Effect of surgery type on time to adjuvant chemotherapy and impact of delay on breast cancer survival: a national cancer database analysis
Abstract
Background Timeliness of care is emerging as a quality indicator for breast cancer care. We sought to evaluate the impact of surgical treatment type on time to adjuvant chemotherapy and impact of treatment delay on survival.Methods Patients with stage I-III breast cancer treated with both surgery and adjuvant chemotherapy from 2010 to 2014 were identified from the National Cancer Database (NCDB). Delay in treatment was defined as > 120 days from diagnosis to chemotherapy. Multivariable analysis was performed to assess factors associated with delay in treatment and the effect of treatment delay on overall survival.Results Of 172,043 patients identified, 89.5% initiated chemotherapy within 120 days of diagnosis. Median time from diagnosis to surgery was shorter in patients undergoing breast conservation (25 days) than mastectomy (29 days, p < 0.001) and within mastectomy patients was shorter for mastectomy without reconstruction (26 versus 35 days, p < 0.001). Time from diagnosis to surgery showed larger differences between surgical groups than time from surgery to chemotherapy. On multivariable analysis of mastectomy patients, reconstruction remained significantly associated with delay to chemotherapy [odds ratio (OR) 1.7, p < 0.001]. For all patients regardless of type of surgery, after adjusting for patient, clinical, and treatment factors, delay of > 120 days from diagnosis to chemotherapy was associated with worse overall survival [hazard ratio (HR) 1.29, p < 0.001].Conclusions Initiation of chemotherapy greater than 120 days after diagnosis was associated with poorer overall survival. Time interval from diagnosis to surgery had the greatest impact on time from diagnosis to chemotherapy, with reconstruction resulting in the greatest delay.
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Myelosuppression risk is elevated in older people.
“Primary prophylaxis with granulocyte colony-stimulating factors is advisable for patients receiving chemotherapy in view of the higher risk of myelosuppression in older individuals [[84], [85], [86]].”
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- Authors
- Kupstas, A. R., Hoskin, T. L., Day, C. N., Habermann, E. B., & Boughey, J. C.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Boughey, Judy C.
- Venue
- Annals of Surgical Oncology
- Published
- 2019-07-22
- Volume
- 26
- Issue
- 10
- Pages
- 3240-3249
- ISSN
- 1068-9265 (ISSN-L)
- 1534-4681
- OpenAlex
- W2963166017
- Cited by
- 70
- References
- 21
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 7 · 2023: 8 · 2022: 13 · 2021: 14 · 2020: 13 · 2019: 2
- FWCI
- 3.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Surgical Oncology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Breast Cancer Treatment Studies
- Health Sciences › Medicine › Pathology and Forensic Medicine › Breast Lesions and Carcinomas
- Health Sciences › Medicine › Surgery › Breast Implant and Reconstruction
- Keywords
- breast cancer, adjuvant chemotherapy, treatment delay, breast-conserving surgery, mastectomy, breast reconstruction, time to surgery, overall survival, timeliness of care, quality indicators
- MeSH terms
- Adult, Aged, Aged, 80 and over, Breast Neoplasms, Female, Follow-Up Studies, Humans, Mastectomy, Middle Aged, Prognosis, Retrospective Studies, Time Factors, Survival Rate, Databases, Factual, Chemotherapy, Adjuvant, Time-to-Treatment
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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