Adjuvant treatment delay in breast cancer patients

Abstract

Background: to evaluate if time between surgery and the first adjuvant treatment (chemotherapy, radiotherapy or hormone therapy) in patients with breast cancer is a risk factor for lower overall survival (OS). Method: data from a five-year retrospective cohort study of all women diagnosed with invasive breast cancer at an academic oncology service were collected and analyzed. Results: three hundred forty-eight consecutive women were included. Time between surgery and the first adjuvant treatment was a risk factor for shorter overall survival (HR=1.3, 95CI 1.06-1.71, p=0.015), along with negative estrogen receptor, the presence of lymphovascular invasion and greater tumor size. A delay longer than 4 months between surgery and the first adjuvant treatment was also associated with shorter overall survival (cumulative survival of 80.9% for delays ≤ 4 months vs. 72.6% for delays > 4 months; p=0.041, log rank test). Conclusion: each month of delay between surgery and the first adjuvant treatment in women with invasive breast cancer increases the risk of death in 1.3-fold, and this effect is independent of all other well-established risk factors. Based on these results, we recommend further public strategies to decrease this interval.

Factors Associated With Delays in Chemotherapy Initiation Among Patients With Breast Cancer at a Comprehensive Cancer Center

“…Retrospective studies examining the impact of adjuvant chemotherapy wait times on survival and patient outcomes have had mixed results, which may be attributed to differences in patient populations, disease-specific factors, variability in the adjuvant treatment administered, and overall patient health status. [7][8][9][10][11][12]17,18 However, emerging data suggest that, particularly for patients at higher risk of recurrence, including those with higher-stage disease, HER2positive or TNBC subtypes, or a high proliferative rate, delayed time from surgery to chemotherapy can adversely impact outcomes. [6][7][8][9][10][11] Gagliato et al 10 found that patients with stage II disease experienced an 18% increase in the risk of distant relapse-free survival when treatment was initiated 31 to 60 days after surgery (hazard ratio, 1.18; 95% CI, 1.03-1.34) compared with when therapy was initiated within 30 days of surgery.…”

“…Recent studies suggest that delays in adjuvant chemotherapy initiation greater than 49 to 90 days after surgery may be associated with inferior outcomes, particularly among patients with triple-negative breast cancer (TNBC), HER2-positive subtypes, and higher-stage tumors. [7][8][9][10][11][12] A meta-analysis conducted by Yu et al 13 suggested that overall survival decreases by 15% for every 4-week delay in chemotherapy initiation. Although these retrospective data must be interpreted carefully given potential confounders and selection bias, from a patient-centered perspective, delays to chemotherapy initiation also can adversely impact patient satisfaction and increase stress and anxiety.…”

Availability of Diagnostic Services and their Impact on Patient Flow in Two Brazilian Referral Centres of Breast Cancer Treatment

“…Most Brazilian studies of SD were performed in the southern, south-eastern and central-western regions of the country (Trufelli et al, 2007;Souza et al, 2008;Trufelli et al, 2008;Rezende et al, 2009;Lourenço, 2010;Soares et al, 2012;Barros et al, 2013;Oshiro et al, 2014;Guerra et al, 2015;Souza et al, 2015;Trufelli et al, 2015;Lopes et al, 2017). By contrast, only a few studies of SD focused on populations in the Brazilian northeastern region that is experiencing increasing disease incidence (Cavalcanti et al, 2012;Paiva et al, 2015;Ferreira et al, 2017).…”

Disparities in Time to Treatment of Hepatocellular Carcinoma in Patients with Hepatitis B Virus versus Hepatitis C Virus

“…Delay in time from diagnosis to treatment in several cancers can lead to adverse outcomes, especially in curative settings. For instance, in breast and colon cancer, when adjuvant chemotherapy is indicated, delay between curative surgeries to adjuvant chemotherapy treatment leads to a decline in cure rate [23,24].…”