Best to Start Chemotherapy Within 30 Days of Surgery

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Doctors recommend starting treatment as soon as possible after breast cancer is diagnosed. Timely treatment reduces the risk that the cancer will spread and increases the chances for survival. Still, sometimes women delay treatment for a number of reasons, including cost and scheduling. But if treatment is delayed too long it can affect survival.

A new study has found that women who wait more than 60 days after surgery to start chemotherapy are more likely to have the cancer come back someplace in the body away from the breast (metastasize) and also are less likely to survive compared to women who start chemotherapy within 30 days of surgery.

The study was published online on Jan. 27, 2014 by the Journal of Clinical Oncology. Read the abstract of “Clinical Impact of Delaying Initiation of Adjuvant Chemotherapy in Patients With Breast Cancer.”

Doctors call treatments given after surgery adjuvant treatments.

For the study, the researchers reviewed the medical records of 6,827 women treated for early-stage breast cancer at the MD Anderson Cancer Center in Houston, Texas from 1997 to 2011. The women were followed for about 5 years after diagnosis:

  • about 85% of the women were diagnosed with stage I or stage II disease
  • about 15% of the women were diagnosed with stage III disease
  • about 40% of the women started chemotherapy within 30 days after surgery
  • about 44% of the women started chemotherapy 31 to 60 days after surgery
  • about 16% of the women started chemotherapy 61 or more days after surgery

Overall, women who started chemotherapy 61 or more days after surgery were 19% less likely to survive than women who started chemotherapy within 30 days after surgery.

In women diagnosed with stage III breast cancer, this difference was even larger: Women diagnosed with stage III disease who waited 61 or more days were 76% less likely to survive than women diagnosed with stage III disease who started chemotherapy within 30 days after surgery.

Women diagnosed with stage II disease were about 20% less likely to survive if they started chemotherapy more than 30 days after surgery compared to women with stage II disease who started chemotherapy within 30 days after surgery.

Women diagnosed with HER2-positive breast cancer who started Herceptin within 30 days after surgery were 75% more likely to survive than women diagnosed with HER2-positive disease who started Herceptin 61 or more days after surgery.

Women diagnosed with triple-negative breast cancer who started chemotherapy within 30 days after surgery were 52% more likely to survive than women diagnosed with triple-negative disease who started chemotherapy 61 or more days after surgery. Triple-negative breast cancer is breast cancer that is estrogen-receptor-negative, progesterone-receptor-negative, and HER2-negative. Triple-negative cancers usually are more aggressive, harder to treat, and more likely to come back than cancers that are hormone-receptor-positive and/or HER2-positive.

If you’ve been diagnosed with breast cancer, it makes sense to take the time to do some research to make sure your diagnosis is correct and your treatment plan makes sense. But this study strongly suggests it also makes sense to start chemotherapy within 30 days of surgery, especially if you’ve been diagnosed with breast cancer that is HER2-positive, triple-negative, or stage III.

If you don’t have insurance or are unemployed, you may be considering delaying chemotherapy because you’re worried about how you’ll pay for it. Don’t panic and don’t skip any doctor’s visits or delay chemotherapy. Your life may depend on it. There are resources available to help you.

Someone at your doctor’s office may be able to give you a list of organizations that offer financial assistance for breast cancer treatments and care, as well as local organizations that offer financial assistance for your practical needs, such as transportation, food, and child care.

Also, many hospitals now include patient navigators as part of the breast cancer care team. A patient navigator can help you understand and move through the health care and insurance systems. Patient navigators also can help overcome language and cultural barriers, as well as any biases based on culture, race, or age and can help you and your doctor communicate better. Ask your doctor or nurse for a patient navigator recommendation.

There is only one of you and you deserve the best care possible, given in a timely manner. Don’t let any obstacles get in the way of your treatment!

For more information on how you can get financial help, visit the Breastcancer.org Paying for Your Care pages.


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