Luis A Riba1, Ryan A Gruner1, Aaron Fleishman2, Ted A James3,4. 1. Department of Surgery / BreastCare Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. 2. Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. 3. Department of Surgery / BreastCare Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. ted.james@bidmc.harvard.edu. 4. Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. ted.james@bidmc.harvard.edu.
Abstract
BACKGROUND: Timely administration of adjuvant chemotherapy for breast cancer is associated with a survival benefit. Specific elements of surgical management may lead to delays initiating chemotherapy, resulting in unfavorable outcomes. The purpose of this study was to determine the correlation between surgical factors and delayed chemotherapy in breast cancer patients. METHODS: A retrospective analysis of the National Cancer Database was performed. The study cohort consisted of female patients with stage 1-3 breast cancer diagnosed between 2010 and 2014. Initiation of chemotherapy beyond 90 days after surgery was defined as delayed. Multivariable logistic regression modeling was performed to establish associations between delayed chemotherapy and clinical and demographic factors of interest. Survival analysis was performed using the Kaplan-Meier estimation and Cox proportional hazards regression to evaluate potential 5-year overall survival disadvantage of delayed initiation of chemotherapy. RESULTS: Of 166,681 women assessed, 4.3% had a delay in the initiation of chemotherapy. Surgery-specific risk factors included unplanned readmission in the postoperative period, lower surgical volume, mastectomy with immediate autologous reconstruction, and positive surgical margins. Adjusted survival analysis showed a survival disadvantage of delayed initiation of chemotherapy (hazard ratio [HR] 1.46; p < 0.01). CONCLUSIONS: Risk factors for delayed initiation of chemotherapy specific to the surgical process were identified. Delayed initiation of adjuvant chemotherapy was associated with a survival detriment. Efforts should be made to address these surgical management issues and optimize the perioperative process to ensure timely patient treatment.
BACKGROUND: Timely administration of adjuvant chemotherapy for breast cancer is associated with a survival benefit. Specific elements of surgical management may lead to delays initiating chemotherapy, resulting in unfavorable outcomes. The purpose of this study was to determine the correlation between surgical factors and delayed chemotherapy in breast cancerpatients. METHODS: A retrospective analysis of the National Cancer Database was performed. The study cohort consisted of female patients with stage 1-3 breast cancer diagnosed between 2010 and 2014. Initiation of chemotherapy beyond 90 days after surgery was defined as delayed. Multivariable logistic regression modeling was performed to establish associations between delayed chemotherapy and clinical and demographic factors of interest. Survival analysis was performed using the Kaplan-Meier estimation and Cox proportional hazards regression to evaluate potential 5-year overall survival disadvantage of delayed initiation of chemotherapy. RESULTS: Of 166,681 women assessed, 4.3% had a delay in the initiation of chemotherapy. Surgery-specific risk factors included unplanned readmission in the postoperative period, lower surgical volume, mastectomy with immediate autologous reconstruction, and positive surgical margins. Adjusted survival analysis showed a survival disadvantage of delayed initiation of chemotherapy (hazard ratio [HR] 1.46; p < 0.01). CONCLUSIONS: Risk factors for delayed initiation of chemotherapy specific to the surgical process were identified. Delayed initiation of adjuvant chemotherapy was associated with a survival detriment. Efforts should be made to address these surgical management issues and optimize the perioperative process to ensure timely patient treatment.
Authors: Rachel L O'Connell; Tim Rattay; Rajiv V Dave; Adam Trickey; Joanna Skillman; Nicola L P Barnes; Matthew Gardiner; Adrian Harnett; Shelley Potter; Chris Holcombe Journal: Br J Cancer Date: 2019-03-29 Impact factor: 7.640
Authors: Murad J Karadsheh; Jacob Y Katsnelson; Karen J Ruth; Eric S Weiss; James C Krupp; Elin R Sigurdson; Richard J Bleicher; Marilyn Ng; M Shuja Shafqat; Sameer A Patel Journal: Plast Reconstr Surg Glob Open Date: 2021-04-15
Authors: Won Sup Yoon; Chai Hong Rim; Dae Sik Yang; Jung Ae Lee; Gil Soo Son; Young Woo Chang; Sang Uk Woo; Deok-Woo Kim; Eun-Sang Dhong Journal: Ann Transl Med Date: 2019-12