR = 1.324, 95% CI = 1.164-1.506, P <.001), hormone receptor positivity (OR = 1.375, 95% CI = 1.187-1.593, P <.001), and mastectomy (OR = 1.312, 95% CI = 1.138-1.513, P <.001). Delay in postoperative radiation was associated with younger age (OR = 1.376, 95% CI = 1.370-1.382, P <.001), urban residence (OR = 1.741, 95% CI = 1.732-1.751, P <.001), treatment after Medicaid expansion (OR = 2.007, 95% CI = 1.994-2.021, P <.001), early stage disease (OR = 5.661, 95% CI = 5.640-5.682, P <.001), and mastectomy (OR = 1.884, 95% CI = 1.870-1.898, P <.001). Conclusions: Patient, tumor, and socioeconomic factors influence the timing of breast cancer treatment. Improving timeliness of treatment will likely require improvements in outreach, education, and healthcare infrastructure.