Delaying Chemotherapy More Than 30 Days Linked to Worse Outcomes for Triple-Negative Breast Cancer

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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 people delay treatment for a number of reasons, including cost and scheduling. But if treatment is delayed too long it can affect outcomes.

A study has found that people diagnosed with early-stage, triple-negative breast cancer who waited more than 30 days after surgery to start chemotherapy had a higher risk of recurrence (the cancer coming back) and worse survival than people who started treatment within 30 days after surgery.

The research was presented on Dec. 5, 2018, at the San Antonio Breast Cancer Symposium. Read the abstract of “Impact of the delayed initiation of adjuvant chemotherapy in the outcomes of triple negative breast cancer.”

Watch Marisa Weiss, M.D., chief medical officer of Breastcancer.org, discuss the study results and what they mean for you.

About the study

In the study, which was done in Lima, Peru, the researchers looked at the records of 687 people diagnosed with early-stage, triple-negative breast cancer:

  • The ages of the people in the study ranged from 21 to 89; the average age was 49.15.
  • About 60% were diagnosed with stage II triple-negative disease.
  • About 30% were diagnosed with stage III triple-negative disease.

All the people in the study were scheduled to have chemotherapy after surgery:

  • 189 people started chemotherapy 30 or fewer days after surgery
  • 329 people started chemotherapy 31 to 60 days after surgery
  • 115 people started chemotherapy 61 to 90 days after surgery
  • 54 people started chemotherapy more than 90 days after surgery

As the time increased before chemotherapy was started, the 10-year disease-free survival rate decreased. Disease-free survival is how long the people lived without a breast cancer recurrence. Ten-year disease-free survival rates were:

  • 81.4% for people who started chemotherapy within 30 days of surgery
  • 68.6% for people who started chemotherapy 31 to 60 days after surgery
  • 70.8% for people who started chemotherapy 61 to 90 days after surgery
  • 68.1% for people who started chemotherapy more than 90 days after surgery

Effect on risk of breast cancer recurrence

The researchers then looked to see how a delay in chemotherapy affected the risk of cancer recurrence and survival.

Compared to people who started chemotherapy within 30 days of surgery, the risk of recurrence was increased:

  • 92% for people who started chemotherapy 31 to 60 days after surgery
  • 138% for people who started chemotherapy 61 to 90 days after surgery
  • 147% for people who started chemotherapy more than 90 days after surgery

Effect on survival

Similarly, a longer delay in starting chemotherapy was linked to a higher risk of dying from breast cancer. Compared to people who started chemotherapy within 30 days after surgery, the risk of death was increased:

  • 94% for people who started chemotherapy 31 to 60 days after surgery
  • 145% for people who started chemotherapy 61 to 90 days after surgery
  • 179% for people who started chemotherapy more than 90 days after surgery

“Our data show that it must be a priority for patients with triple-negative breast cancer to begin adjuvant chemotherapy within 30 days of completing surgery,” said Zaida Morante, M.D., medical oncologist at Instituto Nacional de Enfermedades Neopláicas in Lima, Peru. “After this period of time, the benefit of the chemotherapy is significantly diminished.”

The researchers didn’t report why most of the people in the study started chemotherapy more than 30 days after surgery.

How to get timely treatment

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 is right for you. But this and other studies strongly suggest it also makes sense to start chemotherapy within 30 days of surgery if you’ve been diagnosed with early-stage, triple-negative breast cancer.

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 healthcare 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.

To talk with others who have been diagnosed with triple-negative breast cancer, join the Breastcancer.org Discussion Board forum Triple-Negative Breast Cancer. Or, if you'd like to discuss chemotherapy treatment, join the forum Chemotherapy - Before, During, and After.

Written by: Jamie DePolo, senior editor


Lilly Oncology

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