Further assessment of structural and social determinant of health effects on breast cancer care timelines: A qualitative study.

121 Background: Time to treatment (TTI) delays result in increased morbidity and mortality for cancer patients. These treatment delays disproportionately occur within marginalized communities due to structural challenges with social determinants of health (SDoH), disengagement with the healthcare system and limited or low health literacy that impacts their ability to obtain timely, appropriate care. We conducted semi-structured interviews with patients treated for breast cancer about their care treatment trajectories to further understand barriers and facilitators for timely treatment from the patient perspective. Methods: We conducted semi-structured interviews with 30 patients in 2023 who received curative intent breast cancer treatment at Montefiore Medical Center from 2019 to 2023. Interviews addressed barriers and facilitators of timely TTI, perceived timeliness and salience of timeliness, emotional well-being, and perceptions of the healthcare team and communication. We analyzed interviews using framework analysis. Results: A total of 30 patients were interviewed (mean age 58.9 year ± 10.6, 75% Non-Hispanic Black, 25% Non-Hispanic White). The median TTI was 52.5 days (49, 62 IQR). First treatment modality included surgery (75%) and chemotherapy (25%). Many participants found significant emotional and logistical support through family, social networks, religion, and connecting with survivors. Several patients faced transportation issues hindered their ability to adhere to schedules, childcare challenges, and difficulty managing numerous appointments, with some wishing transportation services had been offered at diagnosis. Some participants experienced unique cancer presentation, required clearances, involvement of non-oncologic providers and consultants, and time for decision-making about treatment options that may have contributed to delays. Some patients faced financial burdens including personal expenses, family support needs, and difficulties accessing third-party assistance (i.e., short-term disability, Supplemental Security Income). Some patients valued mental health counseling and other resources like group therapy and social workers, though some wished for earlier, more specialized support, indicating gaps in the support timeline. A few patients expressed preference for longer TTI that afforded them time to make important decisions and seek opinions. Conclusions: The study revealed that many patients faced logistical, emotional, and informational challenges while awaiting treatment and highlighted a need for more tailored assistance and timely interventions. Findings from our work highlight the need for further study on how healthcare systems can better equip and engage patients early in the care timeline to avoid delayed TTI.