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Wait times and breast cancer survival: a population-based retrospective cohort study using CanIMPACT data

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Abstract

Purpose

The time from breast cancer surgery to chemotherapy has been shown to affect survival outcomes; however, the effect of time from first breast cancer-related healthcare contact to first cancer specialist consultation, or the time from first breast cancer-related healthcare contact to adjuvant chemotherapy on survival has not been well explored. We aimed to determine whether various wait times along the breast cancer treatment pathway (contact-to-consultation, contact-to-chemotherapy, surgery-to-chemotherapy) were associated with overall survival in women within the Canadian province of Ontario.

Methods

We performed a population-based retrospective cohort study of women diagnosed with stage I–III breast cancer in Ontario between 2007 and 2011 who received surgery and adjuvant chemotherapy. This was the Ontario cohort of a larger, nationwide study (the Canadian Team to improve Community-Based Cancer Care along the Continuum – CanIMPACT). We used Cox-proportional hazards regression to determine the association between the contact-to-consultation, contact-to-chemotherapy, and surgery-to-chemotherapy intervals and overall survival while adjusting for cancer stage, age, comorbidity, neighborhood income, immigration status, surgery type, and method of cancer detection.

Results

Among 12,782 breast cancer patients, longer surgery-to-chemotherapy intervals (HR 1.13, 95% CI 1.03–1.18 per 30-day increase), but not the contact-to-consultation (HR 0.979, 95% CI 0.95–1.01 per 30-day increase), nor the more comprehensive contact-to-chemotherapy intervals (HR 1.00, 95% CI 0.98–1.02 per 30-day increase) were associated with decreased survival in our adjusted analyses.

Conclusion

Our findings emphasize the prognostic importance of a shorter surgery-to-chemotherapy interval, whereas the contact-to-consultation and contact-to-chemotherapy intervals have less impact on survival outcomes.

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Data availability

The dataset from this study is held securely in coded form at ICES. While data sharing agreements prohibit ICES from making the dataset publicly available, access may be granted to those who meet pre-specified criteria for confidential access, available at www.ices.on.ca/DAS. The full dataset creation plan and underlying analytic code are available from the authors upon request, understanding that the computer programs may rely upon coding templates or macros that are unique to ICES and are therefore either inaccessible or may require modification. Please contact Rachel Walsh (rachel.walsh@sunnybrook.ca) for further information.

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Acknowledgements

Parts of this material are based on data and information provided by Ontario Health (Cancer Care Ontario (CCO)). The opinions, results, views, and conclusions reported in this paper are those of the authors and do not necessarily reflect those of CCO. No endorsement by CCO is intended or should be inferred. Parts of this material are based on data and information compiled and provided by CIHI and the Ontario Ministry of Health. However, the analyses, conclusions, opinions, and statements expressed herein are those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred.

Funding

This study was funded by the Canadian Institutes of Health Research (CIHR; grant 128272). This study is supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario Ministry of Health and Long-Term Care is intended or should be inferred.

Author information

Authors and Affiliations

  1. Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada

    Rachel Walsh, Aisha Lofters, Rahim Moineddin & Eva Grunfeld

  2. Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Rachel Walsh

  3. Queen’s University, Kingston, ON, Canada

    Patti Groome

  4. ICES Queen’s, Kingston, ON, Canada

    Rebecca Griffiths

  5. Department of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada

    Monika Krzyzanowska

  6. Department of Family and Community Medicine, Women’s College Hospital, Toronto, ON, Canada

    Aisha Lofters

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Contributions

Authors RW, AL, PG, RM, MK, and EG contributed to the study conception and design. Material preparation and data analysis were performed by RG. The first draft of the manuscript was written by RW and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Rachel Walsh.

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Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. We received approval from the Sunnybrook Health Sciences Centre research ethics board.

Consent to participate

No individual participant consent was obtained. As a prescribed entity under Ontario’s privacy legislation, ICES is authorized to collect and use health care data for the purposes of health system analysis, evaluation, and decision support.

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Walsh, R., Lofters, A., Groome, P. et al. Wait times and breast cancer survival: a population-based retrospective cohort study using CanIMPACT data. Cancer Causes Control (2024). https://doi.org/10.1007/s10552-024-01879-z

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