Factors Associated With Breast Cancer Surgery Delay Within a Coordinated Multihospital Community Health System: When Does Surgical Delay Impact Outcome?

• Published in: Clinical breast cancer Vol. 22; no. 1; pp. e91 - e100
• Main Authors: Tjoe, Judy A., Heslin, Kayla, Perez Moreno, Ana C., Thomas, Shanita, Kram, Jessica J.F.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2022
• Subjects: Adult; Aged; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Community Health Services; Disease Progression; Disease-Free Survival; Female; Humans; Middle Aged; Retrospective Studies; Time to Surgery, Disease Free Survival; Time-to-Treatment - statistics & numerical data; Treatment Outcome; Time to Surgery, Disease Free Survival
• ISSN: 1526-8209; 1938-0666
• DOI: 10.1016/j.clbc.2021.04.012

•Multiple factors impact timing of breast cancer surgery after initial diagnosis.•Surgical delays don't negatively impact DFS as long as surgery occurs within 60 days of diagnosis.•Race/ethnicity other than non-Hispanic White were more often associated with surgical delays.•DCIS, total mastectomy, and no adjuvant therapy were associated with delayed breast cancer surgery.
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.
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).
Overall, 4462 patients were analyzed, 43.4% of whom underwent surgery beyond 30 days. The following factors were associated with TTS >30 days: age <50, non-Hispanic White race/ethnicity, commercial or health exchange/Medicaid insurance, diagnosis of noninvasive disease (i.e., ductal carcinoma in situ), had breast magnetic resonance imaging before definitive surgery, underwent total mastectomy (especially if immediate reconstruction, particularly if autologous, was performed), and did not receive adjuvant therapies (P < .001 for all). After adjusting for relevant variables, significant predictors of recurrence/death included a TTS >60 days, increased patient age, higher breast cancer stage, and triple-negative biomarker expression.
Risk of recurrence or death is not compromised until TTS exceeds 60 days after initial breast cancer diagnosis.
• Multiple factors delay time to surgery (TTS) after breast cancer diagnosis.
• We analyzed 4462 patients to identify factors delaying TTS and when TTS impacts disease-free survival (DFS).
• After adjusting for relevant variables, DFS was negatively impacted only after TTS >60 days.
• The programmatic metric demanding TTS <30 days, which places significant strain on hospital resources, may be too restrictive without improving DFS.
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