Race/Ethnicity, Delay of Adjuvant Chemotherapy Initiation Following Breast Cancer Surgery and Associated Patient Survival: An Analysis of the United States National Cancer Database 2004-2016
Year: 2021
Type: preprint
Study design: Observational Study
Abstract: Introduction: The relationship between survival and time to the start of adjuvant chemotherapy (AC) among breast cancer patients is unclear. Most breast cancer patients start adjuvant chemotherapy within a few weeks after surgery, but it is still unclear whether a delay in the initiation of chemotherapy will lead to adverse outcomes.Methods: Women diagnosed between 2004 and 2016 with invasive breast cancer (stages I-III) and treated with surgery and adjuvant chemotherapy were selected from the National Cancer Database (n= 443,100). We evaluated factors associated with prolonged time to start adjuvant chemotherapy (≥60, ≥90, and ≥120 days after surgical resection) using multivariable log binomial models to estimate risk ratios (RRs) and 95% CIs. Cox proportional hazards model was used to investigate the effect of delay on survival.Results: The average time to adjuvant chemotherapy was 47.93 days (±29.17 days). Non-Hispanic African American patients had higher risk of 60-day delay (RR, 1.41; 95% CI, 1.38 to 1.43), 90-day delay (RR, 1.55; 95% CI, 1.50 to 1.60), and 120-day delay (RR, 1.69; 95% CI, 1.61 to 1.78) compared with non-Hispanic white patients. Early initiation of chemotherapy, less than 1 month (RR, 0.893; 95% CI, 0.86 to 0.92), 1-2 month (RR, 0.80; 95% CI, 0.77 to 0.82), and 2-3 month (RR, 0.87; 95% CI, 0.84 to 0.90); was associated with decreased overall mortality. Non-Hispanic African Americans (RR, 1.16; 95% CI, 1.13 to 1.19) were associated with increased overall mortality compared to non-Hispanic whites. Conclusion: Black breast cancer patients experience clinically relevant delays in the initiation of adjuvant chemotherapy more often than white patients, which may in part explain the increased mortality observed among black patients. Efforts should be made to reduce the time to surgery when possible to enhance overall survival.
Source: Research Square
Institution: University of Virginia
Language: English
Subfield: Cancer Research
Domain: Life Sciences
Open Access status: green
OpenAlex ID: W3167325624