Factors associated with breast cancer surgery delay within a coordinated multihospital community health system: When does surgical delay impact outcome?
Tjoe JA, Heslin K, Perez Moreno AC, Thomas S, Kram JJF. Factors associated with breast cancer surgery delay within a coordinated multihospital community health system: when does surgical delay impact outcome? Clin Breast Cancer. Published online May 3, 2021:S1526-8209(21)00090-2. doi: 10.1016/j.clbc.2021.04.012. Online ahead of print
BACKGROUND: Multiple factors influence the time elapsed between diagnosis of breast cancer and surgical extirpation of the primary tumor. The disease-free interval between resection of primary breast cancer and first evidence of recurrence is predictive of mortality. We aimed to determine patient, disease, and treatment factors associated with a delay in time to surgery (TTS) and identify the point when prolonged TTS negatively impacts disease-free survival.
PATIENTS AND METHODS: Cancer registry and electronic medical record data for patients with breast cancer who underwent surgery as first course of treatment during 2006-2016 were retrospectively reviewed. Patients undergoing surgery in ≤30 vs. 31-60 vs. >60 days of initial diagnosis were compared. Kaplan-Meier survival analyses with Cox proportional hazards were performed to evaluate impact of time from breast cancer diagnosis to definitive therapeutic surgery on breast cancer recurrence or death (all-cause).
RESULTS: Overall, 4462 patients were analyzed, 43.4% of whom underwent surgery beyond 30 days. The following factors were associated with TTS >30 days: age60 days, increased patient age, higher breast cancer stage, and triple-negative biomarker expression.
CONCLUSION: Risk of recurrence or death is not compromised until TTS exceeds 60 days after initial breast cancer diagnosis.