Factors Associated With Breast Cancer Surgery Delay Within a Coordinated Multihospital Community Health System: When Does Surgical Delay Impact Outcome?
| Autor: | Shanita Thomas, Judy A. Tjoe, Kayla Heslin, Jessica J.F. Kram, Ana Cristina Perez Moreno |
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| Rok vydání: | 2022 |
| Předmět: |
Adult
0301 basic medicine Cancer Research medicine.medical_specialty Breast Neoplasms Disease Disease-Free Survival Time-to-Treatment 03 medical and health sciences 0302 clinical medicine Breast cancer Humans Medicine Community Health Services Stage (cooking) Aged Retrospective Studies Proportional hazards model business.industry Middle Aged medicine.disease Primary tumor Cancer registry Surgery Treatment Outcome 030104 developmental biology Oncology 030220 oncology & carcinogenesis Community health Disease Progression Biomarker (medicine) Female business |
| Zdroj: | Clinical Breast Cancer. 22:e91-e100 |
| ISSN: | 1526-8209 |
| DOI: | 10.1016/j.clbc.2021.04.012 |
| Popis: | 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 TTS30 days: age50, 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 TTS60 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. |
| Databáze: | OpenAIRE |
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