Ipshita Prakash1,2, Samantha M Thomas3,4, Rachel A Greenup1,5,6,7, Jennifer K Plichta1,5, Laura H Rosenberger1,5,8, Terry Hyslop3,4, Oluwadamilola M Fayanju9,10,11,12,13. 1. Department of Surgery, Duke University Medical Center, Box 3513, Durham, NC, 27710, USA. 2. Department of Surgery, Glen Campus, Royal Victoria Hospital, McGill University Health Centre, 1001 Blvd Decarie, Montreal, QC, Canada. 3. Biostatistics Shared Resource, Duke Cancer Institute, Durham, NC, 27710, USA. 4. Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, 27710, Box 2717, USA. 5. Duke Cancer Institute, Women's Cancer Program, Durham, NC, 27710, USA. 6. Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA. 7. Duke Margolis Center for Health Policy, Durham, NC, USA. 8. Department of Surgery, Duke Regional Hospital, 3643 N. Roxboro Street, Durham, NC, 27704, USA. 9. Department of Surgery, Duke University Medical Center, Box 3513, Durham, NC, 27710, USA. lola.fayanju@duke.edu. 10. Duke Cancer Institute, Women's Cancer Program, Durham, NC, 27710, USA. lola.fayanju@duke.edu. 11. Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA. lola.fayanju@duke.edu. 12. Duke Forge, Duke University, Durham, NC, 27710, USA. lola.fayanju@duke.edu. 13. Department of Surgery, Durham VA Medical Center, 508 Fulton St, Durham, NC, 27705, USA. lola.fayanju@duke.edu.
Abstract
PURPOSE: Time to surgery (TTS) is a potentially modifiable factor associated with survival after breast cancer diagnosis and can serve as a proxy for quality of oncologic care coordination. We sought to determine whether factors associated with delays in TTS vary between patients who receive neoadjuvant systemic therapy (NST) vs upfront surgery and whether the impact of these delays on overall survival (OS) varies with treatment sequence. METHODS: Women ≥ 18 years old with Stage I-III breast cancer were identified in the National Cancer Database (2004-2014). Multivariate linear regression stratified by treatment sequence (upfront surgery vs NST [neoadjuvant chemotherapy {NAC}, neoadjuvant endocrine therapy {NAE}, or both {NACE}]) was used to identify factors associated with TTS. Cox proportional hazards models were used to estimate the effect of TTS on overall survival (OS). RESULTS: Of 693,469 patients, 14.8% (n = 102,326) received NST (NAC n = 85,143, NAE n = 10,004, NACE n = 7179). Non-White race/ethnicity, no or government-issued insurance, more extensive surgery (i.e., mastectomy and contralateral prophylactic mastectomy vs breast-conserving surgery), and post-mastectomy reconstruction were associated with significantly longer adjusted TTS for NAC and upfront-surgery recipients, but only upfront-surgery patients had progressively worse OS with increasing TTS (> 180 vs ≤ 30 days: HR = 1.31, all p < 0.001). CONCLUSIONS: Surgery extent, race/ethnicity, and insurance were associated with TTS across treatment groups, but longer TTS was only associated with worse OS in upfront-surgery patients. Our findings can help inform surgeon-patient communication, shared decision making, care coordination, and patients' expectations throughout both NST and in the perioperative period.
PURPOSE: Time to surgery (TTS) is a potentially modifiable factor associated with survival after breast cancer diagnosis and can serve as a proxy for quality of oncologic care coordination. We sought to determine whether factors associated with delays in TTS vary between patients who receive neoadjuvant systemic therapy (NST) vs upfront surgery and whether the impact of these delays on overall survival (OS) varies with treatment sequence. METHODS: Women ≥ 18 years old with Stage I-III breast cancer were identified in the National Cancer Database (2004-2014). Multivariate linear regression stratified by treatment sequence (upfront surgery vs NST [neoadjuvant chemotherapy {NAC}, neoadjuvant endocrine therapy {NAE}, or both {NACE}]) was used to identify factors associated with TTS. Cox proportional hazards models were used to estimate the effect of TTS on overall survival (OS). RESULTS: Of 693,469 patients, 14.8% (n = 102,326) received NST (NAC n = 85,143, NAE n = 10,004, NACE n = 7179). Non-White race/ethnicity, no or government-issued insurance, more extensive surgery (i.e., mastectomy and contralateral prophylactic mastectomy vs breast-conserving surgery), and post-mastectomy reconstruction were associated with significantly longer adjusted TTS for NAC and upfront-surgery recipients, but only upfront-surgery patients had progressively worse OS with increasing TTS (> 180 vs ≤ 30 days: HR = 1.31, all p < 0.001). CONCLUSIONS: Surgery extent, race/ethnicity, and insurance were associated with TTS across treatment groups, but longer TTS was only associated with worse OS in upfront-surgery patients. Our findings can help inform surgeon-patient communication, shared decision making, care coordination, and patients' expectations throughout both NST and in the perioperative period.
Entities:
Keywords:
Breast cancer; Chemotherapy; Endocrine therapy; Neoadjuvant; Quality of care; Time to treatment
Authors: Romualdo Barroso-Sousa; Danilo D A Fonseca Reis Silva; Joao Victor Machado Alessi; Max Senna Mano Journal: Ecancermedicalscience Date: 2016-01-07
Authors: Urvish Jain; Bhav Jain; Oluwadamilola M Fayanju; Fumiko Chino; Edward Christopher Dee Journal: Am J Surg Date: 2022-01-22 Impact factor: 3.125
Authors: Oluwadamilola M Fayanju; Yi Ren; Ilona Stashko; Steve Power; Madeline J Thornton; P Kelly Marcom; Terry Hyslop; E Shelley Hwang Journal: Cancer Date: 2020-11-11 Impact factor: 6.860