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Delaying Chemotherapy More Than 120 Days After Diagnosis Linked to Worse Survival for Early-Stage Breast Cancer

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If chemotherapy after surgery is part of a woman’s recommended treatment plan for early-stage breast cancer, chemo should be started within 4 months of diagnosis because waiting longer is linked to worse overall survival, a study suggests.

The research was published online on July 22, 2019, by the Annals of Surgical Oncology. Read the abstract of “Effect of Surgery Type on Time to Adjuvant Chemotherapy and Impact of Delay on Breast Cancer Survival: A National Database Analysis.”

Overall survival is how long a person lives, whether or not the cancer comes back.

About the study

According to the scientists who did the study, earlier research suggests that timeliness in breast cancer care affects outcomes. Still, they pointed out that few guidelines recommend time points for treatment combinations.

To do the study, the researchers looked at the records of 172,043 women diagnosed with stage I to stage III breast cancer between 2010 and 2014 who were treated with both surgery and chemotherapy after surgery. Doctors call treatments given after surgery adjuvant treatments.

The records came from the National Cancer Database, a database with information on more than 70% of newly diagnosed cancer cases in the United States maintained by the American College of Surgeons and the American Cancer Society.

The researchers defined a delay in chemotherapy as chemotherapy that started more than 120 days after a breast cancer diagnosis.

The researchers then analyzed overall survival for women who started chemotherapy within 120 days of diagnosis and women who started chemotherapy more than 120 days after diagnosis. The researchers also looked to see if the type of breast cancer surgery affected when a woman started chemotherapy.

Overall, 89.5% of the women in the study started chemotherapy within 120 days of diagnosis. This means about 11% of the women started chemotherapy more than 120 days after being diagnosed.

Women who had lumpectomy generally had a shorter time between diagnosis and surgery — about 25 days — compared to women who had mastectomy, who had about 29 days between diagnosis and surgery.

Women who had mastectomy with no reconstruction had about 26 days between diagnosis and surgery, and women who had mastectomy with reconstruction had about 35 days between diagnosis and surgery.

The researchers’ analysis showed that starting chemotherapy more than 120 days after diagnosis was mostly due to a longer time between diagnosis and the first breast cancer surgery. Still, the researchers adjusted for differences in treatments and patients and found that the type of breast cancer surgery did not affect the time between surgery and starting chemotherapy.

The researchers’ analysis also found that no matter the type of surgery a woman had, starting chemotherapy more than 120 days after diagnosis was linked to worse overall survival.

"Our study findings confirm that timely care is important for breast cancer patients and should be considered in their treatment plan," said Judy Boughey, M.D., professor of surgery and vice chair for research at the Mayo Clinic, who was the senior author of the study. "It is … encouraging that 89% of women who are recommended chemotherapy postoperatively do get it within 120 days of their diagnosis, but there is still room for improvement."

The researchers recommended that hospitals evaluate the time from breast cancer diagnosis to breast cancer surgery to see if the time can be shortened.

What this means for you

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 120 days of a breast cancer diagnosis.

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 Paying for Your Care pages.

To talk with others about chemotherapy treatment, join the forum Chemotherapy - Before, During, and After.

Written by: Jamie DePolo, senior editor

Reviewed by: Brian Wojciechowski, M.D., medical adviser

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