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Timing of Postoperative Treatment After Diagnosis of Breast Cancer and Survival

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Key Points

  • Despite the Commission on Cancer recommendation that appropriate patients start combination chemotherapy within 120 days from their cancer diagnosis, 11% of patients did not.
  • The delay between diagnosis and chemotherapy initiation largely stemmed from a longer time from diagnosis to the first operation.
  • The type of surgery did not influence the time from the operation to starting chemotherapy, even after the researchers adjusted the statistical analyses for multiple differences in patients and treatment.

When chemotherapy is recommended as part of a treatment plan, women with breast cancer should start postoperative treatment ideally within 4 months of their cancer diagnosis. New study findings published by Kupstas et al in the Annals of Surgical Oncology show delaying chemotherapy further is associated with poorer overall survival. The study was also presented at the American College of Surgeons Quality and Safety Conference.

Results of a growing number of studies suggest that timeliness in breast cancer care affects patient outcomes and could be considered a metric of quality of care, but few guidelines exist that recommend timepoints for combination treatment, said the study's senior author, Judy C. Boughey, MD, FACS, Professor of Surgery and Vice Chair for Research, Mayo Clinic Department of Surgery. “Our study findings confirm that timely care is important for [patients with] breast cancer and should be considered in their treatment plan,” she explained.

Methods

The researchers looked at 172,043 records of patients with stages I to III breast cancer diagnosed between 2010 and 2014 who received both surgical removal of the cancer and adjunctive chemotherapy. Patients who received preoperative chemotherapy, hormone therapy, or radiation therapy were excluded from the study. Patients’ records came from the National Cancer Database (NCDB).

The investigators defined a delay in chemotherapy as greater than 120 days from cancer diagnosis to the first dose of combination chemotherapy. They based this time on a 2008 quality measure from the American College of Surgeons Commission on Cancer, which recommends administering combination chemotherapy within 4 months to patients with breast cancer under age 70 with hormone receptor–negative tumors larger than 1 centimeter or stages IB to III.

Besides comparing overall survival rates at the last follow-up visit in patients whose time from diagnosis to chemotherapy did and did not exceed 120 days, the researchers evaluated the influence of type of operation on time to chemotherapy. They analyzed groups by lumpectomy vs mastectomy, and for mastectomy, immediate breast reconstruction vs no reconstruction.

Results

Despite the Commission on Cancer recommendation that appropriate patients start combination chemotherapy within 120 days from their cancer diagnosis, 11% of patients did not. The delay between diagnosis and chemotherapy initiation largely stemmed from a longer time from diagnosis to the first operation. The type of surgery did not influence the time from the operation to starting chemotherapy, even after the researchers adjusted the statistical analyses for multiple differences in patients and treatment.

Although the researchers found a statistically significantly longer time from the operation to starting chemotherapy for women who underwent mastectomy with immediate reconstruction vs those treated without immediate reconstruction, Dr. Boughey said the difference was not significant. Both groups had a median of 44 days from their operation to chemotherapy.

The researchers also found that having a double mastectomy did not lengthen the time from operation to chemotherapy—a finding Dr. Boughey called “reassuring” for women who choose a prophylactic mastectomy of the noncancerous breast.

“It is also encouraging that 89% of women who are recommended chemotherapy postoperatively do get it within 120 days of their diagnosis, but there is still room for improvement,” she said said.

Dr. Boughey recommended that hospitals evaluate their times from breast cancer diagnosis to surgical procedure to determine if they can decrease this interval.

Data from the NCDB do not show why this time from diagnosis to surgical treatment is longer in patients undergoing mastectomy with reconstruction than those not having reconstruction. Possible reasons, according to Dr. Boughey, include poor access to care; longer wait times for a second opinion; and for patients desiring immediate breast reconstruction, coordinated availability of a plastic surgeon and breast surgeon.

Disclosure: For full disclosures of the study authors, visit link.springer.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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