The impact of breast reconstruction on the delivery of chemotherapy

Abstract

Background: : The purpose of this study was to evaluate the impact of postmastectomy breast reconstruction on the timing of chemotherapy.

Methods: : The authors included stage I-III breast cancer patients from 8 National Comprehensive Cancer Network institutions for whom guidelines recommended chemotherapy. Surgery type was categorized as breast-conserving surgery (BCS), mastectomy alone, mastectomy with immediate reconstruction (M + IR), or mastectomy with delayed reconstruction (M + DR). A Cox regression analysis was used to assess the association between surgery type and timing of chemotherapy initiation.

Results: : Of the 3643 patients, only 5.1% received it > or =8 weeks from surgery. In the multivariate analysis, higher stage, Caucasian and Hispanic race/ethnicity, lower body mass index, and absence of comorbid conditions were all significantly associated with earlier time to chemotherapy. There was also significant interaction among age, surgery, and chemotherapy delivery. Among women <60, time to chemotherapy was shorter for all surgery types compared with M + IR (statistical significant for all surgery types in the youngest age group and for BCS in women 40 to <50 years old). In contrast, among women > or =60, time to chemotherapy was shorter among women receiving M + IR or M + DR compared with those undergoing BCS or mastectomy alone, a difference that was statistically significant for the M + IR versus BCS comparison.

Conclusions: : Immediate postmastectomy breast reconstruction does not appear to lead to omission of chemotherapy, but it is associated with a modest, but statistically significant, delay in initiating treatment. For most, it is unlikely that this delay has any clinical significance. Cancer 2010. (c) 2010 American Cancer Society.

Figure 1

Proportion of Patients who Received Chemotherapy within 8 Weeks of Definitive Surgery by Patient Age and Type of Surgery

Figure 2

Time to chemotherapy by surgery group for patients under age 60 (Panel A) and 60 or older (Panel B). The sample population for <60 years included 1,454 BCS, 440 mastectomy alone, 521 mastectomy with immediate reconstruction and 90 with mastectomy and delayed reconstruction. The sample population for ≥60 years included 701 BCS, 352 mastectomy alone, 75 mastectomy with immediate reconstruction and 10 mastectomy with delayed reconstruction.