The relationship between time to initiation of adjuvant chemotherapy and survival in breast cancer: a systematic review and meta-analysis

Abstract

The relationship between survival and time to the start of adjuvant chemotherapy (AC) among breast cancer patients is unclear. In order to illustrate the effect of delaying the initiation of AC on survival we have undertaken a systematic review and meta-analysis. We identified 12 available studies in the meta-analysis including 15 independent analytical groups. This meta-analysis showed that a 4-week delay before AC was associated with a significantly worse overall survival (OS)(HR=1.13; 95% confidence interval [CI], 1.08-1.19) and disease free survival (DFS)(HR=1.14; 95%CI, 1.05-1.24). Two studies categorized patients into hormone receptor-positive, ERBB2-positive, and triple-negative breast cancer (TNBC) patients according to the clinicopathological features of breast cancer. The HRs for OS between waiting time (WT) ≤30 days and 31-60 days in the subgroups were extracted and analyzed. The analysis demonstrated that a WT of 31-60 days was related to worse OS among patients with TNBC (HR, 1.26; 95% CI, 1.08-1.48), but had no significant effect on OS among those with hormone receptor-positive (HR, 1.02; 95% CI, 0.89-1.15) or ERBB2-postive (HR, 0.95; 95%CI, 0.79-1.14) tumors. In this meta-analysis of the eligible literatures reviewing the time to AC, a longer waiting time to adjuvant chemotherapy may lead to worse survival in breast cancer patients, especially in TNBC patients. www.impactjournals.com/oncotarget/

Postoperative complications in combined gynecologic, plastic, and breast surgery: An analysis from National Surgical Quality Improvement Program

“…Timely adjuvant systemic therapy (within 8‐12 weeks of surgery) in patients with an invasive breast cancer has been found to improve survival . A meta‐analysis has demonstrated that for every 4 weeks delay in adjuvant therapy a 15% decrease in survival can occur; emphasizing the importance of reducing postoperative recovery time from a breast cancer surgery …”

“…1 A meta-analysis has demonstrated that for every 4 weeks delay in adjuvant therapy a 15% decrease in survival can occur; emphasizing the importance of reducing postoperative recovery time from a breast cancer surgery. 2 Many patients undergo coordinated breast cancer surgery in association with an immediate reconstruction inclusive of contralateral prophylactic mastectomy (CPM). Previous studies have demonstrated increased postoperative complications in breast cancer patients who undergo bilateral mastectomy as compared with unilateral mastectomy.…”

COVID-19 e os Danos Invisíveis

“…6 Os doentes com neoplasias ativas têm um risco aumentado devido ao efeito imunossupressor das terapêuticas e da própria patologia. São difíceis as decisões que iremos ter de tomar nos próximos meses na procura do ténue equilíbrio entre evitar a ocorrência de uma 9 Várias Sociedades Oncológicas e Cirúrgicas têm publicado normas para tentar minimizar estes efeitos e a replicação dessas recomendações ultrapassa os objectivos deste texto. No entanto, esta população de doentes representa um grupo de risco e que precisa de respostas rápidas para não verem o seu futuro comprometido.…”

Análise de sobrevida de mulheres com câncer de mama

“…21 In addition, studies have shown that the best prognosis for breast cancer was found when the surgical procedure was associated with other treatments such as radiotherapy, chemotherapy and hormone therapy, which may be associated with the fact that these therapies help in the reduction of metastases to distance. 22 The mortality rate in this study was higher in women aged 50-69 years, 65.22% (n = 15), of whom 87% (n = 54) of the causes of mortality were cancer-related and its complications. Authors have reported similar results.…”