Research from Cleveland Clinic in the U.S. and Cleveland Clinic Abu Dhabi in the UAE has found a decrease in patient survival rates when treatment options – surgery, chemotherapy, and radiation – are completed more than 38 weeks from the time of diagnosis.
The observational study, which included more than 28,000 breast cancer patients registered in the American National Cancer Database, found the treatment duration of less than 38 weeks was associated with a higher five-year survival – 89.9 per cent compared to the 83.3 per cent in the greater than 38 weeks treatment duration. This builds on previous research that noted poorer outcomes when there was a delay in time to treatment initiation, although time to treatment completion was not assessed in these studies.
Study findings indicated that patient survival did not differ based on receptor status. Patients receiving neoadjuvant chemotherapy were more likely to take longer than 38 weeks for completion of all acute treatment than patients receiving surgery first, suggesting that such a strategy may reduce the patient outcome.
The preoperative evaluation of breast cancer patients has become increasingly complex, and delays have the potential to occur at multiple time points. Times between abnormal mammogram and biopsy, MRI assessment, genetic testing, fertility consults, multidisciplinary care with plastic surgery consultations, combined surgical scheduling, preadmission testing, cardiac clearance, and metastatic survey are all potential sources of delay.
Understanding patient data
The study’s authors point out that further study is needed to identify the causes for the delay before changes can be made to improve the coordination and efficiency of breast cancer care.
According to Debra Pratt M.D., director of the Breast Center at Cleveland Clinic Fairview Hospital, and the lead author of the study: “One of the data points missing in our study was the last day of chemotherapy for these patients, so we could not determine where the majority of delays occurred. One of my hopes is to look at our patients’ data to know where the challenges lie and how we can fix them.”
Ultimately, troubleshooting treatment delays will improve the efficiency of multimodality breast cancer treatment and boost optimal breast cancer patient outcomes on tumour receptor phenotype, undergoing all three treatment modalities.