Survival and Time to Surgery and Chemotherapy for Patients With Breast Cancer
More than 3 months from surgery to chemotherapy and increasing delays from diagnosis to surgery in patients with breast cancer are associated with increased risk of death from the disease, according to two original investigations published in JAMA Oncology (doi:10.1001/jamaoncol.2015.3856; doi:10.1001/jamaoncol.2015.4508).
In the first study, Mariana Chavez-MacGregor, MD, MSc, of the University of Texas MD Anderson Cancer Center, Houston, and coauthors analyzed data from 24 843 patients with invasive breast cancer (stages I to III) in the California Cancer Registry to examine the relationship between time to chemotherapy after surgery and overall survival and breast cancer-specific survival, including identification of factors associated with delayed chemotherapy initiation.
Median age at diagnosis of the 24 843 patients was 53 years, and median time to chemotherapy after surgery was 46 days. In the study, 21% of patients started chemotherapy less than 31 days after surgery; 50%, 31 to 60 days; 19.2%, 61 to 90 days; and 9.8%, 91 or more days after surgery.
The factors associated with delays in chemotherapy initiation included low socioeconomic status, breast reconstruction, nonprivate insurance, and being Hispanic or black, according to the study.
The study reports no adverse outcomes were associated with chemotherapy initiation 30 to 90 days after surgery compared with chemotherapy initiation within 31 days of surgery. However, risk of worse overall survival and worse breast cancer-specific survival was increased for patients who received chemotherapy 91 or more days after surgery. The findings suggest risk of overall death and risk of death from breast cancer was increase by 34% and 27%, respectively, in patients who received chemotherapy 91 or more days after surgery.
In patients with triple-negative breast cancer, 91 or more days to chemotherapy initiation was associated with worse overall and breast cancer-specific survival, according to the study.
In the second study, Richard J. Bleicher, MD, of the Fox Chase Cancer Center in Philadelphia, Pennsylvania, and coauthors examined the relationship between the time from diagnosis to surgery in patients with breast cancer and survival rates. The authors analyzed patient data from 2 of the largest cancer databases in the United States. Analysis between the databases was not done, nor warranted, therefore the authors presented both analyses.
Data were analyzed for 95 544 patients (mostly women, average age 75 years) in the Surveillance, Epidemiology and End Results (SEER)-Medicare database. In this cohort, 77.7% of patients underwent surgery in 30 days or less; 18.3%, 31 to 60 days; 2.7%, 61 to 90 days; 0.7%, 91 to 120 days; and 0.5%, 121 to 180 days.
The increase in death at all stages of disease for all the patients and from all causes was 9% for each increase in preoperative time. Although overall survival declined with each delay, the decline was most pronounced in patients with stages I and II disease. The risk of death from breast cancer for each 60-day increase in time-to-surgery was significant in patients with stage I disease.
Data also were analyzed for 115 790 patients (nearly all women, average age 60 years) in the National Cancer Database. In this cohort, 69.5% of patients underwent surgery in 30 days or less; 24.9%, 31 to 60 days; 4.1%, 61 to 90 days; 1%, 91 to 120 days; and 0.5%, 121 to 180 days. The added risk of death from all causes for each interval increase in time-to-surgery was 10% for the entire group, and most pronounced in patients with stages I and II disease.
“Survival outcomes in early stage breast cancer are affected by the length of the interval between diagnosis and surgery, and efforts to minimize that interval are appropriate. Although the effect on both overall and disease-specific survival remains small, consideration should be given to establishing reasonable and attainable goals for the timing of surgical interventions to afford this population a finite, but clinically relevant, survival benefit,” the study concluded.