Preoperative delays in treatment of breast cancer, the most common type of cancer among women in the United States, have been a source of controversy in healthcare for decades. The problem centers around exactly how prolonged “time to surgery”—or the time period between the initial diagnosis of a disease and treatment through surgery—impacts overall patient survival.
The relationship between time to surgery and mortality rates in breast cancer patients has yet to be properly investigated, said Richard Bleicher, MD, of the Fox Chase Cancer Center in Philadelphia, Penn., and his co-authors, in study results recently published in JAMA Oncology.
“There is little doubt that waiting for treatment causes anxiety, but the published medical literature has not provided a consistent answer as to whether any specific preoperative time to surgery is associated with an effect on overall or disease-specific survival,” they wrote. “There has been a movement to include time to surgery as a breast cancer quality measure, but only recently has this preoperative interval and the relationship of patient evaluation components to delay been comprehensively evaluated in Medicare patients.”
Bleicher and his team set out to investigate the relationship between the time from the initial finding of breast cancer to surgery and survival. To do so, they analyzed two of the largest cancer databases in the United States— the Surveillance, Epidemiology, and End Results (SEER)-Medicare–linked database and the National Cancer Database (NCDB)—to assess breast cancer survival according to various time intervals between diagnosis and surgery.
Their results showed that patients in the SEER-Medicare cohort (66 years of age and over) had lower overall survival rates with each increase in time interval, including patients with stage I and stage II disease. Significant drops in survival only correlated with time intervals in the NCDB cohort (18 years old and up) in patients with advanced stages of disease.
“Greater time to surgery is associated with lower overall and disease-specific survival, and a shortened delay is associated with benefits comparable to some standard therapies,” the authors concluded. “Although time is required for preoperative evaluation and consideration of options such as reconstruction, efforts to reduce time to surgery should be pursued when possible to enhance survival.”
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