Longer delays in breast cancer treatment may affect survival

Delays between a breast cancer diagnosis and treatment increase the risk of death for women with late-stage cancers, according to a recently published study. A second study found that the median wait time between diagnosis and treatment has grown longer. The authors suggest that findings from these studies may provide data that can be used to develop quality measures for breast cancer care.

The first study looked at the length of time between a breast cancer diagnosis and the start of treatment among women who were enrolled in the North Carolina Medicaid system. John M. McLaughlin, PhD, MSPH, of The Ohio State University and his colleagues found that women with late-stage breast cancer who waited more than 60 days between diagnosis and treatment had a 66% greater risk of death from any cause and an 85% greater risk of death from breast cancer than women who began treatment within 60 days.

By contrast, treatment delays of more than 60 days in patients with early-stage breast cancer were not associated with survival differences.

The findings “suggest that interventions should target late-stage patients to increase the timeliness of receiving breast cancer treatments and that clinicians should structure their practice settings to promptly triage and initiate treatment for patients diagnosed at late stage,” the authors wrote.

The second study looked at patients with nonmetastatic breast cancer from the SEER-Medicare Linked Database and found that the median wait between the first physician visit and first surgery rose from 21 days in 1992 to 32 days in 2005.

Richard Bleicher, MD, of the Fox Chase Cancer Center in Philadelphia and his colleagues found that times to surgery were longest among black and Hispanic patients, patients in the Northeast, and patients in large metropolitan areas. The researchers also found that more complex surgeries—for example, a simultaneous mastectomy and reconstruction—were associated with longer wait times.

Imaging, biopsies, and clinician visits all made statistically significant contributions to surgery delays. “More episodes of care may cause delay but may allow for better assessment of treatment alternatives,” the authors explained.

“One challenge in caring for patients is not just to give quality care but to give timely care,” Bleicher said. “My hope is that this study provides physicians—and patients—a point of reference for time to surgery that we've never really had before.”

These studies were published in the Journal of Clinical Oncology (2012; doi:10.1200/JCO.2012.39.7695 and doi:10.1200/JCO.2012.41.7972).
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