Delaying chemotherapy in breast cancer patients reduces overall survival, especially for those with triple-negative breast cancer

MD Anderson study identifies socio-demographic factors contributing to delayed treatment

Jo-Carolyn Goode | 12/10/2015, 11:56 a.m.
Postponing the start of adjuvant chemotherapy for more than 90 days following surgery may significantly increase risk of death for ...
Mariana Chavez Mac Gregor, M.D

This study also sought to determine factors contributing to delayed administration of chemotherapy in order to identify patient groups in need of improved care delivery. While patients with later stage disease and TNBC were less likely to experience delays, increased age, reconstructive surgery and certain socio-demographic factors were associated with postponed treatment.

“We observed, not surprisingly, that socio-demographic factors determined, in great part, some of this delay. Patients with low socio-economic status (SES), those without private insurance and those of Hispanic or African-American descent were more likely to have delays in their treatment,” said Chavez Mac Gregor.

Worse overall survival was also associated with patients of African-American descent, lower SES and those with Medicare and Medicaid coverage. In contrast, those patients receiving care at National Cancer Institute-designated cancer centers had a 34 percent lower risk of death compared to those who were treated elsewhere.

“We need to identify the determinants of delays in treatment so we can act on them and potentially improve the delivery of care in vulnerable populations. In most clinical scenarios, administering chemotherapy within three months is more than feasible,” said Chavez Mac Gregor.

The results of the current study support including time to chemotherapy initiation as a quality metric, and additionally suggest that treatment should begin within 90 days of surgery, explained Chavez Mac Gregor.

While the authors acknowledge the study may be limited by its retrospective nature, they conclude that all breast cancer patients receiving adjuvant chemotherapy should do so within 90 days of surgery or 120 days of diagnosis.

“We need to start chemotherapy in a timely manner,” said Chavez Mac Gregor. “In those patients who want to delay their chemotherapy, I share this data and let them know that a delay can dilute the benefits of treatment. If at all possible, we should not delay.”

In addition to Chavez Mac Gregor and Giordano, additional authors include: Christina A Clarke, Ph.D, and Daphne Y. Lichtensztajn, M.D., Cancer Prevention Institute of California, Fremont, CA.

This study was funded by the National Cancer Institute R01-CA121052, HHSN261201000040C, N01-PC-35139, N01-PC-54404, and 2P30 CA016672), the National Institute of Environmental Health Sciences (R01-ES015552), the Cancer Prevention Research Institute of Texas, the Centers for Disease Control and Prevention’s National Program of Cancer Registries, and the California Department of Public Health as mandated by California Health and Safety Code Section 103885.

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