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The association of delay in curative intent treatment with survival among breast cancer patients: findings from the Women’s Health Initiative

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Delays in adjuvant breast cancer (BC) therapy have been shown to worsen outcomes. However, thus far studies have only evaluated delays to initial treatment, or a particular modality, such as chemotherapy, leaving uncertainty about the role of delay to subsequent therapy and the effects of cumulative delay, on outcomes. We investigated the associations of delays across treatment modalities with survival.

Methods

We included 3368 women with incident stage I–III BC in the Women’s Health Initiative (WHI) enrolled in fee-for-service Medicare who underwent definitive surgery. This prospective analysis characterized treatment delays by linking WHI study records to Medicare claims. Delays were defined as > 8 weeks to surgery, chemotherapy, and radiation from diagnosis or prior treatment. We used Cox proportional hazards models to estimate BC-specific mortality (BCSM) and all-cause mortality (ACM) in relation to treatment delays.

Results

We found 21.8% of women experienced delay to at least one therapy modality. In adjusted analysis, delay to chemotherapy was associated with a higher risk of BCSM (HR = 1.71; 95% CI 1.07–2.75) and ACM (HR = 1.39; 95% CI 1.02–1.90); delay in radiation increased BCSM risk (HR = 1.49; 95% CI 1.00–2.21) but not ACM risk (HR = 1.19; 95% CI 0.99–1.42). Delays across multiple treatment modalities increased BCSM risk threefold (95% CI 1.51–6.12) and ACM risk 2.3-fold (95% CI 1.50–3.50).

Conclusions

A delay to a single treatment modality and delay to a greater extent an accumulation of delays were associated with higher BCSM and ACM after BC. Timely care throughout the continuum of breast cancer treatment is important for optimal outcomes.

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Funding

The Women’s Health Initiative (WHI) program is funded by National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through contracts, HHSN268201600018C, HHSN268201600001C, HSN268201600002C, HHSN268201600003C, and HHSN268201600004C. The WHI Life and Longevity after Cancer (LILAC) study was funded by NCI grant UM1 CA173642, and the project to analyze time to treatment was funded by the Seattle Cancer Consortium Support Grant- Safeway Early Career Award awarded to KWR.

Author information

Authors and Affiliations

  1. Seattle Cancer Care Alliance, Breast Oncology, Seattle, WA, USA

    Rachel Yung

  2. Division of Medical Oncology, University of Washington, Seattle, WA, USA

    Rachel Yung

  3. Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Roberta M. Ray, Joshua Roth, Lisa Johnson, Greg Warnick, Garnet L. Anderson, Wendy E. Barrington & Kerryn W. Reding

  4. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA

    Candyce H. Kroenke

  5. Hematology and Medical Oncology, Harbor-UCLA Medical Center, Los Angeles, WA, USA

    Rowan T. Chlebowski & Kathy Pan

  6. Department of Oncology, Karmanos Cancer Institute at Wayne State University, Detroit, MI, USA

    Michael S. Simon

  7. Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA

    Chunkit Fung

  8. Division of Oncology, Kaiser Permanente Southern California, Torrance, CA, USA

    Kathy Pan

  9. School of Nursing, University of Washington, Seattle, WA, USA

    Di Wang, Wendy E. Barrington & Kerryn W. Reding

Authors
  1. Rachel Yung
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  2. Roberta M. Ray
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  3. Joshua Roth
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  4. Lisa Johnson
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  7. Candyce H. Kroenke
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  8. Rowan T. Chlebowski
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  10. Chunkit Fung
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  11. Kathy Pan
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  12. Di Wang
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  14. Kerryn W. Reding
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Corresponding author

Correspondence to Kerryn W. Reding.

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Conflict of interest

Author R. Chlebowski has received a speaker honorarium from Novartis and AstraZeneca. Author R. Chlebowski consults for Pfizer, Novartis, AstraZeneca, and Genentech; author J. Roth consults for Bayer, BMS, and Epigenomics Inc. All remaining authors have no conflicts to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Yung, R., Ray, R.M., Roth, J. et al. The association of delay in curative intent treatment with survival among breast cancer patients: findings from the Women’s Health Initiative. Breast Cancer Res Treat 180, 747–757 (2020). https://doi.org/10.1007/s10549-020-05572-y

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  • DOI: https://doi.org/10.1007/s10549-020-05572-y

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