Abstract B060: Sociodemographic and geographic disparities in NCCN-concordant first-line systemic therapy in metastatic breast cancer, 2014–2022: The PRISM Study

Abstract

Despite established NCCN guidelines, disparities in guideline-concordant care persist in metastatic breast cancer (mBC). We examined first-line Category 1 systemic therapy concordance and time to treatment to characterize equity gaps at an academic medical center. In the PRISM (Precision Oncology Risk Identification and System-level Modeling) study, we linked EHR and tumor registry data at Duke Cancer Institute (2014–2022). Eligible patients had metastatic breast cancer and survival >120 days. Geocoded addresses were linked to 2020 census-tract measures. NCCN Category 1 first line therapy concordance was modeled using univariable and multivariable logistic regression, and time to concordant therapy with Cox regression, adjusting for sociodemographic, geographic, and BC subtype covariates. The cohort comprised 668 patients: 68.3% Non-Hispanic White, 29.0% Non-Hispanic Black, 2.7% Hispanic, with 16.5% below age 45 years. Overall first-line therapy concordance was 72.9% (median 19 days to treatment). In univariable analyses, therapy concordance was lower for patients with Medicare versus commercial insurance (OR 0.57, 95% CI 0.38–0.86), and TNBC than HR+/HER2− disease (OR 0.23, 0.15–0.36), and higher among patients in upper neighborhood household-income quartiles (Q3 vs. Q1 OR 2.29, 1.36–3.92; Q4 vs. Q1 OR 2.00, 1.20–3.38). Younger age (<45 vs. 45–65 years) was associated with higher concordance (OR 1.89, 1.10–3.39). In time-to-treatment analyses, younger age (HR 1.34, 1.05–1.70) and later diagnosis year (HR 1.04 per year relative to 2014, 95% CI 1.00–1.12) were associated with shorter time to concordant therapy, while Medicare insurance (vs. commercial) and TNBC (vs. HR+/HER2−) were associated with shorter time to concordant therapy (HR 0.75, 0.59–0.94; HR 0.45, 0.34–0.60). After multivariable adjustment, TNBC and neighborhood household income remained significantly associated with therapy concordance, while younger age and later diagnosis year remained significantly associated with faster time to concordant therapy. Within an academic health system, NCCN-concordant first-line mBC therapy varied by neighborhood socioeconomic context and insurance type. Findings highlight the need for equity-focused, system-level quality improvement strategies to mitigate disparities in evidence-based cancer treatment delivery. Drew Neish, Tomi Akinyemiju, Ashwini Joshi, Steven Patierno, John Strickler, Cheyenne Corbett, Thomas LeBlanc, Cosmina Hogea. Sociodemographic and geographic disparities in NCCN-concordant first-line systemic therapy in metastatic breast cancer, 2014–2022: The PRISM Study [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr B060.