Abstract PS1-04-11: From Prediction to Prevention: The TIDE Score and a Navigator-Based Intervention to Reduce Delayed Breast Cancer Treatment in Southeast Texas

Abstract Background: Delays in breast cancer treatment initiation are associated with worse outcomes, particularly among underserved populations. While socioeconomic disparities are well documented, there is no standardized tool to identify patients at high risk for treatment delays. We aimed to (1) develop a predictive model to stratify delay risk and (2) design a scalable quality improvement (QI) intervention targeting high-risk patients in a community oncology setting. Methods: We analyzed data from 609 breast cancer patients treated between 2018 and 2023 across a multi-hospital network in Southeast Texas. Treatment delays were defined using established modality-specific thresholds. Logistic regression identified predictors of delay, and a point-based risk score—the TIDE Score (Treatment Initiation Delay Estimator)—was developed using significant socioeconomic and clinical variables. Based on this score, we proposed a QI model incorporating early navigator engagement, social work referral, and expedited care pathways. Results: The final predictive model demonstrated good performance (AUC = 0.81). The TIDE Score ranged from 0 to 6 and included Medicaid insurance (2 points), unmarried status (1 point), age under 50 years (1 point), AJCC stage ≥ II (1 point), and absence of Medicare coverage (1 point). Patients scoring ≥4 had 3.6-fold increased odds of treatment delay (p < 0.001). Using this risk stratification, we designed a navigator-led QI intervention including EMR-based alerts at diagnosis, navigator contact within 5 days, and support service linkage within 2 weeks. This dual approach bridges risk prediction with timely intervention. Conclusion: The TIDE Score is a simple, SES-informed tool to identify breast cancer patients at risk of treatment delay. Coupled with a navigator-driven workflow, it offers a low-cost, scalable solution applicable across Texas and other underserved oncology settings. Citation Format: N. Ganatra, A. Jamal, J. Doshi, P. Jain, S. Patel. From Prediction to Prevention: The TIDE Score and a Navigator-Based Intervention to Reduce Delayed Breast Cancer Treatment in Southeast Texas [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS1-04-11.