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 “We are not taking about providing care in days, but a woman should
not have to wait months,” said Dr. Eric Winer, a researcher at
Harvard University and director of the breast program at Dana-Farber
Cancer Institute in Boston.
“We need to reinforce for doctors that delays could be a problem for
some patients and that, in any case, timely care could not be bad,”
Winer, senior author of an editorial accompanying the studies in
JAMA Oncology, said by email.
Most women with breast cancer have some type of surgery – either a
lumpectomy that removes malignant tissue while sparing the rest of
the breast or a mastectomy that removes the entire breast. After
surgery, many of them also receive chemotherapy to remove any
remaining abnormal cells and reduce the risk of cancer coming back.
To see how the time between diagnosis and surgery impacts survival,
the research team for the first study analyzed records from two
large U.S. databases, each with approximately 100,000 women.
Researchers sorted the women into groups based on how long they
waited for surgery: 30 days or less; 31 to 60 days; 61 to 90 days;
91 to 120 days; and 121 to 180 days.
The majority of women – 78 percent in one data set and 70 percent in
the other – got surgery within 30 days of diagnosis.
For each additional interval of waiting time, the risk of death rose
by 9 to 10 percent. The increased risk was most pronounced for women
with earlier stages of breast cancer.
“This is critical information because nearly every patient asks
either `how long do I have before I have to schedule surgery’ or
`can I do X, Y or Z before I begin my treatment,’ and this study
provides information on the survival cost of adding delay so that
patients and their physicians can make an informed decision about
what their level of urgency should be,” said lead study author Dr.
Richard Bleicher, breast clinical program leader at Fox Chase Cancer
Center in Philadelphia.
While the absolute increased risk is small, and varies based on the
type of tumor and how advanced the cancer may be, the findings
should encourage doctors to make every reasonable effort to avoid
treatment delays, Bleicher added by email.
The second study assessed how women fared depending on how long they
waited after surgery to start chemotherapy, using data for about
25,000 patients in the California Cancer Registry – all with
invasive breast cancer.
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This study also sorted women into groups based on wait times, using
one-month intervals up to three months and then combining all women
who had longer delays into a fourth group.
Survival rates weren’t affected when chemotherapy was delayed for up
to three months after surgery.
But women with delays of more than three months had an 34 percent
increased risk of death, and 27 percent higher odds of dying from
breast cancer, compared to women who started chemotherapy sooner.
The added risk was even more pronounced for women with so-called
triple negative breast cancer, an aggressive form of the disease
that doesn’t respond to many available drugs.
Factors associated with delays in time to chemotherapy included low
socioeconomic status, breast reconstruction, lack of private
insurance, and being Hispanic or black, the study found.
It’s possible that women who got chemotherapy more quickly after
surgery had more timely care at other steps along the way, with
tumors detected sooner and surgery performed more quickly,
contributing to better outcomes, said study leader Dr. Mariana
Chavez-MacGregor of the University of Texas MD Anderson Cancer
Center in Houston.
“That is clearly a limitation of observational data,” Chavez-MacGregor
said by email.
SOURCES: http://bit.ly/1TDcY0D, http://bit.ly/1TDcU0E and http://bit.ly/1mcMcSg
JAMA Oncology, online December 10, 2015.
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