Adjuvant treatment delay in breast cancer patients

to evaluate if time between surgery and the first adjuvant treatment (chemotherapy, radiotherapy or hormone therapy) in patients with breast cancer is a risk factor for lower overall survival (OS).

Method:

data from a five-year retrospective cohort study of all women diagnosed with invasive breast cancer at an academic oncology service were collected and analyzed.

Results:

three hundred forty-eight consecutive women were included. Time between surgery and the first adjuvant treatment was a risk factor for shorter overall survival (HR=1.3, 95CI 1.06-1.71, p=0.015), along with negative estrogen receptor, the presence of lymphovascular invasion and greater tumor size. A delay longer than 4 months between surgery and the first adjuvant treatment was also associated with shorter overall survival (cumulative survival of 80.9% for delays ≤ 4 months vs. 72.6% for delays > 4 months; p=0.041, log rank test).

Conclusion:

each month of delay between surgery and the first adjuvant treatment in women with invasive breast cancer increases the risk of death in 1.3-fold, and this effect is independent of all other well-established risk factors. Based on these results, we recommend further public strategies to decrease this interval.

Keywords:
breast neoplasms; time-to-treatment; prognosis; survival; health care quality assurance

Characteristic	Cases
Characteristic	n	%
Age^* * Median (range);	57 years (27-92)
Time from surgery until 1^st	2 months (0-11)
adjuvant treatment^* * Median (range);
Delay to treatment
≤ 4 months	312		89.6%
> 4 months	36		10.4%
Adjuvant treatment (1 ^st )
Chemotherapy	205		58.9%
Radiotherapy	98		28.2%
Hormone therapy	45		12.9%
Histologic type
Ductal carcinoma	262		75.3%
Non-ductal carcinoma	86		27.7%
Pathological stage
I / II	268		77.0%
III	80		23.0%
Tumor size^ Mean ± standard deviation.	2.6 cm±1.7
Positive lymph nodes^ Mean ± standard deviation.	2.6±4.2
Angiolymphatic invasion
No	168		70.0%
Yes	72		30.0%
Perineural invasion
No	181		75.4%
Yes	59		24.6%
Histologic grade
Grade I/II	258		74.1%
Grade III	90		25.9%
Estrogen receptor
Positive	269		78.2%
Negative	75		21.8%
HER2 status
Negative	290		89.5%
Positive	34		10.5%

Characteristic	Univariate analysis			Multivariate analysis
Characteristic	HR	95CI	p^* * = Cox regression; N/A: not applied.	HR	95CI	p^* * = Cox regression; N/A: not applied.
Time from surgery until first adjuvant treatment	1.13	0.96 – 1.33	0.146	1.35	1.06 – 1.71	0.015
1 st adjuvant treatment
Chemotherapy	1.00			1.00
Radiotherapy	0.35	0.12 – 1.04	0.059	0.39	0.04 – 4.10	0.369
Hormone therapy	0.19	0.03 – 1.44	0.108	1.43	0.13 – 15.6	0.927
Age	0.96	0.93 – 0.99	0.039	1.01	0.96 – 1.06	0.637
Histologic type
Ductal carcinoma	1.00				N/A
Non-ductal carcinoma	1.22	0.50 – 3.00	0.669
Pathological stage
I/II	1.00			1.00
III	5.69	1.83 – 17.7	0.030	1.76	0.27 – 11.3	0.552
Tumor size	1.34	1.13 – 1.59	0.001	1.36	1.06 – 1.75	0.016
Positive lymph nodes	1.09	1.01 – 1.18	0.022	0.91	0.78 – 1.05	0.208
Angiovascular invasion
No	1.00			1.00
Yes	5.37	1.96 – 14.7	0.001	4.85	1.21 – 19.4	0.025
Perineural invasion
No	1.00			1.00
Yes	1.96	0.74 – 5.17	0.172	0.83	1.17 – 4.13	0.818
Histologic grade
Grade I/II	1.00			1.00
Grade III	5.27	0.67 – 41.3	0.114	0.71	0.17 – 2.94	0.635
Estrogen receptor
Positive	1.00			1.00
Negative	3.20	1.38 – 7.40	0.007	3.58	1.01 – 12.7	0.049
HER2 status
Negative	1.00				N/A
Positive	1.53	0.45 – 5.18	0.493

Associação Médica Brasileira R. São Carlos do Pinhal, 324, 01333-903 São Paulo SP - Brazil, Tel: +55 11 3178-6800, Fax: +55 11 3178-6816 - São Paulo - SP - Brazil
E-mail: ramb@amb.org.br

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[1] *Correspondence: Address: Av. Principe de Gales, 821 Santo André, SP – Brazil Postal code: 09060-650damilatrufelli@yahoo.com.br