In a study, published in JAMA Oncology, Richard J. Bleicher, M.D., of the Fox Chase Cancer Center, Philadelphia, and coauthors looked at the relationship between the time from diagnosis to breast cancer surgery and survival. The authors analyzed patient data from two of the largest cancer databases in the United States. Analysis between the two databases was not done, or warranted, so the authors present both analyses.
Data were analyzed for 95,544 patients (mostly women, average age 75) in the Surveillance, Epidemiology and End Results (SEER)-Medicare database. Of the patients, 77.7 percent had surgery in 30 days or less; 18.3 percent in 31 to 60 days; 2.7 percent in 61 to 90 days; 0.7 percent in 91 to 120 days; and 0.5 percent in 121 to 180 days. The increase in death in all stages of disease for all patients and from all causes was 9 percent for each preoperative time interval increase. While overall survival was lower with each interval of delay increase, the decline was most pronounced in patients with stage I and stage II disease. The risk of death from breast cancer for each 60-day increase in time to surgery was significant for stage I disease, according to the results.
Data were analyzed for 95,544 patients (mostly women, average age 75) in the Surveillance, Epidemiology and End Results (SEER)-Medicare database. Of the patients, 77.7 percent had surgery in 30 days or less; 18.3 percent in 31 to 60 days; 2.7 percent in 61 to 90 days; 0.7 percent in 91 to 120 days; and 0.5 percent in 121 to 180 days. The increase in death in all stages of disease for all patients and from all causes was 9 percent for each preoperative time interval increase. While overall survival was lower with each interval of delay increase, the decline was most pronounced in patients with stage I and stage II disease. The risk of death from breast cancer for each 60-day increase in time to surgery was significant for stage I disease, according to the results.
Data were also analyzed for 115,790 patients (nearly all women, average age 60) in the National Cancer Database. Of the patients, 69.5 percent of patients had surgery in 30 days or less; 24.9 percent in 31 to 60 days; 4.1 percent in 61 to 90 days; 1 percent in 91 to 120 days; and 0.5 percent in 121 to 180 days. The added risk of death from all causes for each interval increase in time to surgery was 10 percent for the entire group, and most pronounced for stage I and stage II disease.
The authors acknowledge unmeasured confounders may exist in their study.
"In conclusion, survival outcomes in early-stage breast cancer are affected by the length of the interval between diagnosis and surgery, and efforts to minimize that interval are appropriate. Although the effect on both overall and disease-specific survival remains small, consideration should be given to establishing reasonable and attainable goals for the timing of surgical interventions to afford this population a finite, but clinically relevant, survival benefit," the study concludes.
Bleicher et al. Time to Surgery and Breast Cancer Survival in the United States. JAMA Oncol. 2015. doi:10.1001/jamaoncol.2015.4508 [Article]
The authors acknowledge unmeasured confounders may exist in their study.
"In conclusion, survival outcomes in early-stage breast cancer are affected by the length of the interval between diagnosis and surgery, and efforts to minimize that interval are appropriate. Although the effect on both overall and disease-specific survival remains small, consideration should be given to establishing reasonable and attainable goals for the timing of surgical interventions to afford this population a finite, but clinically relevant, survival benefit," the study concludes.
Bleicher et al. Time to Surgery and Breast Cancer Survival in the United States. JAMA Oncol. 2015. doi:10.1001/jamaoncol.2015.4508 [Article]
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