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. 2020 Apr;9(7):2435-2444.
doi: 10.1002/cam4.2830. Epub 2020 Feb 13.

Impact of delayed treatment in women diagnosed with breast cancer: A population-based study

Peh Joo Ho  1   2 , Alex R Cook  2 , Nur Khaliesah Binte Mohamed Ri  2 , Jenny Liu  2 , Jingmei Li  1   3 , Mikael Hartman  2   3
Affiliations

Impact of delayed treatment in women diagnosed with breast cancer: A population-based study

Peh Joo Ho et al. Cancer Med. 2020 Apr.

Abstract

The impact of timely treatment on breast cancer-specific survival may differ by tumor stage. We aim to study the impact of delayed first treatment on overall survival across different tumor stages. In addition, we studied the impact of delayed adjuvant treatments on survival in patients with invasive nonmetastatic breast cancer who had surgery ≤90 days postdiagnosis. This population-based study includes 11 175 breast cancer patients, of whom, 2318 (20.7%) died (median overall survival = 7.9 years). To study the impact of delayed treatment on survival, hazard ratios and corresponding 95% confidence intervals were estimated using Cox proportional-hazards models. The highest proportion of delayed first treatment (>30 days postdiagnosis) was in patients with noninvasive breast cancer (61%), followed by metastatic breast cancer (50%) and invasive nonmetastatic breast cancer (22%). Delayed first treatment (>90 vs ≤30 days postdiagnosis) was associated with worse overall survival in patients with invasive nonmetastatic (HR: 2.25, 95% CI 1.55-3.28) and metastatic (HR: 2.09, 95% CI 1.66-2.64) breast cancer. Delayed adjuvant treatment (>90 vs 31-60 days postsurgery) was associated with worse survival in patients with invasive nonmetastatic (HR: 1.50, 95% CI 1.29-1.74). Results for the Cox proportional-hazards models were similar for breast cancer-specific death. A longer time to first treatment (31-90 days postdiagnosis) may be viable for more extensive diagnostic workup and patient-doctor decision-making process, without compromising survival. However, patients' preference and anxiety status need to be considered.

Keywords: Singapore; breast cancer; population; proportional-hazards models; survival.

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Conflict of interest statement

The authors declare no potential conflicts of interest.

Figures

Figure 1
Figure 1
Survival of 1820 women diagnosed with noninvasive breast cancer between 2005 and 2011, for all‐cause death
Figure 2
Figure 2
Survival of 7930 women diagnosed with invasive nonmetastatic breast cancer between 2005 and 2011, for all‐cause death
See this image and copyright information in PMC

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