Timely Initiation of Treatment Critical In Reducing Mortality Risk In Breast Cancer

By  //  December 12, 2015

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breast cancer
Two recent reports published in JAMA Oncology suggest that delaying surgery by 30 days, chemo by 90 days increases mortality risk in early stage breast cancer.

According to a cohort study using two large clinical databases, SEER-Medicare and National Cancer Database, to investigate associations between time to surgery after diagnosis and overall and disease-specific survival among women with breast cancer, it is critical that women with early breast cancer initiate surgical treatment within 30 days after diagnosis.

Richard J. Bleicher, MD, of Fox Chase Cancer Center in Philadelphia, and co-authors reported online in JAMA Oncology that as compared with surgery within 30 days of diagnosis of early breast cancer, the overall mortality hazard increased by 9 percent and 10 percent respectively in the two databases, for every additional 30-day delay.

Mariana S. Chavez-MacGregor, MD

Women with stage I breast cancer had 13 percent and 16 percent lower survival odds with each 30-day delay, and the likelihood of dying of breast cancer increased by 26 percent with every 60-day delay in surgery.

According to another article focused on the impact of delayed breast cancer chemotherapy on mortality and also appearing in JAMA Oncology, the adverse effects of delaying chemotherapy after surgery did not kick in until 90 days.

Women who did not receive the first dose of adjuvant chemotherapy until 91 days or more after surgery had a 34 percent lower survival odds, increasing to 53 percent among women with triple-negative breast cancer, reported Mariana S. Chavez-MacGregor, MD, of the University of Texas MD Anderson Cancer Center in Houston, and co-authors.

Collectively, these two studies solidify evidence that delaying therapy for early breast cancer can be hazardous to patients.

The effects of delaying treatment are an increasingly important consideration because evidence shows that delays are lengthening over time, with the median time from breast cancer diagnosis to surgery increasing from 21 days in 1992 to 32 days in 2005, and the interval from diagnosis to adjuvant chemotherapy increasing from 10.8 weeks in 2003 to 13.3 weeks in 2009.

breast cancer clinical team
The logistics related to engaging the multiple physicians required for optimal breast cancer decision-making and treatment planning can be time consuming and delay initiation of treatment.

These delays in treatment are not surprising in light of the expanding set of diagnostic modalities being used to tailor breast cancer management, and the oftentimes complex logistics related to engaging the multiple physicians required for optimal decision-making and treatment.

When asked by Med Page Today whether all women should have surgery within 30 days of diagnosis, Dr. Bleicher said, “I would say the sooner, the better. We also must be cognizant of the fact that the workup itself needs to be complete and can take time. There are also options, which patients may wish to investigate, such as second opinions with plastic surgeons for reconstruction.

Richard J. Bleicher, MD

“For elective things, such as taking time off for a family event, or where options for scheduling exist, these data provide information to patients and clinicians, so they can understand the tradeoff in survival where certain choices they make may delay surgery.”

In the context of the ever-increasing advances that add specificity to breast cancer management, but also take time and may lead to more complex decision-making, the studies by Bleicher et al and Chavez-Macgregor et al firmly support a tightly integrated approach to breast cancer management that ensures timely diagnostic processes and treatment planning, and focuses on minimizing time from diagnosis to the initiation of that plan.