Association of patient factors with time to treatment for breast cancer

Abstract

Background Studies have shown that in the United States, there is an increasing time from breast cancer diagnosis to first treatment (time to treatment or “TTT”), with concern that such delays may worsen oncologic outcomes. A component of TTT is the time from the initial diagnosis to initial surgical consultation (SC). We sought to identify patient‐related factors associated with time to initial SC, and evaluate how this interval is associated with overall total time to treatment (TTT). Methods A prospective database of women diagnosed with breast cancer at our institution from 2015 to 2016 was reviewed. Time from initial breast cancer diagnosis to SC and overall TTT was collected from the electronic medical record. Documented patient‐identified preferences regarding scheduling the first surgical appointment were reviewed. A multivariate analysis was performed to determine clinical and patient factors associated with TTT. Results Of 553 breast cancer patients included in the study, 27% of women opted for the earliest appointment while 73% chose a later date. The median time from diagnosis to SC was 8.5 ± 4.7 days. Patients who accepted a first available SC waited an average of 5.6 ± 3.4 days, while those who deferred waited 9.5 ± 4.6 days (P < .001). Patients who deferred the earliest available SC were older, with a median age of 67 versus 63 years, (P = .018), and had a preference for a specific location in the geographical hospital region (P = .003). Patients who deferred the first available SC also had a longer TTT (33 vs. 28 days, P = .027). Discussion Among newly diagnosed breast cancer patients, there is a substantial population that defers the first available SC. These patients are also more likely to have a prolonged TTT. Future follow‐up of this cohort is necessary to determine the delays on TTT affect cancer outcomes and overall survival.

Timeliness of Breast Diagnostic Imaging and Biopsy in Practice: 15 Years of Collecting, Comparing, and Defining Quality Breast Cancer Care

“… 27 Additionally, patients do not always choose the first available appointment due to personal scheduling conflicts or other concerns. 28 …”

“…27 Additionally, patients do not always choose the first available appointment due to personal scheduling conflicts or other concerns. 28 NQMBC centers were polled by the NCBC in 2021 regarding methods to improve timeliness. Strategies used by centers to decrease time included adding open time slots, improving office organization, sharing timeliness data at breast conference, meeting with pathology to assess turnaround times, and optimizing the phone tree and front office.…”

Associations between health insurance status, neighborhood deprivation, and treatment delays in women with breast cancer living in Georgia

“…We found that compared to patients with private insurance, those who were Medicare insured had 27% higher odds of delayed treatment. Treatment delays seen in patients with Medicare coverage may be due to age related factors, as older age was a patient‐related factor shown to increase time to treatment 42 . A study found moderate delays in breast cancer treatment to occur more frequently in older patients, however longer delays were not common 43 .…”

“…Treatment delays seen in patients with Medicare coverage may be due to age related factors, as older age was a patient‐related factor shown to increase time to treatment. 42 A study found moderate delays in breast cancer treatment to occur more frequently in older patients, however longer delays were not common. 43 Compared to patients who were privately insured, Medicaid enrollees had 75% higher odds of delayed treatment, higher than the odds for Medicare enrollees.…”