Timing May Be Key to Success of Surgery, Chemo for Early Breast Cancer

Scheduling the operation soon as possible after diagnosis seems to raise odds for survival, study finds

Thursday, December 10, 2015

THURSDAY, Dec. 10, 2015 (HealthDay News) -- The sooner early stage breast cancer patients have surgery following their diagnosis, and chemotherapy after their surgery, the better their chances of survival, two new studies find.

In one study, researchers at Fox Chase Cancer Center in Philadelphia analyzed data from more than 94,500 American women aged 66 and older. All were diagnosed with breast cancer between 1992 and 2009.

The team, led by Dr. Richard Bleicher, found a 9 percent increased risk of death from all causes for each 30-day delay in the time from diagnosis to surgery.

The link between time to surgery and risk of death from all causes was only statistically significant for patients with earlier stages of cancer, the researchers noted. In the study, delays seemed to affect prognosis for patients with stage 1 and stage 2 cancers, but not for those with stage 3 cancers.

The findings were similar when Bleicher's team conducted a second analysis of data involving more than 115,700 American women age 18 and older, who were diagnosed with breast cancer between 2003 and 2005.

Even after adjusting for a number of other factors, a longer time to surgery was still associated with increased risk of death, the researchers found.

This is "the most comprehensive study of the subject ever performed, and includes two extraordinarily large groups from two of the largest cancer databases in the United States," Bleicher, associate professor of surgical oncology, said in a Fox Chase news release. "The findings from the analysis answer a question that nearly every patient asks: 'Will my prognosis be affected by the time it takes me to get to surgery?'"

Long delays were rare: Only 1.2 percent of patients in the first analysis and 1.5 of those in the second analysis had surgery more than 90 days after their breast cancer diagnosis, the researchers noted.

In a second study, researchers at the University of Texas MD Anderson Cancer Center in Houston tracked outcomes for almost 25,000 patients in California who were diagnosed with invasive breast cancer (stages 1 to 3).

The researchers wanted to see if survival was affected by the time elapsed between breast cancer surgery and the initiation of follow-up chemotherapy.

The women averaged 53 years of age and the median time to chemotherapy after their breast cancer surgery was 43 days, reported a team led by Dr. Mariana Chavez-MacGregor.

The researchers found no differences in outcomes for patients whose chemotherapy began anywhere between 31 days and 90 days after their surgery.

However, women whose post-op chemo started 91 days or longer after their surgery did fare worse. Those women had a 34 percent higher odds for death from any cause, and a 27 percent higher risk for death linked to breast cancer, compared to women whose chemo started sooner, the researchers said.

"Given the results of our analysis, we would suggest that all breast cancer patients that are candidates for adjuvant chemotherapy should receive this treatment within 91 days of surgery or 120 days from diagnosis," Chavez-MacGregor and colleagues wrote.

"Administration of chemotherapy within this frame is feasible in clinical practice under most clinical scenarios, and as medical oncologists, we should make every effort not to delay the initiation of adjuvant chemotherapy," they added.

Both studies were published Dec. 10 in JAMA Oncology.

Experts in breast cancer care agreed that timing is important to patient outcomes.

"Though these two studies are retrospective, and not the highest level of evidence, they nonetheless support the notion that delays of beyond 30 days in both time to surgery and time to adjuvant chemotherapy after breast surgery -- especially in women with triple negative breast cancer -- should be kept to a minimum as much as possible," said Dr. Charles Shapiro, director of Translational Breast Cancer Research at Mount Sinai Health System in New York City.

Another expert said that a patient's medical team must work together to ensure that treatments occur in a timely manner.

"The best way to treat breast cancer is with a team approach," said Dr. Frank Monteleone, chief of breast services and director of the Breast Health Center at Winthrop-University Hospital in Mineola, N.Y.

"Radiologists, breast surgeons, radiation oncologists and medical oncologists need to work together to ensure that the time between diagnosis, surgery and oncology treatment is done in the quickest time possible," he said. "Also important is a supportive staff, including nurse navigators and social workers, to identify and reduce or eliminate barriers that will delay patients from receiving the care they need."

Dr. Lauren Cassell, chief of breast surgery at New York City's Lenox Hill Hospital, agreed. "There's nothing wrong with a little helping hand in navigating the process, particularly for a patient who may be overwhelmed by her diagnosis," she said.

SOURCES: Lauren Cassell, M.D., chief, breast surgery, Lenox Hill Hospital, New York City; Frank Monteleone, M.D., chief, breast services and director, Breast Health Center, Winthrop-University Hospital, Mineola, N.Y.; Charles L. Shapiro, M.D., director, Translational Breast Cancer Research, Mount Sinai Health System, New York City; Fox Chase Cancer Center, news release, Dec. 10, 2015;JAMA Oncology, news release, Dec. 10, 2015

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