Impact of Delay to Treatment Upon Survival in 1067 Patients With Breast-Cancer

Rabinovich, M; Vallejo, Carmen; Pérez, José Duarte; Rodríguez, Rafael Gómez; Cuevas, María Victoria; Machiavelli, M; Lacava, J.; Leone, Bernardo Amadeo; Romero, A; Mickiewicz, E.; Chacón, Reinaldo; Estévez, R

doi:10.3892/ijo.2.2.197

Cited by 7 publications

(11 citation statements)

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“…We found a substantial reduction in the interval between the first symptom noted by the patient and the definite diagnosis, although this finding did not show increased survival. We have previously reported this observation (9), which is similar to the experience of other investigators (10–15). A possible explanation for the negative findings of these studies could be that for pts within a same clinical stage, the duration of symptoms has no impact on survival as other studies have shown (16).…”

Section: Discussionsupporting

confidence: 91%

Treatment of Early Breast Cancer, a Long-term Follow-up Study: The GOCS Experience

Iturbe¹,

Zwenger²,

Leone

et al. 2011

The Breast Journal

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Most cases of breast cancer are diagnosed at early stage of disease; therefore, treatment is oriented to increase the disease-free interval (DFI) and overall survival (OS). The prognosis, in comparison with other malignancies, has improved in the last decades as a result of mammographic screening. The aim of the study was to report the incidence of local and distant recurrence, DFI and OS in patients (pts) with stage I and stage II breast cancer over a period of 26 years divided into three groups. From January 1978 to December 2004, 927 women with early breast cancer (EBC) were included, 350 were stage I and 577 Stage II (AJCC 2002). Patients were divided according to the year of diagnosis into three periods of 10 years: Group A (1978-1987) 135 pts, Group B (1988-1997) 412 pts, and Group C (1998-2004) 380 pts. DFI was analyzed from the date of initial diagnosis to the date of local or distant recurrence. OS was estimated from the date of initial diagnosis to the last follow-up or date of death. Median age was 51 years (28-92). Conservative surgery was performed in 69% of pts, adjuvant radiation therapy in 78%, adjuvant chemotherapy in 29%, and adjuvant hormone therapy in 18%. The median follow-up was 8.4 years (0.3-30). The mean tumor size in Group A was 2.7 cm, in Group B 2.2 cm, and in Group C 1.94 cm (p = 0.0001). The percentage of pts with stage I increased from 13% in Group A to 38% in Group B and to 47% in Group C (p = 0.0001). Local recurrence was documented in 5% of all pts, whereas 28% developed metastatic disease. The DFI and OS showed a statistically significant difference among the three groups (p = 0.005). DFI rate at 5, 10, 15, 20, and 25 years was 71%, 67%, 65%, 65%, and 64%, respectively. OS at 5, 10, 15, 20, and 25 years was 82%, 62%, 49%, 39%, and 28%, respectively. Factors that had an effect in OS demonstrated by the multivariate regression analysis were: Tumor size, ER status, and nodal involvement (p < 0.001). Clinical outcomes in EBC in our experience are similar to those reported in international literature. The DFI and OS showed a statistically significant difference among the three groups. This group of pts continues to have a good prognosis as shown by the OS rate at 5, 10, 15, 20, and 25 years, although a high percentage of pts still to have recurrence and die from breast cancer after 5, 10, 15, 20, and 25 years of follow-up.

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Section: Discussionsupporting

confidence: 91%

Treatment of Early Breast Cancer, a Long-term Follow-up Study: The GOCS Experience

Iturbe¹,

Zwenger²,

Leone

et al. 2011

The Breast Journal

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“…The influence on survival of delays in each of these intervals and of the influence on survival of delays between first symptom and treatment ('total delay') remains contentious. Several studies reported in the past 30 years have indicated that survival is worse among women with longer duration of symptoms (Sheridan et al, 1971;Wilkinson et al, 1979;Elwood and Moorehead, 1980;Feldman et al, 1983;Charlson, 1985;Vernon et al, 1985;Huguley et al, 1988;Machiavelli et al, 1989;Rossi et al, 1990;Neave et al, 1990;Rabinovich et al, 1993;Afzelius et al, 1994;Raabe et al, 1996). Other studies, however, have not shown that survival is affected by duration of symptoms (Dennis et al, 1975;Fisher et al, 1977;Hainsworth et al, 1993) These apparently conflicting results may possibly be explained by differences in sample characteristics (e.g.…”

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confidence: 57%

The influence on survival of delay in the presentation and treatment of symptomatic breast cancer

et al. 1999

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SummaryThe aim of this study was to examine the possible influence on survival of delays prior to presentation and/or treatment among women with breast cancer. Duration of symptoms prior to hospital referral was recorded for 2964 women who presented with any stage of breast cancer to Guy's Hospital between 1975 and. Median follow-up is 12.5 years. The impact of delay (defined as having symptoms for 12 or more weeks) on survival was measured from the date of diagnosis and from the date when the patient first noticed symptoms to control for lead-time bias. Thirty-two per cent (942/2964) of patients had symptoms for 12 or more weeks before their first hospital visit and 32% (302/942) of patients with delays of 12 or more weeks had locally advanced or metastatic disease, compared with only 10% (210/2022) of those with delays of less than 12 weeks (P < 0.0001). Survival measured both from the date of diagnosis (P < 0.001) and from the onset of the patient's symptoms (P = 0.003) was worse among women with longer delays. Ten years after the onset of symptoms, survival was 52% for women with delays less than 12 weeks and 47% for those with longer delays. At 20 years the survival rates were 34% and 24% respectively. Furthermore, patients with delays of 12-26 weeks had significantly worse survival rates than those with delays of less than 12 weeks. Multivariate analyses indicated that the adverse impact of delay in presentation on survival was attributable to an association between longer delays and more advanced stage. However, within individual stages, longer delay had no adverse impact on survival. Analyses based on 'total delay' (i.e. the interval between a patient first noticing symptoms and starting treatment) yielded very similar results in terms of survival to those based on delay to first hospital visit (delay in presentation).

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“…Because the studies also used different interval cut‐off points, it is difficult to compare the found survival rates. Most showed that longer patient delays or total delays were associated with worse tumour characteristics, and hence adversely affected prognosis 21,23−26,28,48 . The systematic review by Richards et al .…”

Section: Resultsmentioning

confidence: 99%

“…Studies assessing the risk of complications of inguinal hernias in time considered a notable small number of patients on waiting lists 12,13,30,46 and the natural course of gallstones is primarily investigated in patients with no obvious need for surgery 19,32−34,47 . The studies focusing on delayed breast cancer treatment 21−29,48 show a different impact on survival depending on the type and length of the delay, but do not specifically address delay caused by waiting lists.…”

Section: Discussionmentioning

confidence: 99%

Waiting for elective general surgery: physical, psychological and social consequences

Oudhoff

Timmermans

Bijnen

et al. 2004

ANZ Journal of Surgery

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Impact of Delay to Treatment Upon Survival in 1067 Patients With Breast-Cancer

Cited by 7 publications

References 0 publications

Treatment of Early Breast Cancer, a Long-term Follow-up Study: The GOCS Experience

Treatment of Early Breast Cancer, a Long-term Follow-up Study: The GOCS Experience

The influence on survival of delay in the presentation and treatment of symptomatic breast cancer

Waiting for elective general surgery: physical, psychological and social consequences

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