Abstract
It is generally accepted that delay in receiving treatment for breast cancer results in adverse outcomes. The purpose of this study was to evaluate the impact of delay in treatment after the diagnosis of metastatic disease on survival measured from metastatic breast cancer diagnosis and from first treatment while controlling for immortal time effect among patients with metastatic breast cancer. A total of 553 patients with breast cancer metastasis diagnosis from one large urban practice have been followed between January 1, 1999 and June 30, 2008. Prognostic factors and outcomes of these patients were analyzed using log-rank test and Cox regression model. Backward stepwise selection of covariates was conducted to assess the association of treatment delay with survival. The median survival was 40 months (range 1–114 months), with 265 (47.9%) women alive and 288 (52.1%) having died at the end of the follow-up period. Treatment delays of more than 12 weeks had impact on poor survival from first treatment than the delays of 4–12 weeks with borderline significance level (HR 1.76, 95% CI 0.99–3.13, P = 0.056) in multivariate analysis, adjusted by BMI, history of hypertension, ER/PR status, HER2 status, number of metastatic sites, and liver metastasis. Moreover, the interval of 12–24 weeks, compared to the interval of 4–12 weeks was associated with greater risk of death from first treatment (HR 2.39, 95% CI 1.19–4.77, P = 0.014). The treatment delay interval of >12 weeks was not related with survival since metastatic breast cancer diagnosis, compared to the 4–12 weeks of treatment delays. This study demonstrated that delays of over 12 weeks in receiving treatment for metastatic breast cancer were related to adverse survival outcomes measured from initiation of first treatment. The findings of this study support targeted efforts to ensure prompt treatment initiation in patients diagnosed with metastatic breast cancer.
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References
Surveillance Epidemiology and End Results Program (SEER) (2008). SEER Stat Database: SEER Stat Fact Sheets
Wingo PA, Tong T, Bolden S (1995) Cancer statistics, 1995. CA Cancer J Clin 45(1):8–30
McGinn K, Moore J (2001) Metastatic breast cancer: understanding current management options. Oncol Nurs Forum 28(3):507–512 quiz 513–514
Greenberg PA et al (1996) Long-term follow-up of patients with complete remission following combination chemotherapy for metastatic breast cancer. J Clin Oncol 14(8):2197–2205
Handerson IC, Harris JR, Kinne DW (1989) Cancer of the breast. In: De Vita VT, Hellman S, Rosenberg SA (eds) Cancer principles practice of oncology, 3rd edn. Lippincott, Philadelphia, pp 1197–1268
Insa A et al (1999) Prognostic factors predicting survival from first recurrence in patients with metastatic breast cancer: analysis of 439 patients. Breast Cancer Res Treat 56(1):67–78
Chang J et al (2003) Survival of patients with metastatic breast carcinoma: importance of prognostic markers of the primary tumor. Cancer 97(3):545–553
Beslija S et al (2009) Third consensus on medical treatment of metastatic breast cancer. Ann Oncol 20(11):1771–1785
Rezaianzadeh A et al (2009) Survival analysis of 1148 women diagnosed with breast cancer in Southern Iran. BMC Cancer 9:168
Vincent MD et al (1986) An analysis of possible prognostic features of long term and short term survivors of metastatic breast cancer. Eur J Cancer Clin Oncol 22(9):1059–1065
Bradley CJ, Given CW, Roberts C (2002) Race socioeconomic status, and breast cancer treatment and survival. J Natl Cancer Inst 94(7):490–496
Whiteman MK et al (2005) Body mass and mortality after breast cancer diagnosis. Cancer Epidemiol Biomarkers Prev 14(8):2009–2014
Braithwaite D et al (2009) Hypertension is an independent predictor of survival disparity between African-American and white breast cancer patients. Int J Cancer 124(5):1213–1219
Ahern TP et al (2009) Impact of acquired comorbidities on all-cause mortality rates among older breast cancer survivors. Med Care 47(1):73–79
Gregorio DI, Cummings KM, Michalek A (1983) Delay stage of disease, and survival among White and Black women with breast cancer. Am J Public Health 73(5):590–593
Kievit J (2002) The effect of treatment delay on the prognosis of breast cancer patients. Ned Tijdschr Geneeskd 146(22):1031–1034
Gorin SS et al. (2006) Effect of race/ethnicity and treatment delay on breast cancer survival. J Clin Oncol; ASCO Annual Meeting Proceedings Part I, 24(18S):6063
Gorin SS, Hebert JR, Cheng B (2007) Killing time: treatment delay and breast cancer survival. J Clin Oncol; ASCO Annual Meeting Proceedings Part I, 25(18S):6589
Richards MA et al (1999) The influence on survival of delay in the presentation and treatment of symptomatic breast cancer. Br J Cancer 79(5–6):858–864
Afzelius P (1994) Patient’s and doctor’s delay in primary breast cancer. Prognostic implications. Acta Oncol 33(4):345–351
Hermann RE et al (1985) Results of conservative operations for breast cancer. Arch Surg 120(6):746–751
Sheridan B et al (1971) The effects of delay in treatment of survival rates in carcinoma of the breast. Med J Aust 1(5):262–267
Smith ER et al (2008) Breast cancer survival among economically disadvantaged women: the influences of delayed diagnosis and treatment on mortality. Cancer Epidemiol Biomarkers Prev 17(10):2882–2890
Elmore JG et al (2005) Racial inequities in the timing of breast cancer detection, diagnosis, and initiation of treatment. Med Care 43(2):141–148
Hershman D et al (2005) Racial disparities in treatment and survival among women with early-stage breast cancer. J Clin Oncol 23(27):6639–6646
Vernon SW et al (1985) Ethnicity, survival, and delay in seeking treatment for symptoms of breast cancer. Cancer 55(7):1563–1571
Neale AV, Tilley BC, Vernon SW (1986) Marital status delay in seeking treatment and survival from breast cancer. Soc Sci Med 23(3):305–312
Charlson ME (1985) Delay in the treatment of carcinoma of the breast. Surg Gynecol Obstet 160(5):393–399
Gardner B (1978) The relationship of delay in treatment to prognosis in human cancer. Prog Clin Cancer 7:123–133
Machiavelli M et al (1989) Relation between delay and survival in 596 patients with breast cancer. Oncology 46(2):78–82
Dennis CR, Gardner B, Lim B (1975) Analysis of survival and recurrence vs. patient and doctor delay in treatment of breast cancer. Cancer 35(3):714–720
Luini A et al (2007) Metaplastic carcinoma of the breast, an unusual disease with worse prognosis: the experience of the European Institute of Oncology and review of the literature. Breast Cancer Res Treat 101(3):349–353
Suissa S (2007) Immortal time bias in observational studies of drug effects. Pharmacoepidemiol Drug Saf 16(3):241–249
Suissa S (2008) Immortal time bias in pharmaco-epidemiology. Am J Epidemiol 167(4):492–499
Ray WA (2005) Observational studies of drugs and mortality. N Engl J Med 353(22):2319–2321
Census 2000 summary file 3 (SF 3) (2000) US Census Bureau
Richards MA et al (1999) Influence of delay on survival in patients with breast cancer: a systematic review. Lancet 353(9159):1119–1126
American Heart Association. What is high blood pressure? 2009. Available from http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Understanding-Blood-Pressure-Readings_UCM_301764_Article.jsp. Accessed 1 Aug 2009
Charlson ME et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383
Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45(6):613–619
Dempster AP, Laird NM, Rubin DB (1977) Maximum likelihood from incomplete data via the EM algorithm. J Royal Stat Soc Ser B (Methodol) 39(1):1–38
Pater JL, Loeb M, Siu TO (1979) A multivariate analysis of the contribution of “auxometry” to prognosis in breast cancer. J Chronic Dis 32(5):375–384
Andre F et al (2004) Breast cancer with synchronous metastases: trends in survival during a 14-year period. J Clin Oncol 22(16):3302–3308
Grasic-Kuhar C, Bracko M, Zakotnik B (2008) Risk factors for late relapse and death in patients with early breast cancer. Neoplasma 55(5):416–420
Falkson G et al (1991) Factors predicting for response, time to treatment failure, and survival in women with metastatic breast cancer treated with DAVTH: a prospective Eastern Cooperative Oncology Group study. J Clin Oncol 9(12):2153–2161
Caplan LS, May DS, Richardson LC (2000) Time to diagnosis and treatment of breast cancer: results from the National Breast and Cervical Cancer Early Detection Program, 1991–1995. Am J Public Health 90(1):130–134
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Jung, S.Y., Sereika, S.M., Linkov, F. et al. The effect of delays in treatment for breast cancer metastasis on survival. Breast Cancer Res Treat 130, 953–964 (2011). https://doi.org/10.1007/s10549-011-1662-4
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DOI: https://doi.org/10.1007/s10549-011-1662-4