Disparities in time-to-treat insured patients with newly diagnosed cancer in an insured southern California cohort.

187 Background: Delays in initiating treatment after a cancer diagnosis may impact treatment response, disease progression, and overall survival. Race and ethnicity and socioeconomic status (SES) are factors that may contribute to time to initial cancer treatment. Methods: We conducted a retrospective cross-sectional analysis of an insured Southern California cohort of 333,097 Time to first treatment (surgery, radiation, chemotherapy, hormonal therapy, or immunotherapy) was analyzed as a single outcome across income quantiles and stratified by race/ethnicity based on diagnosis and treatment dates. We reported the mean time to treat. Patients with in-situ cancer, unknown stage, or time to treatment exceeding 7 months were excluded. Independent variables included geocoded socioeconomic status income quintiles (SES), age, sex, race/ethnicity, SEER stage, insurance status, and hospital of diagnosis (KPSC or non-KPSC). Although patients were diagnosed in different years, we evaluated the overall distribution of time to treatment at the cohort level, rather than tracking changes over time. Results: The mean TTT in days for Black patients was the greatest across all SES quintiles and the longest compared to other race and ethnicity groups. Within each income quintile, Black patients consistently started cancer treatment later than other racial/ethnic groups. The range of days from minimum to maximum time to treatment was wide across all SES quintiles, with the standard deviation of the mean nearly always being longer than the mean time-to-treat. Conclusions: Race appears to be a more important factor in longer time to treat than SES. The longer time to treat noted for Black patients deserves further exploration. Race/Ethnicity Lowest 20% SD Low-Mid SD Mid SD Mid-High SD Top 20% SD White 39.4 41.7 38.0 39.6 37.1 38.4 36.0 37.6 34.7 36.3 Black 44.8 44.0 44.5 43.8 45.3 44.2 44.5 43.3 43.9 42.2 Hispanic 40.9 43.7 40.0 41.9 39.3 41.1 37.8 39.2 37.5 38.4 Asian/PI 38.3 39.7 39.3 40.6 38.9 38.7 38.0 36.7 36.3 35.8 Other/Mixed/Unknown 43.6 44.6 38.2 42.9 40.0 41.6 37.4 41.9 34.4 36.8