Completion of Treatment Within 38 Weeks of Breast Cancer Diagnosis Linked With Improved OS

Debra Pratt, MD

Completion of treatment options such as surgery, chemotherapy, and radiation within 38 weeks from a diagnosis with breast cancer was associated with improved survival in this population, according to data from a study published in the Annals of Surgical Oncology.¹

The observational study, examined information from the National Cancer Database from 2010 on patients with stage I to III breast cancer and found that a subset of 28,284 patients received all 3 treatment modalities. Among these patients, the risk of delaying completion of all treatment beyond 38 weeks was linked with a decrease in overall survival (OS). The 5-year OS rate in those who completed treatment within 38 weeks was 89.8% (95% CI, 89.3%-90.4%) vs 83.3% (95% CI, 82.7%-84.0%) in those whose treatment extended beyond that time point (hazard ratio [HR], 1.21).

“The biggest difference in our study from others that have looked at time to treat was that we looked at the time from diagnosis to the completion of the multimodality treatment, not only at one individual part, to identify the 38-week window to improve survival rate for patients with breast cancer,” Debra Pratt MD, lead study author and director of the Breast Center Program at Cleveland Clinic Fairview Hospital, stated in a press release.²

Delays in breast cancer treatment are common, often multifactorial, and have been shown to be associated with a decrease in survival. Previous studies have examined time intervals between surgery and adjuvant chemotherapy initiation, or from chemotherapy and surgery to the initiation of adjuvant radiation therapy. These efforts revealed an association between increased treatment delays and worse outcomes.

However, prior to this research, few studies have evaluated the link between the time interval from diagnosis to completion of all acute treatment modalities and survival. As such, investigators sought to assess whether an association exists between survival and the time to completion of all 3 modalities used in this disease: surgery, chemotherapy, and radiation.

Because few studies have examined the impact of certain tumor characteristics on patient survival, a key secondary end point of the current effort was to assess whether survival outcomes related to delayed treatment would vary based on tumor receptor status.

The study population was comprised of newly diagnosed patients with breast cancer in the year 2010. To be eligible for inclusion, patients needed to be younger than 80 years, have a single cancer diagnosis, and have stage I to III invasive disease that required treatment with all 3 modalities. 

The median age of study patients (n = 28,284) at the time of diagnosis was 53.8 years and 70.1% were White. Additionally, 28.6% of patients had stage I disease, 44.4% had stage II disease, and 27.0% had stage III disease.

A total of 20,772 patients underwent surgery first, followed by chemotherapy and radiation therapy, whereas 7512 patients underwent chemotherapy first, followed by surgery and radiation therapy. More patients who underwent neoadjuvant chemotherapy first experienced delays of longer than 38 weeks; this subset took an average of 27 to 30 more days for treatment than patients who underwent surgery first.

Additional data from the study showed that the decrease in OS was significant, irrespective of major tumor receptor status. The statistically significant HRs for these subtypes included triple-negative (HR, 1.188; 95% CI, 1.06-1.34), estrogen receptor (ER)-positive/progesterone receptor (PR)–positive/HER2-negative (HR, 1.22; 95% CI, 1.09-1.36), ER-negative/PR-negative/HER2-positive (HR, 1.29; 95% CI 1.004-1.67), and ER-positive/PR-positive/HER2-positive (HR, 1.32; 95% CI, 1.01-1.72).

The study authors concluded that efforts are needed to improve the efficiency of multimodality breast cancer treatment and to reduce treatment delays to optimize outcomes for this patient population.

“What we see happen traditionally in the United States, and even in the United Arab Emirates, is that the patient has to visit multiple specialists—first a surgeon, then a medical oncologist for chemotherapy, followed by a radiation oncologist—all of which are scheduled weeks apart and in different places,” Stephen Grobmyer, MD, chair of the Oncology Institute at Cleveland Clinic Abu Dhabi, and a co-author on the study, stated in the release. “There is this phenomenon of ‘serial care,’ rather than coordinated and planned care. We are trying to anticipate the needs of the patients and plan for all their treatment from the beginning so that it is seamless, efficient, and reduces their anxiety.”

References

1. Pratt D, Burneikis T, Tu C, et al. Time to completion of breast cancer treatment and survival. Ann Surg Oncol. Published on June 8, 2021. doi:10.1245/s10434-021-10116-9
2. New breast cancer study finds survival increases when time between diagnosis and treatment conclusion is limited. News release. Cleveland Clinic. June 30, 2021. Accessed July 1, 2021. https://cle.clinic/3dzgHik