Social Support and Treatment Delays in Breast Cancer Patients Within an Integrated Health Care System.

Abstract

Objective: We evaluated associations between social support and delays to surgery and adjuvant chemotherapy in a cohort of women with breast cancer (BC) from a large integrated healthcare system in Northern California.

Methods: This study included 3983 women from the Pathways Study diagnosed from 2005 to 2013 with stages I-IV BC, who had surgery as their first line of treatment and who responded to the Medical Outcomes Study Social Support survey ∼2 months following diagnosis. A second set of analyses included those receiving adjuvant chemotherapy (N = 1761). We used log binomial regression to evaluate associations of social support, and types of support, with relative prevalence of delays from diagnosis to definitive surgery > 30 days, delays to chemotherapy from diagnosis > 90 days, and delays to chemotherapy from definitive surgery > 60 days. We further examined analyses stratified by sociodemographic factors and disease severity.

Results: Twenty-one percent had surgery delays and 18.3% had chemotherapy delays from diagnosis (24.7% from surgery). Adjusted for covariates, women in the lowest tertile of social support were more likely to have delays to surgery (prevalence ratio (PR) = 1.27, 95% confidence interval (CI):1.08-1.48, p-continuous = 0.01) and chemotherapy (PR = 1.48, 95% CI: 1.08-2.02, p = 0.05) from diagnosis, due to associations of low tangible and emotional support with delays. We noted no effect modification in these analyses. By contrast, low social support was related to chemotherapy delays from diagnosis in women < 54 (PR = 1.96, 95% CI: 1.33-2.88) but not ≥ 54 (PR = 1.09, 95% CI: 0.79-1.49) years of age, p-interaction = 0.05. Other tests of effect modification were nonsignificant.

Conclusions: Low social support was associated with delays to BC surgery and chemotherapy.