Present
This study found that decreased survival was associated with a time longer than 38 weeks from diagnosis to completion of multimodality therapy.4 The unavailability of select data points within the large cancer databases led to study limitations. Further studies addressing timeliness of treatment and survival would benefit from including the dates of the last systemic therapies into the NCDB and Surveillance, Epidemiology, and End Results (SEER) databases.
Future
The time to treatment can and should be improved. In 2014, the author’s program identified the time from diagnosis to the first treatment for breast cancer as a quality measure. System inefficiencies were identified by a multidisciplinary team using continuous improvement processes and value-stream mapping. A weekly huddle process to address and manage delays was instituted. This achieved a 33 % reduction in the median days from diagnosis to first treatment.5
Programs measuring and pursuing optimization of TTT could provide meaningful benefits for patients by improving survival and decreasing anxiety. Analysis of patients experiencing extended TTT will help to identify opportunities for improving care within delivery systems.
Using time to completion of multimodality therapy as a composite quality measure combines several individual metrics to provide a comprehensive picture of breast cancer treatment quality. Balancing quality measures are needed to ensure that the improving TTT does not become a singular end point. For example, a metastatic workup should not be omitted to expedite initiation of systemic therapy for a patient presenting with clinical stage 3 breast cancer. Adoption of time-to-completion multimodality therapy as a quality measure should improve breast cancer treatments, resulting in improved patient experience and outcomes.
References
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Bleicher RJ, Ruth K, Sigurdson ER, et al. Time to surgery and breast cancer survival in the United States. JAMA Oncol. 2016;2:330–9.
Khorana AA, Tullio K, Elson P, et al. Time to initial cancer treatment in the United States and association with survival over time: an observational study. PLOS ONE. 2019;14:e0215108.
Pratt D, Burneikis T, Tu C, Grobmyer S. Time to completion of breast cancer treatment and survival. Ann Surg Oncol. 2021. https://doi.org/10.1245/s10434-021-10116-9.
Khorana AA, Bolwell BJ. Reducing time-to-treatment for newly diagnosed cancer patients. NEJM Catalyst Case Study. 2019. https://catalyst.nejm.org/doi/full/10.1056/CAT.19.0010.
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Pratt, D., Grobmyer, S.R. ASO Author Reflections: Time to Treatment: A New Quality Metric in Breast Cancer Care?. Ann Surg Oncol 28, 8609 (2021). https://doi.org/10.1245/s10434-021-10169-w
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DOI: https://doi.org/10.1245/s10434-021-10169-w