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Scodari BT, Schaefer AP, Kapadia NS, Brooks GA, O'Malley AJ, Moen EL. The Association Between Oncology Outreach and Timely Treatment for Rural Patients with Breast Cancer: A Claims-Based Approach. Ann Surg Oncol 2024; 31:4349-4360. [PMID: 38538822 PMCID: PMC11176015 DOI: 10.1245/s10434-024-15195-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/05/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Oncology outreach is a common strategy for increasing rural access to cancer care, where traveling oncologists commute across healthcare settings to extend specialized care. Examining the extent to which physician outreach is associated with timely treatment for rural patients is critical for informing outreach strategies. METHODS We identified a 100% fee-for-service sample of incident breast cancer patients from 2015 to 2020 Medicare claims and apportioned them into surgery and adjuvant therapy cohorts based on treatment history. We defined an outreach visit as the provision of care by a traveling oncologist at a clinic outside of their primary hospital service area. We used hierarchical logistic regression to examine the associations between patient receipt of preoperative care at an outreach visit (preoperative outreach) and > 60-day surgical delay, and patient receipt of postoperative care at an outreach visit (postoperative outreach) and > 60-day adjuvant delay. RESULTS We identified 30,337 rural-residing patients who received breast cancer surgery, of whom 4071 (13.4%) experienced surgical delay. Among surgical patients, 14,501 received adjuvant therapy, of whom 2943 (20.3%) experienced adjuvant delay. In adjusted analysis, we found that patient receipt of preoperative outreach was associated with reduced odds of surgical delay (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.61-0.91); however, we found no association between patient receipt of postoperative outreach and adjuvant delay (OR 1.04, 95% CI 0.85-1.25). CONCLUSIONS Our findings indicate that preoperative outreach is protective against surgical delay. The traveling oncologists who enable such outreach may play an integral role in catalyzing the coordination and timeliness of patient-centered care.
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Affiliation(s)
- Bruno T Scodari
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Andrew P Schaefer
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | - Nirav S Kapadia
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
- Dartmouth Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Gabriel A Brooks
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
- Dartmouth Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - A James O'Malley
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
- Dartmouth Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Erika L Moen
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.
- Dartmouth Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
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Smith RE, Sprague BL, Henderson LM, Kerlikowske K, Miglioretti DL, Wernli KJ, Onega T, diFlorio-Alexander RM, Tosteson ANA. Breast density knowledge and willingness to delay treatment for pre-operative breast cancer imaging among women with a personal history of breast cancer. Breast Cancer Res 2024; 26:73. [PMID: 38685119 PMCID: PMC11057127 DOI: 10.1186/s13058-024-01820-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/04/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Following a breast cancer diagnosis, it is uncertain whether women's breast density knowledge influences their willingness to undergo pre-operative imaging to detect additional cancer in their breasts. We evaluated women's breast density knowledge and their willingness to delay treatment for pre-operative testing. METHODS We surveyed women identified in the Breast Cancer Surveillance Consortium aged ≥ 18 years, with first breast cancer diagnosed within the prior 6-18 months, who had at least one breast density measurement within the 5 years prior to their diagnosis. We assessed women's breast density knowledge and correlates of willingness to delay treatment for 6 or more weeks for pre-operative imaging via logistic regression. RESULTS Survey participation was 28.3% (969/3,430). Seventy-two percent (469/647) of women with dense and 11% (34/322) with non-dense breasts correctly knew their density (p < 0.001); 69% (665/969) of all women knew dense breasts make it harder to detect cancers on a mammogram; and 29% (285/969) were willing to delay treatment ≥ 6 weeks to undergo pre-operative imaging. Willingness to delay treatment did not differ by self-reported density (OR:0.99 for non-dense vs. dense; 95%CI: 0.50-1.96). Treatment with chemotherapy was associated with less willingness to delay treatment (OR:0.67; 95%CI: 0.46-0.96). Having previously delayed breast cancer treatment more than 3 months was associated with an increased willingness to delay treatment for pre-operative imaging (OR:2.18; 95%CI: 1.26-3.77). CONCLUSIONS Understanding of personal breast density was not associated with willingness to delay treatment 6 or more weeks for pre-operative imaging, but aspects of a woman's treatment experience were. CLINICALTRIALS GOV : NCT02980848 registered December 2, 2016.
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Affiliation(s)
- Rebecca E Smith
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, 1 Medical Center Dr. WTRB Level 5, Hinman Box 7251, NH 03756, Lebanon, NH, USA.
| | - Brian L Sprague
- Department of Surgery, University of Vermont Cancer Center, University of Vermont, Burlington, VT, USA
| | - Louise M Henderson
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karla Kerlikowske
- Departments of Medicine, and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Diana L Miglioretti
- Department of Public Health Sciences, University of California, Davis, CA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Tracy Onega
- Department of Population Health Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Roberta M diFlorio-Alexander
- Radiology Department, Dartmouth Health and Geisel School of Medicine at Dartmouth Lebanon, Lebanon, NH, USA
- Dartmouth Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, 1 Medical Center Dr. WTRB Level 5, Hinman Box 7251, NH 03756, Lebanon, NH, USA
- Dartmouth Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Kameyama H, Dondapati P, Simmons R, Leslie M, Langenheim JF, Sun Y, Yi M, Rottschaefer A, Pathak R, Nuguri S, Fung KM, Tsaih SW, Chervoneva I, Rui H, Tanaka T. Needle biopsy accelerates pro-metastatic changes and systemic dissemination in breast cancer: Implications for mortality by surgery delay. Cell Rep Med 2023; 4:101330. [PMID: 38118415 PMCID: PMC10772461 DOI: 10.1016/j.xcrm.2023.101330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/14/2022] [Accepted: 11/17/2023] [Indexed: 12/22/2023]
Abstract
Increased breast cancer (BC) mortality risk posed by delayed surgical resection of tumor after diagnosis is a growing concern, yet the underlying mechanisms remain unknown. Our cohort analyses of early-stage BC patients reveal the emergence of a significantly rising mortality risk when the biopsy-to-surgery interval was extended beyond 53 days. Additionally, histology of post-biopsy tumors shows prolonged retention of a metastasis-permissive wound stroma dominated by M2-like macrophages capable of promoting cancer cell epithelial-to-mesenchymal transition and angiogenesis. We show that needle biopsy promotes systemic dissemination of cancer cells through a mechanism of sustained activation of the COX-2/PGE2/EP2 feedforward loop, which favors M2 polarization and its associated pro-metastatic changes but are abrogated by oral treatment with COX-2 or EP2 inhibitors in estrogen-receptor-positive (ER+) syngeneic mouse tumor models. Therefore, we conclude that needle biopsy of ER+ BC provokes progressive pro-metastatic changes, which may explain the mortality risk posed by surgery delay after diagnosis.
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Affiliation(s)
- Hiroyasu Kameyama
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 975 NE 10th St., Oklahoma City, OK 73104, USA
| | - Priya Dondapati
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 975 NE 10th St., Oklahoma City, OK 73104, USA
| | - Reese Simmons
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 975 NE 10th St., Oklahoma City, OK 73104, USA
| | - Macall Leslie
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 975 NE 10th St., Oklahoma City, OK 73104, USA
| | - John F Langenheim
- Department of Pharmacology, Physiology & Cancer Biology, Sidney Kimmel Cancer Center, Thomas Jefferson University, 233 S 10th St., BLSB 1008, Philadelphia, PA 19107, USA
| | - Yunguang Sun
- Department of Pathology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Misung Yi
- Division of Biostatistics, Department of Pharmacology, Physiology & Cancer Biology, Sidney Kimmel Cancer Center, Thomas Jefferson University, 233 S 10th St., BLSB 1008, Philadelphia, PA 19107, USA
| | - Aubrey Rottschaefer
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 975 NE 10th St., Oklahoma City, OK 73104, USA
| | - Rashmi Pathak
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 975 NE 10th St., Oklahoma City, OK 73104, USA
| | - Shreya Nuguri
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 975 NE 10th St., Oklahoma City, OK 73104, USA
| | - Kar-Ming Fung
- Department of Pathology, School of Medicine, University of Oklahoma Health Sciences Center, 940 Stanton L Young Boulevard, Oklahoma City, OK 73104, USA
| | - Shirng-Wern Tsaih
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Inna Chervoneva
- Division of Biostatistics, Department of Pharmacology, Physiology & Cancer Biology, Sidney Kimmel Cancer Center, Thomas Jefferson University, 233 S 10th St., BLSB 1008, Philadelphia, PA 19107, USA
| | - Hallgeir Rui
- Department of Pharmacology, Physiology & Cancer Biology, Sidney Kimmel Cancer Center, Thomas Jefferson University, 233 S 10th St., BLSB 1008, Philadelphia, PA 19107, USA
| | - Takemi Tanaka
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 975 NE 10th St., Oklahoma City, OK 73104, USA; Department of Pathology, School of Medicine, University of Oklahoma Health Sciences Center, 940 Stanton L Young Boulevard, Oklahoma City, OK 73104, USA.
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Bassiri A, Badrinathan A, Alvarado CE, Kwak M, Sinopoli J, Tapias Vargas L, Linden PA, Towe CW. Evaluating the Optimal Time Between Diagnosis and Surgical Intervention for Early-Stage Lung Cancer. J Surg Res 2023; 292:297-306. [PMID: 37683454 DOI: 10.1016/j.jss.2023.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/13/2023] [Accepted: 08/07/2023] [Indexed: 09/10/2023]
Abstract
INTRODUCTION There is no consensus on the optimal timing for lung cancer surgery. We aim to evaluate the impact of timing of surgical intervention. We hypothesize delay in intervention is associated with worse overall survival and higher pathologic upstaging in early-stage lung cancer. METHODS We identified patients with cT1/2N0M0 nonsmall cell lung cancer in the National Cancer Database from 2004 to 2018. Patients were categorized by time to surgery groups: early (<26 d), average (26-60 d), and delayed (61-365 d). Primary outcome was overall survival and secondary outcome was pathologic upstaging. Multivariate models and survival analyses were used to determine factors associated with time from diagnosis to surgery, pathologic upstaging, and overall survival. RESULTS In multivariate model, advanced age, non-Hispanic Black patients, nonprivate insurance, low median income and education, and treatment at low-volume facilities were less likely to undergo early intervention and compared to the average group were more likely to receive delayed intervention. Pathologic upstaging was more likely in the delayed group (odds ratio 1.11, 1.07-1.14) compared to early group (odds ratio 0.96, 0.93-0.99). Early intervention was associated with improved overall survival (hazard ratio 0.93, 0.91-0.95), while delayed intervention was associated with inferior survival (hazard ratio 1.11, 1.09-1.14). CONCLUSIONS Expeditious surgical intervention is associated with lower rates of pathologic upstaging and improved overall survival in early-stage lung cancer. Delays in surgery are associated with social and economic factors, suggesting disparities in access to surgery. Lung cancer surgery should be performed as quickly as possible to maximize oncologic outcomes.
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Affiliation(s)
- Aria Bassiri
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
| | - Avanti Badrinathan
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Christine E Alvarado
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Minyoung Kwak
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jillian Sinopoli
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Leonidas Tapias Vargas
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Philip A Linden
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Christopher W Towe
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Silva TS, Tavassoli M, Lee E, Annie Nguyen LA, Vu B, Sinjali K, Allison-Aipa T, Molina DC, Lum S. Timeliness of Multimodal Care for At-Risk Breast Cancer Patients at a Safety Net Institution. J Surg Res 2023; 291:367-373. [PMID: 37516043 DOI: 10.1016/j.jss.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 05/05/2023] [Accepted: 06/18/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION Because limited data exist, we sought to evaluate timeliness of multimodal treatments in a safety net breast cancer population. METHODS Breast cancer patients treated at a safety net hospital from 2016 to 2020 were analyzed retrospectively. Time intervals were defined as primary time (PT) from diagnosis to initiation of primary intervention, secondary time (ST) from completion of primary to initiation of secondary intervention, and tertiary time (TT) from completion of secondary to initiation of tertiary intervention. Variables included primary language, insurance type, and race. RESULTS Of 223 patients, 99 (44.4%) primarily spoke Spanish, 29 (13.0%) were of Black race, and 184 (82.5%) had Medicaid or uninsured status. Median (IQR) age at diagnosis was 55 (48-62) years. Primary intervention was surgical in 127/216 (58.8%); secondary intervention was systemic in 38/169 (22.5%); and tertiary intervention was radiation in 67/80 (83.8%). Overall, median days (IQR) for PT were 69 (53, 98), ST were 65 (42, 95), and TT were 69 (43, 88). PT was significantly longer in Black [105 (76, 142) days] patients compared to non-Hispanic White patients [68 (51, 107) days, P = 0.031)] and White Hispanic patients [65 (53,91) days, P = 0.014]. There were no significant differences in PT, ST, or TT by spoken language or insurance type. CONCLUSIONS Black patients remain at risk due to prolonged time to intervention. Spanish-speaking status was not associated with inferior timeliness or completion of multimodal care at a safety net hospital. Identifying safety net hospital barriers to achieving benchmarks for timely completion of all phases of multimodal care warrants further attention.
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Affiliation(s)
- Trevor S Silva
- Department of Surgery, Riverside University Health System, Moreno Valley, California
| | - Morvarid Tavassoli
- Department of Surgery, Riverside University Health System, Moreno Valley, California
| | - Esther Lee
- Department of Surgery, Riverside University Health System, Moreno Valley, California
| | - Lan-Anh Annie Nguyen
- Department of Surgery, Riverside University Health System, Moreno Valley, California
| | - Brandon Vu
- Department of Surgery, Riverside University Health System, Moreno Valley, California
| | - Kiran Sinjali
- Department of Radiology, Loma Linda University Health, Loma Linda, California
| | - Timothy Allison-Aipa
- Comparative Effectiveness and Clinical Outcomes Research Center (CECORC), Riverside University Health System, Moreno Valley, California
| | - David Caba Molina
- Department of Surgery, Riverside University Health System, Moreno Valley, California; Department of Surgery, Loma Linda University Health, Loma Linda, California
| | - Sharon Lum
- Department of Surgery, Riverside University Health System, Moreno Valley, California; Department of Surgery, Loma Linda University Health, Loma Linda, California.
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Lee YJ, Jeong JH, Jung J, Yoo TK, Lee SB, Kim J, Ko BS, Kim HJ, Lee JW, Son BH, Chung IY. Waiting Time for Breast Cancer Treatment in Korea: A Nationwide Cohort Study. J Breast Cancer 2023; 26:334-343. [PMID: 37565927 PMCID: PMC10475710 DOI: 10.4048/jbc.2023.26.e26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/14/2023] [Accepted: 05/14/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE This study aimed to analyze the waiting time for initial treatment after breast cancer diagnosis and determine the factors influencing treatment delay in South Korea. METHODS This nationwide retrospective cohort study was conducted using the Health Insurance Review and Assessment data. The participants were classified according to the regions where their biopsy and treatment were performed (Seoul-Seoul, Metro-Metro, Other-Other, Metro-Seoul, Other-Seoul). Waiting time was analyzed according to regional subgroup, year of diagnosis, and type of treatment. Multivariable logistic regression models were constructed to identify the factors associated with treatment delay (after 30 days of diagnosis). RESULTS A total of 133,514 participants newly diagnosed between January 2010 and December 2017 were included in the study. The median waiting time for initial treatment in the total population increased from 8 days, in 2010, to 14 days, in 2017. In the Seoul-Seoul group, the waiting time increased from 10 days, in 2010, to 16 days, in 2017. Although the median waiting time was approximately 10 days in the Metro-Metro and Other-Other groups, it was 27 and 24 days, in the Metro-Seoul and Other-Seoul group, respectively, in 2017. The proportion of delayed upfront surgery by more than 30 days was higher in the Metro-Seoul (odds ratio [OR], 8.088; 95% confidence interval [CI], 7.357-8.893; p < 0.001) and Other-Seoul (OR, 6.210; 95% CI, 5.717-6.750; p < 0.001) groups than in the Metro-Metro (OR, 1.468; 95% CI, 1.352-1.594; p < 0.001) and Other-Other (reference) groups. Previous medical history and treatment at tertiary hospital were observed as factors related to delayed surgery. CONCLUSION Waiting times for breast cancer surgery have increased across all regions of Korea, with those traveling to Seoul experiencing particularly long wait times.
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Affiliation(s)
- Young-Jin Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Ho Jeong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinhong Jung
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Kyung Yoo
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sae Byul Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jisun Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Beom Seok Ko
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Jeong Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Won Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Ho Son
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Il Yong Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Zhu S, Li S, Huang J, Fei X, Shen K, Chen X. Time interval between breast cancer diagnosis and surgery is associated with disease outcome. Sci Rep 2023; 13:12091. [PMID: 37495705 PMCID: PMC10372101 DOI: 10.1038/s41598-023-39259-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/22/2023] [Indexed: 07/28/2023] Open
Abstract
Time interval between breast cancer (BC) diagnosis and surgery is of concern to patients and clinicians, but its impact on survival remains unclear. We identified 5130 BC patients receiving surgery between 2009 and 2017 from the Shanghai Jiaotong University Breast Cancer Database (SJTU-BCDB), and divided as Ruijin cohort and SJTU cohort. All participants were divided into three groups according to the interval between diagnosis and surgery: ≤ 1 week, 1-2 weeks, and > 2 weeks. Among 3144 patients of Ruijin cohort, the estimated 5-year breast cancer-free interval (BCFI) rates for the ≤ 1 week, 1-2 weeks and > 2 weeks groups were 91.8%, 87.5%, and 84.0% (P = 0.088), and the estimated 5-year overall survival (OS) rates were 95.6%, 89.6%, and 91.5% (P = 0.002). Multivariate analysis showed that patients with a TTS > 2 weeks had significantly lower BCFI (HR = 1.80, 95%CI 1.05-3.11, P = 0.034) and OS (HR = 2.07, 95% CI 1.04-4.13, P = 0.038) rates than patients with a TTS ≤ 1 week. Among 5130 patients when combining Ruijin cohort with SJTU cohort, the estimated 5-year BCFI rates for the ≤ 1 week, 1-2 weeks, and > 2 weeks groups were 91.0%, 87.9%, and 78.9%, and the estimated 5-year OS rates for the ≤ 1 week, 1-2 weeks, and > 2 weeks groups were 95.8%, 90.6%, and 91.5%, both with a significantly p value < 0.001. Our findings demonstrated the prolonged time to surgery (more than 2 weeks) after BC diagnosis was associated with poor disease outcomes, suggesting that efforts to early initiate treatment after diagnosis need to be pursued where possible to improve survival.
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Affiliation(s)
- Siji Zhu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Shuai Li
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Jiahui Huang
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Xiaochun Fei
- Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Kunwei Shen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
| | - Xiaosong Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
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Abdel-Razeq H, Mansour A, Edaily S, Dayyat A. Delays in Initiating Anti-Cancer Therapy for Early-Stage Breast Cancer-How Slow Can We Go? J Clin Med 2023; 12:4502. [PMID: 37445537 DOI: 10.3390/jcm12134502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/26/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023] Open
Abstract
Breast cancer is the most commonly diagnosed cancer among women worldwide, and is a leading cause of cancer-related deaths. When diagnosed at an early stage, appropriate and timely treatment results in a high cure rate and better quality of life. Delays in initiating anti-cancer therapy, including surgical resection, adjuvant/neoadjuvant chemotherapy and radiation therapy are commonly encountered, even in developed health care systems. Existing comorbidities that mandate referral to other services, genetic counseling and testing that may dictate the extent and type of anti-cancer therapy and insurance coverage, are among the most commonly cited factors. However, delays can be unavoidable; for over three years, health care systems across the globe were busy dealing with the unprecedented COVID-19 pandemic. War across hot zones around the globe resulted in millions of refugees; most of them have no access to cancer care, and when/where available, there may be significant delays. Thus, cancer patients across the globe will probably continue to suffer from significant delays in diagnosis and appropriate treatment. Many retrospective reports showed significant negative impacts on different aspects of treatment outcomes and on patients' psychosocial wellbeing and productivity. In this paper, we review the available data on the impact of delays in initiating appropriate treatment on the outcomes of patients with early-stage breast cancer.
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Affiliation(s)
- Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Asem Mansour
- Department of Radiology, King Hussein Cancer Center, Amman 11941, Jordan
| | - Sarah Edaily
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan
| | - Abdulmajeed Dayyat
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11941, Jordan
- Department of Radiation Oncology, Dalhousie University, Halifax, NS B3H 4R2, Canada
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Pathak R, Leslie M, Dondapati P, Davis R, Tanaka K, Jett E, Chervoneva I, Tanaka T. Increased breast cancer mortality due to treatment delay and needle biopsy type: a retrospective analysis of SEER-medicare. Breast Cancer 2023:10.1007/s12282-023-01456-3. [PMID: 37130988 DOI: 10.1007/s12282-023-01456-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 03/20/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Substantial evidence indicates that delay of first treatment after diagnosis is associated with poorer survival outcomes in breast cancer. Accordingly, the Commission on Cancer introduced a quality measure for receipt of therapeutic surgery within 60 days of diagnostic biopsy for stage I-III breast cancer patients in the non-neoadjuvant setting. It is unknown, however, what may contribute to mortality associated with treatment delay. Therefore, we investigated whether biopsy type moderates the effect of the mortality risk posed by treatment delay. METHODS Retrospective analysis of 31,306 women with stage I-III breast cancer diagnosed between 2003 and 2013 selected from the SEER-Medicare database was performed to determine whether needle biopsy type [core needle biopsy (CNB) or vacuum-assisted biopsy (VAB)] impacts time to treatment (TTT)-associated survival outcomes. Multivariable Fine-Gray competing risk survival models, adjusted for inverse propensity score weights, were used to determine the association between biopsy type, TTT, and breast cancer-specific mortality (BCSM). RESULTS TTT ≥ 60 days was associated with 45% higher risk of BCSM (sHR = 1.45, 95% CI 1.24-1.69) compared to those with TTT < 60 days in stage I-III cases. Independent of TTT, CNB was associated with 28% higher risk of BCSM compared to VAB in stage II-III cases (sHR = 1.28, 95% CI 1.11-1.36), translating to a 2.7% and 4.0% absolute difference in BCSM at 5 and 10 years, respectively. However, in stage I cases, the BCSM risk was not associated with type of biopsy. CONCLUSIONS Our results suggest that treatment delay ≥ 60 days is independently associated with poorer survival outcomes in breast cancer patients. In stage II-III, CNB is associated with higher BCSM than VAB. However, type of biopsy does not underlie TTT-associated breast cancer mortality risk.
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Affiliation(s)
- Rashmi Pathak
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 975 NE 10th, BRC-W, Rm 1415, Oklahoma City, OK, 73104, USA
| | - Macall Leslie
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 975 NE 10th, BRC-W, Rm 1415, Oklahoma City, OK, 73104, USA
| | - Priya Dondapati
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 975 NE 10th, BRC-W, Rm 1415, Oklahoma City, OK, 73104, USA
| | - Rachel Davis
- Department of Surgery, University of Oklahoma Health Sciences Center, 975 NE 10th, Oklahoma City, OK, 73104, USA
| | - Kenichi Tanaka
- Department of Anesthesiology, University of Oklahoma Health Sciences Center, 920 SL Young Blvd, WP1140, Oklahoma City, OK, 73104, USA
| | - Elizabeth Jett
- Department of Radiology, University of Oklahoma Health Sciences Center, 800 SL Young Blvd, Oklahoma City, OK, 73104, USA
| | - Inna Chervoneva
- Department of Pharmacology, Physiology and Cancer Biology, Division of Biostatistics, Thomas Jefferson University, 130 S. 9th Street, 17th Floor, Philadelphia, PA, 19107, USA.
| | - Takemi Tanaka
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 975 NE 10th, BRC-W, Rm 1415, Oklahoma City, OK, 73104, USA.
- Department of Pathology, University of Oklahoma Health Sciences Center, 975 NE 10th, Oklahoma City, OK, 73104, USA.
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10
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Sargent RE, Schellenberg M, Owattanapanich N, Chen A, Chen E, Sener SF, Inaba K. Urgent Breast-Related Consults Seen by Acute Care Surgery at a Safety Net Hospital. Am Surg 2023; 89:1574-1579. [PMID: 34978482 DOI: 10.1177/00031348211068011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
Abstract
BACKGROUND Classically, urgent breast consults are seen by Breast Surgery or Surgical Oncology (BS/SO). At our safety net hospital, Acute Care Surgery (ACS) performs all urgent surgical consultations, including initial assessment of breast consults with coordinated BS/SO follow-up. The objective was to determine safety of ACS initial assessment of acute breast pathology. METHODS All urgent breast-related consultations were included (2016-2019). Demographics, consult indications, and investigations/interventions were captured. Outcomes were compared between patients assessed by ACS versus both ACS and BS/SO at presentation. RESULTS 234 patients met study criteria, with median age 39 years. Patients were primarily Hispanic (82%) women (96%). Most were not seen by BS/SO at presentation (69%), although BS/SO assessment was more frequent among patients ultimately diagnosed with cancer (8% vs 1%, P = .012). No patient had delay >90 days to core biopsy from presentation. Outcomes including time to cancer diagnosis (14 vs 8 days, P = .143) and outpatient BS/SO assessment (16 vs 13 days, P = .528); loss to follow-up (25% vs 21%, P = .414); and ED recidivism (24% vs 18%, P = .274) were comparable between patients seen by ACS versus ACS/BS/SO at index presentation. CONCLUSION Urgent breast consults at our safety net hospital typically underwent initial assessment by ACS with outpatient evaluation by BS/SO. Time to follow-up and cancer diagnosis, loss to follow-up, and ED recidivism were similar after index presentation assessment by ACS versus ACS and BS/SO. In a resource-limited environment, urgent breast consults can be safely managed in the acute setting by ACS with coordinated outpatient BS/SO follow-up.
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Affiliation(s)
- Rachel E Sargent
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
- Division of Surgical Oncology, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Morgan Schellenberg
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Natthida Owattanapanich
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Allen Chen
- Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Eric Chen
- Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Stephen F Sener
- Division of Surgical Oncology, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Kenji Inaba
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
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11
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Wiener AA, Hanlon BM, Schumacher JR, Vande Walle KA, Wilke LG, Neuman HB. Reexamining Time From Breast Cancer Diagnosis to Primary Breast Surgery. JAMA Surg 2023; 158:485-492. [PMID: 36857045 PMCID: PMC9979003 DOI: 10.1001/jamasurg.2022.8388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/27/2022] [Indexed: 03/02/2023]
Abstract
Importance Although longer times from breast cancer diagnosis to primary surgery have been associated with worse survival outcomes, the specific time point after which it is disadvantageous to have surgery is unknown. Identifying an acceptable time to surgery would help inform patients, clinicians, and the health care system. Objective To examine the association between time from breast cancer diagnosis to surgery (in weeks) and overall survival and to describe factors associated with surgical delay. The hypothesis that there is an association between time to surgery and overall survival was tested. Design, Setting, and Participants This was a case series study that used National Cancer Database (NCDB) data from female individuals diagnosed with breast cancer from 2010 to 2014 (with 5-year follow-up to 2019). The NCDB uses hospital registry data from greater than 1500 Commission on Cancer-accredited facilities, accounting for 70% of all cancers diagnosed in the US. Included participants were females 18 years or older with stage I to III ductal or lobular breast cancer who underwent surgery as the first course of treatment. Patients with prior breast cancer, missing receptor information, neoadjuvant or experimental therapy, or who were diagnosed with breast cancer on the date of their primary surgery were excluded. Multivariable Cox regression was used to evaluate factors associated with overall survival. Patients were censored at death or last follow-up. Covariates included age and tumor characteristics. Multinomial regression was performed to identify factors associated with longer time to surgery, using surgery 30 days or less from diagnosis as the reference group. Data were analyzed from March 15 to July 7, 2022. Exposures Time to receipt of primary breast surgery. Measures The primary outcome measure was overall survival. Results The final cohort included 373 334 patients (median [IQR] age, 61 [51-70] years). On multivariable Cox regression analysis, time to surgery 9 weeks (57-63 days) or later after diagnosis was associated with worse overall survival (hazard ratio, 1.15; 95% CI, 1.08-1.23; P < .001) compared with surgery between 0 to 4 weeks (1-28 days). By multinomial regression, factors associated with longer times to surgery (using surgery 1-30 days from diagnosis as a reference) included the following: (1) younger age, eg, the adjusted odds ratio (OR) for patients 45 years or younger undergoing surgery 31 to 60 days from diagnosis was 1.32 (95% CI, 1.28-1.38); 61 to 74 days, 1.64 (95% CI, 1.52-1.78); and greater than 74 days, 1.58 (95% CI, 1.46-1.71); (2) uninsured or Medicaid status, eg, the adjusted OR for patients with Medicaid undergoing surgery 31 to 60 days from diagnosis was 1.35 (95% CI, 1.30-1.39); 61 to 74 days, 2.13 (95% CI, 2.01-2.26); and greater than 74 days, 3.42 (95% CI, 3.25-3.61); and (3) lower neighborhood household income, eg, the adjusted OR for patients with household income less than $38,000 undergoing surgery 31 to 60 days from diagnosis was 1.35 (95% CI, 1.02-1.07); 61 to 74 days, 1.21 (95% CI, 1.15-1.27); and greater than 74 days, 1.53 (95% CI, 1.46-1.61). Conclusions and Relevance Findings of this case series study suggest the use of 8 weeks or less as a quality metric for time to surgery. Time to surgery of greater than 8 weeks may partly be associated with disadvantageous social determinants of health.
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Affiliation(s)
- Alyssa A. Wiener
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
| | - Bret M. Hanlon
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Jessica R. Schumacher
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
- University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison
| | - Kara A. Vande Walle
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
| | - Lee G. Wilke
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
- University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison
| | - Heather B. Neuman
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
- University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison
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12
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Egleston BL, Bleicher RJ, Fang CY, Galloway TJ, Vucetic S. Benefits versus drawbacks of delaying surgery due to additional consultations in older patients with breast cancer. Cancer Rep (Hoboken) 2023; 6:e1805. [PMID: 36943210 PMCID: PMC10172180 DOI: 10.1002/cnr2.1805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/24/2023] [Accepted: 03/01/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Additional evaluations, including second opinions, before breast cancer surgery may improve care, but may cause detrimental treatment delays that could allow disease progression. AIMS We investigate the timing of surgical delays that are associated with survival benefits conferred by preoperative encounters versus the timing that are associated with potential harm. METHODS AND RESULTS We investigated survival outcomes of SEER Medicare patients with stage 1-3 breast cancer using propensity score-based weighting. We examined interactions between the number of preoperative evaluation components and time from biopsy to definitive surgery. Components include new patient visits, unique surgeons, medical oncologists, or radiation oncologists consulted, established patient encounters, biopsies, and imaging studies. We identified 116 050 cases of whom 99% were female and had an average age of 75.0 (SD = 6.2). We found that new patient visits have a protective association with respect to breast cancer mortality if they occur quickly after diagnosis with breast cancer mortality subdistribution Hazard Ratios [sHRs] = 0.87 (95% Confidence Interval [CI] 0.76-1.00) for 2, 0.71 (CI 0.55-0.92) for 3, and 0.63 (CI 0.37-1.07) for 4+ visits at minimal delay. New patient visits predict worsened mortality compared with no visits if the surgical delay is greater than 33 days (CI 14-53) for 2, 33 days (CI 17-49) for 3, and 44 days (CI 12-75) for 4+. Medical oncologist visits predict worse outcomes if the surgical delay is greater than 29 days (CI 20-39) for 1 and 38 days (CI 12-65) for 2+ visits. Similarly, surgeon encounters switch from a positive to a negative association if the surgical delay exceeds 29 days (CI 17-41) for 1 visit, but the positive estimate persists over time for 3+ surgeon visits. CONCLUSION Preoperative visits that cause substantial delays may be associated with increased mortality in older patients with breast cancer.
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Affiliation(s)
- Brian L. Egleston
- Biostatistics and Bioinformatics Facility, Fox Chase Cancer CenterTemple University Health System333 Cottman AvenuePhiladelphiaPennsylvania19111USA
| | - Richard J. Bleicher
- Department of Surgical Oncology, Fox Chase Cancer CenterTemple University Health System333 Cottman AvenuePhiladelphiaPennsylvania19111USA
| | - Carolyn Y. Fang
- Cancer Prevention and Control Program, Fox Chase Cancer CenterTemple University Health System333 Cottman AvenuePhiladelphiaPennsylvania19111USA
| | - Thomas J. Galloway
- Department of Radiation Oncology, Fox Chase Cancer CenterTemple University Health System333 Cottman AvenuePhiladelphiaPennsylvania19111USA
| | - Slobodan Vucetic
- Department of Computer and Information SciencesTemple University1925 N. 12th St., 314 SERCPhiladelphiaPennsylvania19122USA
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13
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Sbrocchi T, Kavanagh K, Chao AH. Optimizing the Timeliness of Surgical Therapy in Patients with Breast Cancer Undergoing Immediate Breast Reconstruction. Ann Surg Oncol 2023; 30:1904-1910. [PMID: 36402899 DOI: 10.1245/s10434-022-12835-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/29/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND In breast cancer, coordination of surgical therapy with immediate breast reconstruction (IBR) has been found to significantly delay surgical therapy, which in turn can have an adverse effect on patient survival. The objective of this study was to investigate factors that impact the timeliness of surgical therapy in this setting, which may help to optimize the care of patients with breast cancer. PATIENTS AND METHODS Patients with breast cancer undergoing surgical therapy for breast cancer and immediate reconstruction were reviewed. Patients were divided into two groups: those who underwent surgery ≤ 30 days (group A) and > 30 days (group B) after diagnosis. Multivariate statistical analysis of demographic, disease, surgical, and process of care factors was performed. RESULTS A total of 348 cases met inclusion criteria, of which 255 (73.2%) were in group A and 93 (26.7%) were in group B. No significant differences were identified in clinical stage, oncologic procedure, or type of reconstruction. On multivariate analysis, an increased likelihood of undergoing surgery ≤ 30 days of diagnosis was observed, with shorter time intervals between surgical oncologist and plastic surgeon consultations [odds ratio (OR) 1.3; 95% confidence interval (CI) 1.1-1.6, p = 0.011]. The number of operating days in common between the surgical oncologist and plastic surgeon nor having the same clinic day impacted timeliness. CONCLUSIONS Patients may undergo both breast conservation surgery and mastectomy with all major types of immediate reconstruction in a timely manner. Early initiation of plastic surgery referrals and surgeon flexibility to work outside the parameters of institutional schedules may help facilitate the timeliness of surgery.
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Affiliation(s)
- Tyler Sbrocchi
- Department of Reconstructive Surgery, The Ohio State University, Columbus, OH, USA
| | - Kaitlin Kavanagh
- Department of Reconstructive Surgery, The Ohio State University, Columbus, OH, USA
| | - Albert H Chao
- Department of Reconstructive Surgery, The Ohio State University, Columbus, OH, USA.
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14
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Raman KS, Ninomiya MM, Bovill ES, Doherty C, Macadam SA, Laeken NV, Isaac KV. Temporal Sequencing of Multimodal Treatment in Immediate Breast Reconstruction and Implications for Wait Times: A Regional Canadian Cross-Sectional Study. Plast Surg (Oakv) 2023. [DOI: 10.1177/22925503231152261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Introduction: Treatment of breast cancer requires a multimodal approach with numerous independent specialists. Immediate breast reconstruction (IBR) adds another layer of coordination to comprehensive breast cancer care. To optimize health outcomes for patients seeking IBR, it is essential to efficiently coordinate the temporal sequence of care modalities inclusive of reconstruction. Methods: In this cross-sectional study, patients undergoing IBR following complete or partial mastectomy at one health centre from 2015 to 2021 were included. Patients were categorized into two main groups defined by the first treatment modality received, namely surgery first and Neoadjuvant Chemotherapy. Primary outcome measures were wait times for diagnostic investigations, initiation of treatment, and transitions between therapeutic modalities. Results: Of 195 patients, 158 underwent surgery first, and 37 underwent neoadjuvant chemotherapy. Median wait time from first consultation to first treatment initiated in the neoadjuvant cohort was shorter by 11.5 days as compared to the Surgery First cohort (21.5 +/− 19 vs 33.0 +/− 28 days; P = 0.001). Twenty-three (82%) of the surgery first and 11 (38%) of the neoadjuvant cohort patients waited longer than 8 weeks for initiation of radiotherapy ( P = 0.001). Following surgical intervention, the majority of patients failed to meet target benchmarks for transition to chemotherapy ( n = 25, 53%) and transition to radiotherapy ( n = 26, 93%; P < 0.001). Conclusion: Patients undergoing IBR may incur delays in the setting of upfront surgery and in transitioning to adjuvant therapies. In the setting of breast reconstruction, further efforts are required to achieve target wait-times in multimodal breast cancer care.
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Affiliation(s)
- Karanvir S. Raman
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maya Morton Ninomiya
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Esta S. Bovill
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher Doherty
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sheina A. Macadam
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nancy Van Laeken
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathryn V. Isaac
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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15
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Vijayaraghavan GR, Guembou IM, Vedantham S. The Current State of Timeliness in the Breast Cancer Diagnosis Journey: Abnormal Screening to Biopsy. Semin Ultrasound CT MR 2023; 44:56-61. [PMID: 36792274 DOI: 10.1053/j.sult.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
There are several steps involved in a breast cancer diagnosis, starting from the initial abnormal screening mammogram. Each step from the additional imaging to a biopsy provokes anxiety. Timely attention to these appointments will not only help allay anxiety but also provide better care. While breast facilities routinely audit their performance, currently timeliness is not one of the audit parameters. The role of timeliness as a robust quality tool is gaining attention. In this study, we review the timeline of care at our facility over a 1-year period (October 2021- September 2022) and compare them with those reported by National Quality Measures for Breast Centers (NQMBC). Race, ethnicity, location, and type of facility affect the outcome of care and contribute to delays in providing care. In this manuscript, we outline some of the major factors. Societal guidelines outlining some metrics for timeliness may be a useful first step.
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Affiliation(s)
- Gopal R Vijayaraghavan
- Department of Radiology, University of Massachusetts Chan School of Medicine, UMass Memorial Healthcare, Worcester, MA.
| | - Isabelle M Guembou
- CITC (Center for Innovation and Transformational Change), UMass Memorial Healthcare, Worcester, MA
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16
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Early Locoregional Breast Surgery and Survival in de novo Metastatic Breast Cancer in the Multicenter National ESME Cohort. Ann Surg 2023; 277:e153-e161. [PMID: 33534229 DOI: 10.1097/sla.0000000000004767] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim was to evaluate the impact of local surgery performed during the year after MBC diagnosis on patients' outcomes from a large reallife cohort. SUMMARY BACKGROUND DATA Locoregional treatment for patients with MBC at the time of diagnosis remains debated. METHODS Women with newly diagnosed, de novo stage IV MBC and who started MBC treatment between January 2008 and December 2014 in one of the 18 French Comprehensive Cancer Centers were included (NCT03275311). The impact of local surgery performed during the first year on overall survival (OS) and progression-free survival (PFS) was evaluated by the Cox proportional hazards model in a 12 month-landmark analysis. RESULTS Out of 16,703 patients in the ESME database, 1977 had stage IV MBC at diagnosis, were alive and progression-free at 12 months and eligible for this study. Among them, 530 (26.8%) had received primary breast cancer surgery within 12 months. A greater proportion of patients who received surgery had less than 3 metastatic sites than the no-surgery group (90.8% vs 78.2%, P < 0.0001). Surgery within 12 months was associated with treatment with chemotherapy, HER2-targeted therapy (89.1% vs 69.6%, P < 0.0001) and locoregional radiotherapy (81.7% vs 32.5%, P < 0.0001). Multivariable analyses showed that surgery performed within 12 months was associated with longer OS and PFS (adjusted HR [95%CI] = 0.75 [0.61-0.92] and 0.72 [0.63-0.83], respectively), which were also affected by pattern and number of metastatic sites, histological subtype, and age. CONCLUSIONS In the large ESME cohort, surgery within 1 year after de novo MBC diagnosis was associated with a significantly better OS and PFS.
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17
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İlgün AS, Özmen V. The Impact of the COVID-19 Pandemic on Breast Cancer Patients. Eur J Breast Health 2022; 18:85-90. [DOI: 10.4274/ejbh.galenos.2021.2021-11-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 12/26/2021] [Indexed: 12/01/2022]
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18
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Chanda AK, Bai T, Egleston BL, Vucetic S. MedCV: An Interactive Visualization System for Patient Cohort Identification from Medical Claim Data. PROCEEDINGS OF THE ... ACM INTERNATIONAL CONFERENCE ON INFORMATION & KNOWLEDGE MANAGEMENT. ACM INTERNATIONAL CONFERENCE ON INFORMATION AND KNOWLEDGE MANAGEMENT 2022; 2022:4828-4832. [PMID: 36636516 PMCID: PMC9830554 DOI: 10.1145/3511808.3557157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Healthcare providers generate a medical claim after every patient visit. A medical claim consists of a list of medical codes describing the diagnosis and any treatment provided during the visit. Medical claims have been popular in medical research as a data source for retrospective cohort studies. This paper introduces a medical claim visualization system (MedCV) that supports cohort selection from medical claim data. MedCV was developed as part of a design study in collaboration with clinical researchers and statisticians. It helps a researcher to define inclusion rules for cohort selection by revealing relationships between medical codes and visualizing medical claims and patient timelines. Evaluation of our system through a user study indicates that MedCV enables domain experts to define high-quality inclusion rules in a time-efficient manner.
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19
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Zipkin RJ, Schaefer A, Wang C, Loehrer AP, Kapadia NS, Brooks GA, Onega T, Wang F, O'Malley AJ, Moen EL. Rural-Urban Differences in Breast Cancer Surgical Delays in Medicare Beneficiaries. Ann Surg Oncol 2022; 29:5759-5769. [PMID: 35608799 PMCID: PMC9128633 DOI: 10.1245/s10434-022-11834-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/15/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Delays between breast cancer diagnosis and surgery are associated with worsened survival. Delays are more common in urban-residing patients, although factors specific to surgical delays among rural and urban patients are not well understood. METHODS We used a 100% sample of fee-for-service Medicare claims during 2007-2014 to identify 238,491 women diagnosed with early-stage breast cancer undergoing initial surgery and assessed whether they experienced biopsy-to-surgery intervals > 90 days. We employed multilevel regression to identify associations between delays and patient, regional, and surgeon characteristics, both in combined analyses and stratified by rurality of patient residence. RESULTS Delays were more prevalent among urban patients (2.5%) than rural patients (1.9%). Rural patients with medium- or high-volume surgeons had lower odds of delay than patients with low-volume surgeons (odds ratio [OR] = 0.71, 95% confidence interval [CI] = 0.58-0.88; OR = 0.74, 95% CI = 0.61-0.90). Rural patients whose surgeon operated at ≥ 3 hospitals were more likely to experience delays (OR = 1.29, 95% CI = 1.01-1.64, Ref: 1 hospital). Patient driving times ≥ 1 h were associated with delays among urban patients only. Age, black race, Hispanic ethnicity, multimorbidity, and academic/specialty hospital status were associated with delays. CONCLUSIONS Sociodemographic, geographic, surgeon, and facility factors have distinct associations with > 90-day delays to initial breast cancer surgery. Interventions to improve timeliness of breast cancer surgery may have disparate impacts on vulnerable populations by rural-urban status.
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Affiliation(s)
- Ronnie J Zipkin
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Andrew Schaefer
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | - Changzhen Wang
- Department of Geography and Anthropology, Louisiana State University, Baton Rouge, LA, USA
| | - Andrew P Loehrer
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
- Department of Surgery, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Nirav S Kapadia
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Gabriel A Brooks
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Tracy Onega
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Population Sciences, University of Utah, Salt Lake City, UT, USA
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Fahui Wang
- Department of Geography and Anthropology, Louisiana State University, Baton Rouge, LA, USA
| | - Alistair J O'Malley
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Erika L Moen
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
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20
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Morrill KE, Robles-Morales R, Lopez-Pentecost M, Martínez Portilla RJ, Saleh AA, Skiba MB, Riall TS, Austin JD, Hirschey R, Jacobs ET, Spotleson L, Hanna TP. Factors associated with cancer treatment delay: a protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e061121. [PMID: 35768104 PMCID: PMC9240873 DOI: 10.1136/bmjopen-2022-061121] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/27/2022] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Treatment delays are significantly associated with increased mortality risk among adult cancer patients; however, factors associated with these delays have not been robustly evaluated. This review and meta-analysis will evaluate factors associated with treatment delays among patients with five common cancers. METHODS AND ANALYSIS Scientific databases including Ovid MEDLINE, Elsevier Embase, EBSCOhost CINAHL Plus Full Text, Elsevier Scopus and ProQuest Dissertations and Theses Global will be searched to identify relevant articles published between January 2000 and October 2021. Research articles published in the USA evaluating factors associated with treatment delay among breast, lung, prostate, cervical or colorectal adult cancer patients will be included. The primary outcome of the meta-analysis will be the pooled adjusted and unadjusted odds of treatment delay for patient, disease, provider and system-level factors defined according to specified time intervals. The secondary outcomes will be mean or median treatment delay for each cancer site according to first treatment and the influence of factors on the pooled mean treatment delay for each cancer site (via meta-regression analyses). Results from qualitative and mixed-methods studies will be narratively synthesised. Three reviewers will independently screen records generated from the search and two reviewers will independently extract data following a consensus agreement. Statistical heterogeneity will be assessed with a standard I2 test and funnel plots will be conducted to evaluate publication bias. Risk of bias will be assessed independently by two authors using validated tools according to the article's study design. ETHICS AND DISSEMINATION Formal ethical approval is not required because the work is being carried out on publicly accessible studies. The findings of this review will be disseminated through a peer-reviewed scientific journal, academic conferences, social media, and key stakeholders. PROSPERO REGISTRATION NUMBER CRD42021293131.
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Affiliation(s)
- Kristin E Morrill
- Community & Systems Health Science Division, The University of Arizona College of Nursing, Tucson, Arizona, USA
| | - Rogelio Robles-Morales
- Department of Clinical and Translational Sciences, The University of Arizona College of Medicine, Tucson, Arizona, USA
- Iberoamerican Research Network in Obstetrics, Gynecology, and Translational Medicine, Mexico City, Mexico
| | - Melissa Lopez-Pentecost
- Department of Clinical and Translational Sciences, The University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Raigam J Martínez Portilla
- Iberoamerican Research Network in Obstetrics, Gynecology, and Translational Medicine, Mexico City, Mexico
- Clinical Research, National Institute of Perinatology, Mexico City, Mexico
| | - Ahlam A Saleh
- Health Sciences Library, The University of Arizona, Tucson, Arizona, USA
| | - Meghan B Skiba
- Division of Biobehavioral Health Science, The University of Arizona College of Nursing, Tucson, Arizona, USA
- The University of Arizona Cancer Center - North Campus, Tucson, Arizona, USA
| | - Taylor S Riall
- The University of Arizona Cancer Center - North Campus, Tucson, Arizona, USA
- Department of Surgery, The University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Jessica D Austin
- Department of Epidemiology, Mayo Clinic College of Medicine and Sciences, Scottsdale, Arizona, USA
| | - Rachel Hirschey
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
- University of North Carolina School of Nursing, Chapel Hill, North Carolina, USA
| | - Elizabeth T Jacobs
- The University of Arizona Cancer Center - North Campus, Tucson, Arizona, USA
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
| | | | - Timothy P Hanna
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston, Ontario, Canada
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
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21
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Fadelu TA, Erfani P, Lormil J, Damuse R, Pierre V, Slater S, Triedman SA, Shulman LN, Rebbeck TR. Gaps in completion and timeliness of breast surgery and adjuvant therapy: a retrospective cohort of Haitian patients with nonmetastatic breast cancer. Breast Cancer Res Treat 2022; 193:625-635. [PMID: 35420316 PMCID: PMC9114044 DOI: 10.1007/s10549-022-06582-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/27/2022] [Indexed: 11/28/2022]
Abstract
Background There are limited data on breast surgery completion rates and prevalence of care-continuum delays in breast cancer treatment programs in low-income countries. Methods This study analyzes treatment data in a retrospective cohort of 312 female patients with non-metastatic breast cancer in Haiti. Descriptive statistics were used to summarize patient characteristics; treatments received; and treatment delays of > 12 weeks. Multivariate logistic regressions were performed to identify factors associated with receiving surgery and with treatment delays. Exploratory multivariate survival analysis examined the association between surgery delays and disease-free survival (DFS). Results Of 312 patients, 249 (80%) completed breast surgery. The odds ratio (OR) for surgery completion for urban vs. rural dwellers was 2.15 (95% confidence interval [CI]: 1.19–3.88) and for those with locally advanced vs. early-stage disease was 0.34 (95%CI: 0.16–0.73). Among the 223 patients with evaluable surgery completion timelines, 96 (43%) experienced delays. Of the 221 patients eligible for adjuvant chemotherapy, 141 (64%) received adjuvant chemotherapy, 66 of whom (47%) experienced delays in chemotherapy initiation. Presentation in the later years of the cohort (2015–2016) was associated with lower rates of surgery completion (75% vs. 85%) and with delays in adjuvant chemotherapy initiation (OR [95%CI]: 3.25 [1.50–7.06]). Exploratory analysis revealed no association between surgical delays and DFS. Conclusion While majority of patients obtained curative-intent surgery, nearly half experienced delays in surgery and adjuvant chemotherapy initiation. Although our study was not powered to identify an association between surgical delays and DFS, these delays may negatively impact long-term outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-022-06582-8.
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Affiliation(s)
- Temidayo A Fadelu
- Dana-Farber Cancer Institute, 450 Brookline Avenue, MA- 1B-17, Boston, MA, 02215, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Parsa Erfani
- Harvard Medical School, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Joarly Lormil
- Hôpital Universitaire de Mirebalais, Mirebalais, Haiti.,Zanmi Lasante, 8A, Santo 22H,, Croix-des-Bouquet, Haiti
| | - Ruth Damuse
- Hôpital Universitaire de Mirebalais, Mirebalais, Haiti.,Zanmi Lasante, 8A, Santo 22H,, Croix-des-Bouquet, Haiti
| | - Viergela Pierre
- Hôpital Universitaire de Mirebalais, Mirebalais, Haiti.,Zanmi Lasante, 8A, Santo 22H,, Croix-des-Bouquet, Haiti
| | - Sarah Slater
- Dana-Farber Cancer Institute, 450 Brookline Avenue, MA- 1B-17, Boston, MA, 02215, USA.,Harvard Medical School, Boston, MA, USA
| | - Scott A Triedman
- Dana-Farber Cancer Institute, 450 Brookline Avenue, MA- 1B-17, Boston, MA, 02215, USA.,The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Lawrence N Shulman
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy R Rebbeck
- Dana-Farber Cancer Institute, 450 Brookline Avenue, MA- 1B-17, Boston, MA, 02215, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
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22
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Kumar P, Rao S, Mundkur A, Adiga P, Poojari VG, Ullagaddi RK. Random Start Ovarian Stimulation. J Hum Reprod Sci 2022; 15:200-203. [PMID: 35928466 PMCID: PMC9345281 DOI: 10.4103/jhrs.jhrs_172_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 05/21/2022] [Accepted: 05/26/2022] [Indexed: 11/08/2022] Open
Abstract
Fertility preservation is emerging in recent years as an important option for various indications many of which being for cancer patients and for certain benign conditions as well. In the present case report, we set out to utilise the same protocol, however, for different indications.
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Affiliation(s)
- Pratap Kumar
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, MAHE University, Manipal, Karnataka, India
| | - Shubha Rao
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, MAHE University, Manipal, Karnataka, India
| | - Anjali Mundkur
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, MAHE University, Manipal, Karnataka, India
| | - Prashanth Adiga
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, MAHE University, Manipal, Karnataka, India
| | - Vidyashree G Poojari
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, MAHE University, Manipal, Karnataka, India
| | - Rashmi K Ullagaddi
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, MAHE University, Manipal, Karnataka, India
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23
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Cobb AN, Adesoye T, Teshome M. Progress and Persistent Challenges in Improving Care for Low-Income Women with Breast Cancer. Ann Surg Oncol 2022; 29:2756-2758. [PMID: 35152360 PMCID: PMC8853375 DOI: 10.1245/s10434-022-11343-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/10/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Adrienne N Cobb
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Taiwo Adesoye
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mediget Teshome
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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24
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Riley D, Chrischilles EA, Lizarraga IM, Charlton M, Smith BJ, Lynch CF. Rural-urban differences in secular trends of locoregional treatment for ductal carcinoma in situ: A patterns of care analysis. Cancer Med 2022; 11:2284-2295. [PMID: 35146946 PMCID: PMC9160801 DOI: 10.1002/cam4.4605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/29/2021] [Accepted: 01/01/2022] [Indexed: 11/25/2022] Open
Abstract
Precis Omission of PORT following BCS remains high among rural patients despite evidence that PORT leads to a significant reduction in the risk of local recurrence. Further research is needed to examine the impact of rural residence on treatment choices and develop methods to ensure equitable care among all breast cancer patients. Background Despite national guidelines, debate exists among clinicians regarding the optimal approach to treatment for patients diagnosed with ductal carcinoma in situ (DCIS). While regional variation in practice patterns has been well documented, population‐based information on rural–urban treatment differences is lacking. Methods Data from the SEER Patterns of Care studies were used to identify women diagnosed with histologically confirmed DCIS who underwent cancer‐directed surgery in the years 1991, 1995, 2000, 2005, 2010, and 2015. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using weighted multivariable logistic regression to evaluate cancer‐directed surgery and use of post‐operative radiation therapy (PORT). Results Of the 3337 patients who met inclusion criteria, 27% underwent mastectomy, 26% underwent breast‐conserving surgery (BCS) without PORT, and 47% underwent BCS with PORT. After adjustment for other covariates, there was no difference in the likelihood of receiving mastectomy between rural and urban patients (aOR = 0.65; 95% CI 0.37–1.14). However, rural residents were more likely than urban residents to have mastectomy during 1991/1995 (aOR = 1.78; 95% CI 1.09–2.91; pinteraction = 0.022). Across all diagnosis years, patients residing in rural areas were less likely to receive PORT following BCS compared to urban patients (aOR = 0.35; 95% CI 0.18–0.67). Conclusions Omission of PORT following BCS remains high among rural patients despite evidence that PORT leads to a significant reduction in the risk of local recurrence. Further research is needed to examine the impact of rural residence on treatment choices and develop methods to ensure equitable care among all breast cancer patients.
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Affiliation(s)
- Danielle Riley
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | | | - Ingrid M Lizarraga
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Mary Charlton
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Brian J Smith
- Holden Comprehensive Cancer Center, University of Iowa, Iowa, USA
| | - Charles F Lynch
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
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25
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Navarro S, Yang Y, Ochoa CY, Mejia A, Kim SE, Liu L, Lerman C, Farias AJ. Asian Ethnic Subgroup Disparities in Delays of Surgical Treatment for Breast Cancer. JNCI Cancer Spectr 2022; 6:pkab089. [PMID: 35047750 PMCID: PMC8763369 DOI: 10.1093/jncics/pkab089] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/31/2021] [Accepted: 10/07/2021] [Indexed: 11/23/2022] Open
Abstract
Background As Asian American breast cancer incidence rises, it is necessary to investigate the origins of differential breast cancer outcomes among Asian ethnic subgroups. This study aimed to examine disparities in delays of breast cancer surgery among Asian ethnic subgroups. Methods We obtained California Cancer Registry data on female breast cancer diagnoses and treatment from 2012 to 2017. Our main independent variable was patient race and ethnicity, including 6 Asian ethnic subgroups. Dependent variables included time to surgical treatment for breast cancer and receipt of surgical treatment within 30 and 90 days of diagnosis. We conducted multivariable logistic regression to determine the odds of receiving surgery within 30 and 90 days of diagnosis and multivariable Cox proportional hazards regression to determine the risk of prolonged time to surgery. Results In our cohort of 93 168 breast cancer patients, Hispanic (odds ratio [OR] = 0.86, 95% confidence interval [CI] = 0.82 to 0.89) and non-Hispanic Black (OR = 0.83, 95% CI = 0.78 to 0.88) patients were statistically significantly less likely than non-Hispanic White patients to receive surgery within 30 days of breast cancer diagnosis, whereas Asian Indian or Pakistani (OR = 1.23, 95% CI = 1.09 to 1.40) and Chinese (OR = 1.30, 95% CI = 1.20 to 1.40) patients were statistically significantly more likely to receive surgery within 30 days of diagnosis. Conclusions This large, population-based retrospective cohort study of female breast cancer patients is the first, to our knowledge, to demonstrate that time to surgical treatment is not equal for all Asians. Distinct differences among Asian ethnic subgroups suggest the necessity of further investigating breast cancer treatment patterns to fully understand and target disparities in breast cancer treatment.
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Affiliation(s)
- Stephanie Navarro
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Yifei Yang
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Carol Y Ochoa
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Aaron Mejia
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Sue E Kim
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Lihua Liu
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.,Los Angeles Cancer Surveillance Program, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Caryn Lerman
- Norris Comprehensive Cancer Center, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Albert J Farias
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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26
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A tool to predict disparities in the timeliness of surgical treatment for breast cancer patients in the USA. Breast Cancer Res Treat 2022; 191:513-522. [PMID: 35013916 PMCID: PMC8747888 DOI: 10.1007/s10549-021-06460-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/15/2021] [Indexed: 11/26/2022]
Abstract
Purpose Breast cancer outcomes are impaired by both delays and disparities in treatment. This study was performed to assess their relationship and to provide a tool to predict patient socioeconomic factors associated with risk for delay. Methods The National Cancer Database was reviewed between 2004 and 2017 for patients with non-metastatic breast cancer managed with upfront surgery. Times to treatment were measured from the date of diagnosis. Patient, tumor, and treatment factors were assessed with attention paid to sociodemographic variables. Results 514,187 patients remained after exclusions, with 84.3% White, 10.8% Black, 3.7% Asian, and Hispanics comprising 5.6% of the cohort. Medicaid and uninsured patients had longer mean adjusted time to surgery (≥ 46 days) versus private (36.7 days), Medicare (35.9 days), or other governmental insurance (39.8 days). After adjustment, Black race and Hispanic ethnicity were most impactful, adding 6.0 and 6.4 preoperative days, 10.9 and 11.5 days to chemotherapy, 11.1 and 9.1 days to radiation, and 12.5 and 8.9 days to endocrine therapy, respectively. Income, education, and insurance, among other factors, also affected delay. A nomogram, including race and sociodemographic factors, was created to predict the risk of preoperative delay. Conclusion Significant disparities exist in timeliness of care for factors, including but not limited to, race and ethnicity. Although exact causes cannot be discerned, these data indicate population subsets whose intervals of care risk being longer than those specified by national quality standards. The nomogram created here may help direct resources to those at highest risk of incurring a treatment delay. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-021-06460-9.
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27
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Bleicher RJ, Moran MS, Ruth K, Edge SB, Dietz JM, Wilke LG, Stearns V, Kurtzman SH, Klein J, Yao KA. The Impact of Radiotherapy Delay in Breast Conservation Patients Not Receiving Chemotherapy and the Rationale for Dichotomizing the Radiation Oncology Time-Dependent Standard into Two Quality Measures. Ann Surg Oncol 2022; 29:469-481. [PMID: 34324114 PMCID: PMC9059503 DOI: 10.1245/s10434-021-10512-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/29/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The Commission on Cancer/National Quality Forum breast radiotherapy quality measure establishes that for women < 70 years, adjuvant radiotherapy after breast conserving surgery (BCS) should be started < 1 year from diagnosis. This was intended to prevent accidental radiotherapy omission or delay due to a long interval between surgery and chemotherapy completion, when radiation is delivered. However, the impact on patients not receiving chemotherapy, who proceed from surgery directly to radiotherapy, remains unknown. PATIENTS AND METHODS Patients aged 18-69, diagnosed with stage I-III breast cancer as their first and only cancer diagnosis (2004-2016), having BCS, for whom this measure would be applicable, were reviewed from the National Cancer Database. RESULTS Among 308,521 patients, the median age was 57.0 years, and > 99% of all patients were compliant with the measure. The cohort of interest included 186,650 (60.5%) patients not receiving chemotherapy, with a mean age of 57.9 years. Of these, 90.5% received external beam radiotherapy (EBRT) and 9.5% brachytherapy. Among them, 24.9% started radiotherapy > 8 weeks after surgery. In a multivariable model, delay from surgery to radiotherapy increased the hazard ratios for overall survival to 9.0% (EBRT) per month and 3.0% (brachytherapy) per week. CONCLUSION While 99.9% of patients undergoing BCS without chemotherapy remain compliant with the current quality measure, 25% have delays > 8 weeks to start radiation, which is associated with impaired survival. These data suggest that the current quality measure should be dichotomized into two, with or without chemotherapy, in order to impel prompt radiotherapy initiation and maximize outcomes in all patients.
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Affiliation(s)
- Richard J Bleicher
- The Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA.
- The Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
| | - Meena S Moran
- The Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA
- The Department of Therapeutic Radiology, Yale University Medical Center, New Haven, CT, USA
| | - Karen Ruth
- The Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Stephen B Edge
- The Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA
- The Department of Surgical Oncology and Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jill M Dietz
- The Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA
- The Department of Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Lee G Wilke
- The Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA
- The Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Vered Stearns
- The Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA
- The Department of Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Scott H Kurtzman
- The Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA
- The Department of Surgery, Waterbury Hospital, Waterbury, CT, USA
| | - Jonah Klein
- The Department of Surgery, Lankenau Medical Center, Main Line Health, Wynnewood, PA, USA
| | - Katharine A Yao
- The Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA
- The Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
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28
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Meriam K, Manel L, Jihene S, Hédi K, Ali M, Thouraya A. Delays in the Surgical Pathway in Breast cancer Patients in Tunisia: A Descriptive Prospective Study. Indian J Surg Oncol 2021; 13:385-393. [DOI: 10.1007/s13193-021-01484-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022] Open
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29
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Chagpar AB, Howard-McNatt M, Chiba A, Levine EA, Gass JS, Gallagher K, Lum S, Martinez R, Willis AI, Fenton A, Solomon NL, Senthil M, Edmonson D, Namm JP, Walters L, Brown E, Murray M, Ollila D, Dupont E, Garcia-Cantu C. Factors Affecting Time to Surgery in Breast Cancer Patients. Am Surg 2021; 88:648-652. [PMID: 34732082 DOI: 10.1177/00031348211054714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We sought to determine factors affecting time to surgery (TTS) to identify potential modifiable factors to improve timeliness of care. METHODS Patients with clinical stage 0-3 breast cancer undergoing partial mastectomy in 2 clinical trials, conducted in ten centers across the US, were analyzed. No preoperative workup was mandated by the study; those receiving neoadjuvant therapy were excluded. RESULTS The median TTS among the 583 patients in this cohort was 34 days (range: 1-289). Patient age, race, tumor palpability, and genomic subtype did not influence timeliness of care defined as TTS ≤30 days. Hispanic patients less likely to have a TTS ≤30 days (P = .001). There was significant variation in TTS by surgeon (P < .001); those practicing in an academic center more likely to have TTS ≤30 days than those in a community setting (55.1% vs 19.3%, P < .001). Patients who had a preoperative ultrasound had a similar TTS to those who did not (TTS ≤30 days 41.9% vs 51.9%, respectively, P = .109), but those who had a preoperative MRI had a significantly increased TTS (TTS ≤30 days 25.0% vs 50.9%, P < .001). On multivariate analysis, patient ethnicity was no longer significantly associated with TTS ≤30 (P = .150). Rather, use of MRI (OR: .438; 95% CI: .287-.668, P < .001) and community practice type (OR: .324; 95% CI: .194-.541, P < .001) remained independent predictors of lower likelihood of TTS ≤30 days. CONCLUSIONS Preoperative MRI significantly increases time to surgery; surgeons should consider this in deciding on its use.
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Affiliation(s)
| | | | - Akiko Chiba
- 12279Wake Forest University, Winston-Salem, North Carolina
| | | | | | | | - Sharon Lum
- 4608Loma Linda University, Loma Linda, CA
| | | | | | | | | | | | | | | | | | - Eric Brown
- 6559Thomas Jefferson University, Philadelphia, PA
| | - Mary Murray
- 205980Doctors Hospital at Renaissance, Edinburg, TX
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30
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Su Y, Zheng X, Ouyang Z. The Relationship between Time to Surgery (TTS) and Survival in Breast Cancer: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:1773-1782. [PMID: 34722372 PMCID: PMC8542807 DOI: 10.18502/ijph.v50i9.7048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/20/2021] [Indexed: 01/10/2023]
Abstract
Background: Curative operation is the practical and primary therapy for masses of breast cancers. In contrast, the correlation between the time interval from breast cancer diagnosis to curative surgery and survival is still uncertain. Methods: An electronic literature search was conducted on PubMed/Medline and EMBASE (between Jan 2000 and Jan 2020). Primary endpoints were overall survival (OS) or Disease-Free Survival (DFS). The HR with 95% confidence intervals were calculated using a random-effects or fixed-effects model. Results: The combined HR for OS was 1. 10 (95% CI 1. 08–1. 11; P=0. 000) by fixed-effects model, no statistically significant heterogeneity was found (P=1. 000; I2=0%), and this difference was statistically significant (Z=11. 99; P=0. 000). Conclusion: This meta-analysis showed a significant adverse association between more prolonged time to surgery (TTS) and lower overall survival in patients with breast cancer. It is reasonable to minimize that interval between diagnosis and curative surgery.
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Affiliation(s)
- Yongcheng Su
- Department of Breast Surgery, The First Affiliated Hospital of Xiamen University, Xiamen Fujian 361003, China
| | - Xiaogang Zheng
- Department of Breast Surgery, The First Affiliated Hospital of Xiamen University, Xiamen Fujian 361003, China
| | - Zhong Ouyang
- Department of Breast Surgery, The First Affiliated Hospital of Xiamen University, Xiamen Fujian 361003, China
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31
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Hanna DN, Ghani MO, Hermina A, Mina A, Bailey CE, Idrees K, Magge D. Impact of Insurance Status on Oncologic and Perioperative Outcomes After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2021; 29:253-259. [PMID: 34432192 DOI: 10.1245/s10434-021-10670-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND A growing body of research has shown that underinsured patients are at increased risk of worse health outcomes compared with insured patients. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is largely performed at highly specialized cancer centers and may pose challenges for the underinsured. This study investigates surgical outcomes following CRS-HIPEC for insured and underinsured patients with peritoneal carcinomatosis. METHODS We performed a retrospective cohort study of 125 patients undergoing CRS-HIPEC between 2013 and 2019. Patients were categorized into two groups. The insured group was comprised of patients with private insurance at the time of CRS-HIPEC or who obtained it during the follow-up period. The underinsured group consisted of patients with Medicaid, or self-pay. Perioperative and oncologic outcomes were compared between the two groups. RESULTS A total of 102 (82.3%) patients were insured, and 22 (17.7%) patients were underinsured. There were no significant differences in age, medical morbidities, primary tumor characteristics, peritoneal carcinomatosis index, or completion of cytoreduction score between the two groups. The median overall survival (OS) for insured patients was 64.8 months and was 52.9 months for underinsured patients (p = 0.01). Additionally, insured patients had a significantly longer follow-up time. Underinsurance status also was associated with increased hospital and intensive care unit length of stay, and higher rate of Clavien-Dindo classification III-IV complications. CONCLUSIONS In this retrospective study conducted at a large, urban, specialized cancer center, private insurance status was associated with increased overall survival and longer follow-up period. Furthermore, underinsurance status was associated with increased perioperative morbidity.
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Affiliation(s)
- David N Hanna
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Muhammad O Ghani
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Alexander Mina
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Christina E Bailey
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kamran Idrees
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Deepa Magge
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
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32
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Dahan M, Hequet D, Bonneau C, Paoletti X, Rouzier R. Has tumor doubling time in breast cancer changed over the past 80 years? A systematic review. Cancer Med 2021; 10:5203-5217. [PMID: 34264009 PMCID: PMC8335823 DOI: 10.1002/cam4.3939] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/03/2021] [Accepted: 04/12/2021] [Indexed: 11/12/2022] Open
Abstract
Over the past century, epidemiologic changes and implementation of screening may have had an impact on tumor doubling time in breast cancer. Our study was designed to evaluate changes in tumor doubling time in breast cancer over the past 80 years. A systematic review of published literature and meta-regression analysis was performed. An online electronic database search was undertaken using the PubMed platform from inception until June 2020. All studies that measured tumor doubling time in breast cancer were included. A total of 151 publications were retrieved. Among them, 16 full-text articles were included in the qualitative analysis. An exponential growth model was used for quantitative characterization of tumor growth rate. Tumor doubling time has remained stable over the past 80 years. Recent studies have not only identified "fast growing tumor" (grade 3, human epidermal growth factor receptor 2-positive, triple-negative, or tumor with an elevated Ki-67) but also "inactive breast cancer" feeding the ongoing debate of overdiagnosis due to screening programs. The stability of tumor doubling time over the past 80 years, despite increasing and changing risk factors, supports the validity for our screening guidelines. Prospective studies based on more precise measurement of tumor size and adjustment for tumor characteristics are necessary to more clearly characterize the prognostic and predictive impact of tumor doubling time in breast cancer.
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Affiliation(s)
- Meryl Dahan
- Department of SurgeryInstitut Curie Hospital GroupSaint‐CloudFrance
- Inserm U900Cancer et génome: bioinformatiquebiostatistiques et épidémiologieInstitut CurieSaint‐CloudFrance
| | - Delphine Hequet
- Department of SurgeryInstitut Curie Hospital GroupSaint‐CloudFrance
- Inserm U900Cancer et génome: bioinformatiquebiostatistiques et épidémiologieInstitut CurieSaint‐CloudFrance
| | - Claire Bonneau
- Department of SurgeryInstitut Curie Hospital GroupSaint‐CloudFrance
- Inserm U900Cancer et génome: bioinformatiquebiostatistiques et épidémiologieInstitut CurieSaint‐CloudFrance
- University Versailles St‐QuentinUniversity Paris‐SaclayMontigny‐le‐BretonneuxFrance
| | - Xavier Paoletti
- Inserm U900Cancer et génome: bioinformatiquebiostatistiques et épidémiologieInstitut CurieSaint‐CloudFrance
- University Versailles St‐QuentinUniversity Paris‐SaclayMontigny‐le‐BretonneuxFrance
| | - Roman Rouzier
- Department of SurgeryInstitut Curie Hospital GroupSaint‐CloudFrance
- Inserm U900Cancer et génome: bioinformatiquebiostatistiques et épidémiologieInstitut CurieSaint‐CloudFrance
- University Versailles St‐QuentinUniversity Paris‐SaclayMontigny‐le‐BretonneuxFrance
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Ogura K, Fujiwara T, Healey JH. Patients with an increased time to treatment initiation have a poorer overall survival after definitive surgery for localized high-grade soft-tissue sarcoma in the extremity or trunk : report from the National Cancer Database. Bone Joint J 2021; 103-B:1142-1149. [PMID: 34058874 DOI: 10.1302/0301-620x.103b6.bjj-2020-2087.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Time to treatment initiation (TTI) is generally defined as the time from the histological diagnosis of malignancy to the initiation of first definitive treatment. There is no consensus on the impact of TTI on the overall survival in patients with a soft-tissue sarcoma. The purpose of this study was to determine if an increased TTI is associated with overall survival in patients with a soft-tissue sarcoma, and to identify the factors associated with a prolonged TTI. METHODS We identified 23,786 patients from the National Cancer Database who had undergone definitive surgery between 2004 and 2015 for a localized high-grade soft-tissue sarcoma of the limbs or trunk. A Cox proportional hazards model was used to examine the relationship between a number of factors and overall survival. We calculated the incidence rate ratio (IRR) using negative binomial regression models to identify the factors that affected TTI. RESULTS Patients in whom the time to treatment initiation was prolonged had poorer overall survival than those with a TTI of 0 to 30 days. These were: 31 to 60 days (hazard ratio (HR) 1.08, p = 0.011); 61 to 90 days (HR 1.11, p = 0.044); and 91 days (HR 1.22; p = 0.003). The restricted cubic spline showed that the hazard ratio increased substantially with a TTI longer than 50 days. Non-academic centres (vs academic centres; IRR ranging from 0.64 to 0.86; p < 0.001) had a shorter TTI. Those insured by Medicaid (vs private insurance; IRR 1.34), were uninsured (vs private insurance; IRR 1.17), or underwent a transition in care (IRR 1.62) had a longer TTI. CONCLUSION A time to treatment initiation of more than 30 days after diagnosis was independently associated with poorer survival. The hazard ratio showed linear increase, especially if the TTI was more than 50 days. We recommend starting treatment within 30 days of diagnosis to achieve the highest likelihood of cure for localized high-grade soft-tissue sarcomas in the limbs and trunk, even when a patient needs to be referred to a specialist centre. Cite this article: Bone Joint J 2021;103-B(6):1142-1149.
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Affiliation(s)
- Koichi Ogura
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomohiro Fujiwara
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama City, Japan
| | - John H Healey
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Weill Cornell Medical College, New York, New York, USA
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Abstract
BACKGROUND Low-income, underinsured and uninsured women are less likely to be diagnosed via mammogram and more often diagnosed at later stages, with a resultant negative impact on survival. The New Jersey Cancer Education and Early Detection Program provides access to cancer screening services for low-income, underinsured and uninsured individuals. This program was recently evaluated, and it was found that enrollees were more likely to be diagnosed at later stages than nonenrollees, which may be related to delays in diagnosis and treatment OBJECTIVE: The aim of this study was to determine if there were delays in diagnosis and treatment for program enrollees and, if so, what were the causes of these delays. METHODS A qualitative methodology was used incorporating in-depth interviews with 20 women diagnosed with breast cancer through the New Jersey Cancer Education and Early Detection Program. Qualitative content analysis was used for data analysis. RESULTS Three themes emerged: poor access to healthcare, lack of knowledge, and sense of spirituality. Nineteen of 20 women experienced delays in care; 9 were diagnosed with late stage (III or IV) disease. CONCLUSIONS While the lack of insurance was a factor, fear, family needs, and a tendency to not prioritize their own health were additional reasons for delays in diagnosis and treatment. IMPLICATIONS FOR PRACTICE Programs such as this are integral to the care of low-income, uninsured individuals. However, such programs are not sufficient to meet the needs of low-income women. The lack of a usual source of care is likely to be a factor in the delays these women experienced.
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Variations in breast cancer surgical treatment and timing: determinants and disparities. Breast Cancer Res Treat 2021; 188:259-272. [PMID: 33689057 PMCID: PMC8233284 DOI: 10.1007/s10549-021-06155-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/20/2021] [Indexed: 01/29/2023]
Abstract
PURPOSE To describe clinical and non-clinical factors associated with receipt of breast conserving surgery (BCS) versus mastectomy and time to surgical intervention. METHODS Cross-sectional retrospective study of January 1, 2012 through March 31, 2018 data from the IBM MarketScan Commercial Claims and Encounter and Medicare Supplemental Databases. Area Health Resource Files provided non-clinical characteristics and sociodemographic data. Eligibility: Female sex, claim(s) with ICD-9-CM or ICD-10-CM diagnosis of non-metastatic invasive breast cancer, > 6 months of continuous insurance pre- and post-diagnosis, evidence of BCS or mastectomy following initial ICD9/10 code diagnosis. Logistic and quantile multivariable regression models assessed the association between clinical and non-clinical factors and the outcome of BCS and time to surgery, respectively. RESULTS A total of 53,060 women were included in the study. Compared to mastectomy, BCS was significantly associated with older age (ORs: 1.54 to 2.99, 95% CIs 1.45 to 3.38; ps < .0001) and higher community density of medical genetics (OR: 5.88, 95% CIs 1.38 to 25.00; p = 0.02) or obstetrics and gynecology (OR: 1.13, 95% CI 1.02 to 1.25; p = .02) physicians. Shorter time-to-BCS was associated with living in the South (-2.96, 95% CI -4.39 to -1.33; p < .0001). Longer time-to-BCS was associated with residence in more urban (4.18, 95% CI 0.08 to 8.29; p = 0. 05), educated (9.02, 95% CI 0.13 to 17.91; p = 0.05), or plastic-surgeon-dense (4.62, 95% CI 0.50 to 8.73; p = 0.03) communities. CONCLUSIONS Clinical and non-clinical factors are associated with adoption of BCS and time to treatment, suggesting opportunities to ensure equitable and timely care.
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Sittenfeld SMC, Greenberg Z, Al-Hilli Z, Abraham J, Moore HCF, Grobmyer S, Monteleone E, Tullio K, Shah C. Reducing time to treatment and patient costs with breast cancer: the impact of patient visits. Breast J 2021; 27:237-241. [PMID: 33533542 DOI: 10.1111/tbj.14174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the impact of processes aimed at reducing time to treatment initiation (TTI) on minimizing the days spent to complete pretreatment visits and the associated costs for patients with nonmetastatic breast cancer. METHODS System-wide initiatives were implemented in 2014 to minimize TTI, by incorporating multiple strategies (eg, creation of teams, patient liaisons, process mapping) and enhanced communication to increase coordinated visits. Average number of days spent to complete visits, TTI, and associated patient costs including driving expenses, parking, food, childcare, and lost wages were calculated and compared between the years 2015 and 2018. RESULTS In 2015, the median TTI was 43.5 days and the average number of separate days spent to attend multidisciplinary visits prior to first treatment was 1.86. These were reduced to 29 days and 1.52 visits, respectively, in 2018 (p < 0.0001 for both). When evaluating treatment visits by surgical procedure, the average number of visits was reduced regardless of surgical procedure. The average number of visits was highest for patients undergoing mastectomy with reconstruction (2.34 in 2015, reduced to 1.65 in 2018, p < 0.0001). A single visit to complete treatment planning was associated with patient costs of $249 as compared with multiple trips costing $491 for 2 visits and up to $1,226 for 5 visits. CONCLUSIONS In breast cancer patients, implementing processes to reduce time to treatment was associated with fewer visits required prior to treatment initiation, resulting in lower patient costs.
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Affiliation(s)
- Sarah M C Sittenfeld
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Zachary Greenberg
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Zahraa Al-Hilli
- Section of Breast Surgery, Department of Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Jame Abraham
- Department of Hematology Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Halle C F Moore
- Department of Hematology Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Stephen Grobmyer
- Section of Breast Surgery, Oncology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Emily Monteleone
- Department of Cancer Center Administration, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Katherine Tullio
- Department of Cancer Center Administration, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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Yao KA, Attai D, Bleicher R, Kuchta K, Moran M, Boughey J, Wilke LG, Dietz JR, Stevens R, Pesce C, Kopkash K, Kurtzman S, Sarantou T, Victorson D. Covid-19 related oncologist's concerns about breast cancer treatment delays and physician well-being (the CROWN study). Breast Cancer Res Treat 2021; 186:625-635. [PMID: 33517522 PMCID: PMC7847535 DOI: 10.1007/s10549-021-06101-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/09/2021] [Indexed: 12/30/2022]
Abstract
Purpose To examine how treatment delays brought on by the COVID-19 pandemic impacted the physical and emotional well-being of physicians treating these patients. Methods A cross-sectional survey of physician breast specialists was posted from April 23rd to June 11th, 2020 on membership list serves and social media platforms of the National Accreditation Program for Breast Centers and the American Society of Breast Surgeons. Physician well-being was measured using 6 COVID-19 burnout emotions and the 4-item PROMIS short form for anxiety and sleep disturbance. We examined associations between treatment delays and physician well-being, adjusting for demographic factors, COVID-19 testing and ten COVID-19 pandemic concerns. Results 870 physicians completed the survey, 61% were surgeons. The mean age of physicians was 52 and 548 (63.9%) were female. 669 (79.4%) reported some delay in patient care as a result of the COVID-19 pandemic. 384 (44.1%) and 529 (60.8%) of physicians scored outside normal limits for anxiety and sleep disturbance, respectively. After adjusting for demographic factors and COVID-19 testing, mean anxiety and COVID-19 burnout scores were significantly higher among physicians whose patients experienced either delays in surgery, adjuvant chemotherapy, radiation, breast imaging or specialty consultation. A multivariable model adjusting for ten physician COVID-19 concerns and delays showed that “delays will impact my emotional well-being” was the strongest concern associated with anxiety, sleep disturbance and COVID-19 burnout factors. Conclusions Breast cancer treatment delays during the initial surge of the COVID-19 pandemic in the United States were associated with a negative impact on physician emotional wellness. Supplementary Information
The online version of this article (10.1007/s10549-021-06101-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katharine A Yao
- Division of Surgical Oncology, Department of Surgery, Clinical Professor of Surgery, Pritzker School of Medicine, NorthShore University HealthSystem, University of Chicago, 2650 Ridge Ave, Evanston, IL, 60201, USA.
| | - Deanna Attai
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Westwood, CA, USA
| | - Richard Bleicher
- Division of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Kristine Kuchta
- Biostatistical Core, NorthShore University HealthSystem Research Institute, Evanston, IL, USA
| | | | - Judy Boughey
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Lee G Wilke
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Jill R Dietz
- Case Western Reserve University, Cleveland, OH, USA
| | - Randy Stevens
- White Plains Hospital Center for Cancer Care, Westchester, NY, USA
| | - Catherine Pesce
- Division of Surgical Oncology, Department of Surgery, Clinical Professor of Surgery, Pritzker School of Medicine, NorthShore University HealthSystem, University of Chicago, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Katherine Kopkash
- Division of Surgical Oncology, Department of Surgery, Clinical Professor of Surgery, Pritzker School of Medicine, NorthShore University HealthSystem, University of Chicago, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | | | - Terry Sarantou
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - David Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Jackson DK, Li Y, Eskander MF, Tsung A, Oppong BA, Bhattacharyya O, Paskett ED, Obeng-Gyasi S. Racial disparities in low-value surgical care and time to surgery in high-volume hospitals. J Surg Oncol 2020; 123:676-686. [PMID: 33616989 DOI: 10.1002/jso.26320] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/07/2020] [Accepted: 11/16/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The objective of this study is to examine racial differences in receipt of low-value surgical care and time to surgery (TTS) among women receiving treatment at high-volume hospitals. METHODS Stage I-III non-Hispanic Black (NHB) and Non-Hispanic White (NHW) breast cancer patients were identified in the National Cancer Database. Low-value care included (1) sentinel lymph node biopsy (SLNB) among T1N0 patients age ≥70 with hormone receptor-positive cancers, (2) axillary lymph node dissection (ALND) in patients meeting ACOSOG Z0011 criteria, and (3) contralateral prophylactic mastectomy (CPM) with unilateral cancer. TTS was days from biopsy to surgery. Bivariate and logistic regression analyses were used to compare the groups. RESULTS Compared to NHWs, NHBs had lower rates of SLNB among women age ≥70 with small hormone-positive cancers (NHB 58.5% vs. NHW 62.2% p < .001) and CPM (NHB 26.3% vs. NHW 36%; p < .001). ALND rates for patients meeting ACOSOG Z0011 criteria were similar between both groups (p = .13). The odds of surgery >60 days were higher among NHBs (odds ratio, 1.77; 95% confidence interval, 1.64-1.91; NHW ref). CONCLUSIONS NHBs treated at high-volume hospitals have higher rates of surgical delay but are less likely to undergo low-value surgical procedures compared to NHW women.
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Affiliation(s)
| | - Yaming Li
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Mariam F Eskander
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Allan Tsung
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Bridget A Oppong
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Oindrila Bhattacharyya
- Department of Economics, Indiana University Purdue University, Indianapolis, Indiana, USA
| | - Electra D Paskett
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
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Shams S, Lippold K, Blohmer JU, Röhle R, Kühn F, Karsten MM. A Pilot Study Evaluating the Effects of Magtrace® for Sentinel Node Biopsy in Breast Cancer Patients Regarding Care Process Optimization, Reimbursement, Surgical Time, and Patient Comfort Compared With Standard Technetium 99. Ann Surg Oncol 2020; 28:3232-3240. [PMID: 33263157 PMCID: PMC8119277 DOI: 10.1245/s10434-020-09280-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/03/2020] [Indexed: 11/18/2022]
Abstract
Background Sentinel lymph node biopsy after technetium-99 (Tc99) localization is a mainstay of oncologic breast surgery. The timing of Tc99 injection can complicate operating room schedules, which can cause increasing overall costs of care and patient discomfort. Methods This study compared 59 patients who underwent breast cancer surgery including sentinel lymph node biopsy. Based on the surgeon’s choice, 29 patients were treated with Tc99, and 30 patients received the iron-based tracer, Magtrace. The primary outcomes were time spent on the care pathway and operating time from commissioning of the probe to removal of the sentinel node. The secondary outcomes were patient pain levels and reimbursement. Results The mean time spent on the preoperative breast cancer care pathway was significantly shorter for the Magtrace group (5.4 ± 1.3 min) than for the Tc99 group (82 ± 20 min) (p < 0.0001). The median time from probe usage to sentinel node extirpation was slightly but not significantly shorter in the Magtrace group (5 min; interquartile range [IQR], 3–15 min vs 10 min; IQR, 7–15 min; p = 0.151). Reimbursement and pain levels remained unchanged, and the hospital length of stay was similar in the two groups (Magtrace: 5.1 ± 2.3 days vs Tc99: 4.5 ± 3.2 days). Conclusions Magtrace localization shortened the preoperative care pathway and did not affect surgical time or reimbursement. Once established, it could allow for cost reduction and improve patient comfort.
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Affiliation(s)
- Sina Shams
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Kai Lippold
- Directorate of Charité Center 17, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Jens Uwe Blohmer
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Robert Röhle
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Friedrich Kühn
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Maria Margarete Karsten
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
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Morante Z, Ruiz R, Araujo JM, Pinto JA, Cruz-Ku GDL, Urrunaga-Pastor D, Namuche F, Flores C, Mantilla R, Luján MG, Fuentes H, Schwarz L, Aguilar A, Neciosup S, Gómez HL. Impact of the Delayed Initiation of Adjuvant Chemotherapy in the Outcome of Triple Negative Breast Cancer. Clin Breast Cancer 2020; 21:239-246.e4. [PMID: 33221201 DOI: 10.1016/j.clbc.2020.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/15/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Adjuvant chemotherapy decreases the recurrence risk and improves survival rates; however, it is unclear whether a delayed initiation is associated with adverse outcomes, especially in triple negative breast cancer (TNBC). In this study, we evaluated the influence of the time to start adjuvant chemotherapy (TTC) in the outcomes of TNBC. PATIENTS AND METHODS We retrospectively analyzed 15 years of data from patients with TNBC who received adjuvant chemotherapy at the Instituto Nacional de Enfermedades Neoplasicas (Lima, Peru). TTC was categorized into 4 groups: ≤ 30, 31 to 60, 61 to 90, and ≥ 91 days. We evaluated overall survival (OS) and distant recurrence-free survival (DRFS). Cox proportional hazard models were used to identify prognostic factors. RESULTS In total, 687 patients were included. The mean age at diagnosis was 49.1 years (SD, 11.8 years), and most (62.6%) patients had pathologic stage T2. The median TTC was 48.1 days (SD, 27.4 days); 189 (27.5%) received chemotherapy ≤ 30 days; 329 (47.9%), between 31 and 60 days; 115 (16.7%), between 61 and 90 days; and 54 (7.9%) in ≥ 90 days. In the multivariate analysis, a TTC between 31 and 60 days (hazard ratio [HR], 1.78; 95% confidence interval [CI], 1.17-2.72), 61 and 90 days (HR, 2.38; 95%CI, 1.43-3.97), and ≥ 91 days (HR, 2.45; 95% CI, 1.32-4.55) was associated with an increased mortality in contrast with a TTC < 30 days. Although a TTC between 31 and 60 days, 61 and 90 days, and ≥ 91 days was associated with an increased risk of DRFS (HR, 1.86; 95% CI, 1.24-2.79; HR, 2.34, 95% CI, 1.42-3.867; and HR, 3.16; 95% CI, 1.78-5.61, respectively). CONCLUSION A delaying in TTC ≥ 30 days was associated with poorer outcomes. Our data suggest that several efforts should be conducted to avoid a delayed TTC in patients with TNBC.
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Affiliation(s)
- Zaida Morante
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru; Grupo de Estudios Clínico Oncológicos Peruano (GECOPERU), Lima, Peru
| | - Rossana Ruiz
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | - Jhajaira M Araujo
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | - Joseph A Pinto
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | | | - Diego Urrunaga-Pastor
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru; Universidad Científica del Sur, Lima, Peru
| | - Fernando Namuche
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | - Claudio Flores
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | - Raúl Mantilla
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - María G Luján
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | - Hugo Fuentes
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Luis Schwarz
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | - Alfredo Aguilar
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | - Silvia Neciosup
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Henry L Gómez
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Grupo de Estudios Clínico Oncológicos Peruano (GECOPERU), Lima, Peru.
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Sutton TL, Schlitt A, Gardiner SK, Johnson N, Garreau JR. Time to surgery following neoadjuvant chemotherapy for breast cancer impacts residual cancer burden, recurrence, and survival. J Surg Oncol 2020; 122:1761-1769. [PMID: 33125715 DOI: 10.1002/jso.26216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/10/2020] [Accepted: 09/04/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The impact of length of time to surgery (TTS) on oncologic outcomes following neoadjuvant chemotherapy (NAC) in breast cancer patients is unclear. We investigated the relationship between TTS on residual cancer burden (RCB) score and oncologic outcomes. METHODS Patients with breast cancer receiving NAC from 2011 to 2017 were identified. The association of TTS with recurrence-free survival (RFS), overall and disease-specific survival (OS, DSS), and RCB score was examined with Kaplan-Meier and Cox proportional hazards analysis, adjusting for relevant clinicopathologic factors. RESULTS We identified 463 patients. Median TTS was 29 days (range 11-153). Median follow-up was 57 months (range, 2-93 months). Five-year local recurrence-free survival, locoregional RFS, OS, and DSS was 86%, 96%, 89%, and 91%, respectively. On multivariate analysis, TTS >6 weeks was independently associated with worse RFS (HR [hazard ratio] 3.45; p < .001) and DSS (HR 2.82; p < .05), while TTS >6 weeks was independently associated with a positive size of the effect on RCB score of 0.59 (p < .0001). CONCLUSION Prolonged TTS is a modifiable risk factor for adverse oncologic outcomes following NAC for breast cancer, possibly mediated by increasing RCB score overtime after NAC. In the absence of contraindications, surgery should be performed within 6 weeks following NAC for optimal oncologic outcomes.
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Affiliation(s)
- Thomas L Sutton
- Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Alexander Schlitt
- College of Osteopathic Medicine of the Pacific-Northwest, Western University Of Health Sciences, Lebanon, Oregon, USA
| | - Stuart K Gardiner
- Devers Eye Institute, Legacy Research Institute, Legacy Health, Portland, Oregon, USA
| | - Nathalie Johnson
- Legacy Cancer Institute, Legacy Medical Group Surgical Oncology, Portland, Oregon, USA
| | - Jennifer R Garreau
- Legacy Cancer Institute, Legacy Medical Group Surgical Oncology, Portland, Oregon, USA
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Azap RA, Hyer JM, Diaz A, Tsilimigras DI, Mirdad RS, Pawlik TM. Sex-based differences in time to surgical care among pancreatic cancer patients: A national study of Medicare beneficiaries. J Surg Oncol 2020; 123:236-244. [PMID: 33084065 DOI: 10.1002/jso.26266] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/01/2020] [Accepted: 10/05/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The objective of this study was to characterize time from cancer symptoms to diagnosis and time from diagnosis to surgical treatment among patients undergoing pancreatectomy for cancer. METHODS Medicare beneficiaries who underwent pancreatectomy for cancer between 2013 and 2017 were identified using the 100% Medicare Inpatient Standard Analytic Files. Mixed effects negative binomial regression models were utilized to determine which factors were associated with the number of weeks to diagnosis and pancreatic resection. RESULTS Among 7647 Medicare beneficiaries, two-thirds (n = 5127, 67%) had symptoms associated with a pancreatic cancer diagnosis before surgery. Median time from the first symptom to diagnosis was 6 weeks (IQR: 1-25) and the median time from diagnosis to surgery was 4 weeks (IQR: 2-15). In risk-adjusted models, female patients had 13% longer waiting times from identification of a related symptom to pancreatic cancer diagnosis (OR = 1.13, 95% CI: 1.05-1.21) and 12% longer waiting times from diagnosis to surgery (OR = 1.12, 95% CI: 1.07-1.18). Older age was associated with 10% longer waiting times from symptom identification to diagnosis (p < .0001). CONCLUSIONS Female and older patients had longer wait times between symptom presentation and pancreatic cancer diagnosis. Sex-based disparities in cancer care need to be recognized and addressed by policymakers and health care institutions.
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Affiliation(s)
- Rosevine A Azap
- Department of Surgery, The Ohio State University, Wexner Medical Center, James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - James M Hyer
- Department of Surgery, The Ohio State University, Wexner Medical Center, James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Adrian Diaz
- National Clinician Scholars Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Diamantis I Tsilimigras
- Department of Surgery, The Ohio State University, Wexner Medical Center, James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Rayyan S Mirdad
- Department of Surgery, The Ohio State University, Wexner Medical Center, James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University, Wexner Medical Center, James Comprehensive Cancer Center, Columbus, Ohio, USA
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Luis Pendola G, Elizalde R, Vargas PS, Mallarino JC, González E, Parada J, Camus M, Schwartz R, Bargalló E, Freitas R, Costa MM, de Oliveira VM, Escobar P, Oller M, Viaña LF, Bambino AJ, Sarria G, Terrier F, Corrales R, Sanabria V, Agostini JCR, Chacón GV, Pérez VM, Avilés V, Galarreta J, Laviña G, Fuentes JP, de Castellanos LB, Osorio BA, Castillo H, Figueroa C. Management of non-invasive tumours, benign tumours and breast cancer during the COVID-19 pandemic: recommendations based on a Latin American survey. Ecancermedicalscience 2020; 14:1115. [PMID: 33209106 PMCID: PMC7652542 DOI: 10.3332/ecancer.2020.1115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Indexed: 11/06/2022] Open
Abstract
Introduction The COVID-19 pandemic has changed health systems across the world, both in general hospitals and in oncology institutes or centres.For cancer specialists, particularly breast cancer (BC), the COVID-19 pandemic represents a combination of challenges since the hospital resources and staff have become more limited; this has obliged oncology specialists to seek a consensus and establish which patients with BC require more urgent attention and which patients can wait until there is a better control of this pandemic. The health system in Latin America has some special characteristics; in some of the countries, there are shortages which limit access to several specialities (surgery, clinical oncology and radiotherapy) in some regions. Objective After a systematic review of the most recent literature regarding the management of BC during the COVID-19 pandemic, the main objective is to understand the position of the different Latin American Societies of Mastology in terms of available alternatives for the treatment of BC. Methods After carrying out a comprehensive and exhaustive search of the most recent guides on the management of BC during the COVID-19 pandemic, the board members of the Latin American Federation of Mastology invited, via email, different specialists, all experts in BC care, to complete an anonymous survey online.The survey was distributed between 30 and 10 May 2020. The survey included 27 questions on four topics: demographic information, consultations, imaging and treatment of BC.The questionnaire was sent and then distributed to various health specialists including breast surgeons, clinical oncologists, radiation oncologists and radiologists via the Presidents of the different Latin American Societies of Mastology in 18 countries. The results are summarised as tallies based on the number of responses to each question. Results A total of 499 responses were received. The majority of the respondents were males (275 (55.11%)); 290 participants were over 45 years (58.11%).The questionnaire presented those surveyed with three possible answers (agree, disagree and neither agree nor disagree). The results reflect that there was consensus in the majority of situations presented. Only seven questions revealed disagreement among those responding. The results are presented as recommendations. Conclusion The management of patients with BC presents unique challenges during the current world health situation produced by COVID-19 pandemic. Breast care specialists (surgical oncologists, breast care clinicians, clinical oncologists, radiation oncologists and radiologists) from 18 countries in Central and South America submitted through their responses and recommendations for the treatment of BC during the COVID-19 pandemic.
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Affiliation(s)
- G Luis Pendola
- Ecuadorian Society of Breast Pathology (SEPAM Guayaquil Ecuador), Mastology Service, National Oncology Institute-Society to Fight Cancer, (CENONI) Comprehensive Oncology Centre, Guayaquil 090513, Ecuador
| | - Roberto Elizalde
- Argentinian Society of Mastology (SAM), Pirovano Hospital Buenos Aires, Buenos Aires, Argentina
| | - Pablo Sitic Vargas
- Bolivian Society of Mastology, Oncology Institute of East Bolivia, Santa Cruz, Bolivia
| | | | - Eduardo González
- Argentinian Society of Mastology (SAM), Ángel H Roffo Oncology Institute, University of Buenos Aires, C1053 CABA, Argentina
| | - José Parada
- Uruguayan Society of Mastology, Image Clinic Drs. Parada, Maldonado Hospital, Dr. Elbio Rivero, Cantegril Sanatorium, Punta del Este, Maldonado, Uruguay
| | - Mauricio Camus
- Chilean Society of Mastology, Clinical Hospital, Catholic Pontificia University of Chile, Chile
| | - Ricardo Schwartz
- Chilean Society of Mastology, Santiago Military Hospital, Las Condes Clinic, Chile
| | - Enrique Bargalló
- Mexican Association of Mastology, National Cancer Institute, ABC Medical Centre, Mexico
| | | | | | | | - Paula Escobar
- Chilean Society of Mastology, Santiago de Chile, Chile
| | - Miguel Oller
- Dominican Society of Surgery, Santo Domingo, Republica Dominicana
| | | | | | | | - Francisco Terrier
- Argentinian Society of Mastology, Italian de La Plata Hospital, Buenos Aires, Argentina
| | | | - Valeria Sanabria
- Paraguayan Society of Mastology, Itauguá National Hospital, Paraguay
| | | | | | | | - Verónica Avilés
- Nicaraguan Mastology Association, Vivian Pellas Hospital Managua, Managua, Nicaragua
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Valente S, Al-Hilli Z, Liu Y, Greve N, Tu C, Grobmyer SR. Association of patient factors with time to treatment for breast cancer. Breast J 2020; 26:1995-2001. [PMID: 32924203 DOI: 10.1111/tbj.14046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 06/20/2020] [Accepted: 08/19/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Studies have shown that in the United States, there is an increasing time from breast cancer diagnosis to first treatment (time to treatment or "TTT"), with concern that such delays may worsen oncologic outcomes. A component of TTT is the time from the initial diagnosis to initial surgical consultation (SC). We sought to identify patient-related factors associated with time to initial SC, and evaluate how this interval is associated with overall total time to treatment (TTT). METHODS A prospective database of women diagnosed with breast cancer at our institution from 2015 to 2016 was reviewed. Time from initial breast cancer diagnosis to SC and overall TTT was collected from the electronic medical record. Documented patient-identified preferences regarding scheduling the first surgical appointment were reviewed. A multivariate analysis was performed to determine clinical and patient factors associated with TTT. RESULTS Of 553 breast cancer patients included in the study, 27% of women opted for the earliest appointment while 73% chose a later date. The median time from diagnosis to SC was 8.5 ± 4.7 days. Patients who accepted a first available SC waited an average of 5.6 ± 3.4 days, while those who deferred waited 9.5 ± 4.6 days (P < .001). Patients who deferred the earliest available SC were older, with a median age of 67 versus 63 years, (P = .018), and had a preference for a specific location in the geographical hospital region (P = .003). Patients who deferred the first available SC also had a longer TTT (33 vs. 28 days, P = .027). DISCUSSION Among newly diagnosed breast cancer patients, there is a substantial population that defers the first available SC. These patients are also more likely to have a prolonged TTT. Future follow-up of this cohort is necessary to determine the delays on TTT affect cancer outcomes and overall survival.
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Affiliation(s)
- Stephanie Valente
- Division of Breast Services, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Zahraa Al-Hilli
- Division of Breast Services, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Yitian Liu
- Division of Breast Services, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Nancy Greve
- Division of Breast Services, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Chao Tu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Stephen R Grobmyer
- Oncology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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Li J, Wang H, Geng C, Liu Z, Lin Y, Nie J, Sun G, Ouyang Q, Wang X, Li X, Liu Y, Chen Q, Fu P, Yao F, Chen J, Chen Y, Zhao H, Yin Y, Zhang J, Chen J, Kong X, Cheng J, Zhang H, Peng S, Wang G, Jin F, Liu Y, Wu G, Sun S, Jiang Z. Suboptimal declines and delays in early breast cancer treatment after COVID-19 quarantine restrictions in China: A national survey of 8397 patients in the first quarter of 2020. EClinicalMedicine 2020; 26:100503. [PMID: 32989430 PMCID: PMC7511845 DOI: 10.1016/j.eclinm.2020.100503] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cancer patients had been profoundly affected by the outbreak of COVID-19 especially after quarantine restrictions in China. We aimed to explore the treatment changes and delays of early breast cancer (EBC) during the first quarter of 2020. METHODS We did this retrospective, multicentre, cohort study at 97 cancer centres in China. EBC patients who received treatment regardless of preoperative therapy, surgery or postoperative therapy during first quarter of 2020 were included. FINDINGS 8397 patients were eligible with a median age of 50 (IQR 43-56). 0·2% (15/8397) of EBC patients were confirmed as COVID-19 infection. Only 5·2% of breast cancer diagnosis occurred after quarantine in Hubei compared with 15·3% in other provinces (OR= 0·30, 95%CI 0·24-0·38). postoperative endocrine therapy were least affected compared with different regions after quarantine (OR=0·37 [95%CI 0·19-0·73]). The proportion of surgery decreased from 16·4% in December last year to 2·6% in February in Hubei. Compared with intervals from diagnosis to treatment before quarantine restrictions, the average time increased with significance from 3·5 to 7·7 days in Hubei and 5·7 to 7·7 days in other provinces (p< 0·001). There were also 18·5 and 7·2 days delay in Hubei and other provinces respectively when calculating interval from surgery to postoperative therapy. INTERPRETATION EBC from high risk regions had a comparative rate of COVID-19 infection. After implementation of COVID-19 quarantine restrictions, fewer diagnosis and surgery with significant delays were seen when compared with treatment before. FUNDING Beijing Medical Award Foundation (YJ0120).
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Affiliation(s)
- Jianbin Li
- The Fifth Medical Centre of Chinese PLA General Hospital, Beijing, China
- Beijing Institute of Biotechnology, Beijing, China
| | - Haibo Wang
- The Affiliated Hospital of Qingdao University, Shandong, China
| | | | | | - Ying Lin
- The First Affiliated Hospital of Sun Yat-sen University, Guangdong, China
| | | | - Gang Sun
- Cancer Hospital of Xinjiang Medical University, Xinjiang, China
| | | | - Xiaojia Wang
- Cancer Hospital of the university of Chinese Academy of Science, Zhejiang, China
| | - Xingrui Li
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Yinhua Liu
- Peking University First Hospital, Beijing, China
| | - Qianjun Chen
- Guangdong Hospital of Traditional Chinese Medicine, Guangdong, China
| | - Peifen Fu
- The First Affiliated Hospital of Zhejiang University, Zhejiang, China
| | - Feng Yao
- Renmin Hospital of Wuhan University, Hubei, China
| | - Jishang Chen
- People's Hospital of Yangjiang, Guangdong, China
| | - Yiding Chen
- The Second Affiliated Hospital School of Medicine Zhejiang University, Zhejiang, China
| | - Haidong Zhao
- The Second Hospital of Dalian Medical University, Liaoning, China
| | | | - Jingjie Zhang
- The First Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Jiayi Chen
- Shanghai Jiaotong University School of Medicine Ruijin Hospital, Shanghai, China
| | | | - Jing Cheng
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Haiqing Zhang
- Affiliated Dalian Municipal Central Hospital of Dalian Medical University, Liaoning, China
| | - Shijun Peng
- The Central Hospital of Enshi Autonomous Prefecture, Hubei, China
| | - Geng Wang
- Affiliated Taihe Hospital of Hubei University of Medicine, Hubei, China
| | - Feng Jin
- The First Hospital of China Medical University, Liaoning, China
| | | | - Gang Wu
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | | | - Zefei Jiang
- The Fifth Medical Centre of Chinese PLA General Hospital, Beijing, China
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Xu J, Bromley L, Chew G, Yeo B. "First Do No Harm": Significance of Delays from Diagnosis to Surgery in Patients with Non-metastatic Breast Cancer. World J Surg 2020; 44:3812-3820. [PMID: 32776194 DOI: 10.1007/s00268-020-05725-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The majority of patients with non-metastatic breast cancer will undergo surgery. This involves complex decisions that inevitably increase time from diagnosis to surgery beyond the currently recommended 30 days. This study aims to analyse factors that increase time to surgery and establish whether it is justifiable in the context of improved individualised breast cancer management. METHODS A retrospective analysis of all patients at Austin Health surgically managed for non-metastatic invasive breast carcinoma between 2013 and 2019 was conducted. Time to surgery (TTS) was defined as time between informed diagnosis and cancer surgery. The patients were grouped into TTS groups of ≤30 days and >30 days. Kaplan-Meier survival analysis and Cox proportional hazards regression model were used to evaluate the impact of time interval between diagnosis and surgery. RESULTS Seven hundred and thirty-one patients were included in our TTS analysis, only half of this cohort received surgery within the recommended 30 days. Many of the factors identified to be associated with increased TTS are the key to optimal management. Median follow-up for the cohort was 30 months. Between wait groups of ≤30 and >30 days, there were no significant association found between TTS and survival outcomes for DFS (HR 1.20 95% CI 0.56-2.60) and OS (HR 1.58 95% CI 0.82-3.03). CONCLUSION Breast cancer management involves complex factors that significantly increase TTS. Surgery within 30 days of diagnosis is not associated with improved DFS and OS. Outcomes from this study support a revision of current recommendations for TTS in non-metastatic breast cancer care.
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Affiliation(s)
- Jennifer Xu
- University of Melbourne, Parkville, VIC, 3010, Australia. .,Royal Melbourne Hospital, 300 Grattan St, Parkville, 3050, Australia.
| | - Luke Bromley
- University of Melbourne, Parkville, VIC, 3010, Australia
| | - Grace Chew
- Department of Surgery, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia.,Department of Surgery, Northern Health, 185 Cooper St, Epping, VIC, 3076, Australia.,St Vincent's BreastScreen, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia
| | - Belinda Yeo
- Department of Medical Oncology, Olivia Newton John Cancer Research Institute, 145 Studley Road, Heidelberg, VIC, 3084, Australia.,Department of Medical Oncology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia.,School of Cancer Medicine, La Trobe University, Bundoora, VIC, 3086, Australia
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Bekeny JC, Luvisa K, Wirth P, Singh T, Black CK, Greenwalt I, Song DH, Giladi AM, Tousimis EA, Fan KL. Critical evaluation of factors contributing to time to mastectomy within a single health care system. Breast J 2020; 26:1702-1711. [PMID: 32656954 DOI: 10.1111/tbj.13953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 11/30/2022]
Abstract
Increased time to mastectomy (TTM) has significant implications for mortality, well-being, and satisfaction. However, certain populations are subject to disparities that increase TTM. This study examines vulnerable populations and the patient-, disease-, provider-, and system-level factors related to treatment delays. Patients undergoing mastectomy for breast cancer from 2014 to 2018 across 8 hospitals in a single health care system were retrospectively reviewed. Demographics, disease characteristics, and provider- and system-level information were collected. Time from biopsy-proven diagnosis to mastectomy was calculated. Univariate analysis identified variables for inclusion in the multivariable model. One thousand, three hundred thirty patients met inclusion. Median TTM was 55.0 days. Factors from all levels-patient, disease, provider, and systemic-were significantly related to disparities. African-American patients had 11.6% longer TTM compared to white patients (69.0 vs 56.0 days, P < .0001). TTM was 15.5% longer for low-income patients when compared to high-income patients (65.0 vs 49.0 days, P = .0014). Preoperative plastic surgery visits led to 19.3% longer TTM (P = .0012); oncologic appointments for neo-adjuvant chemotherapy led to a 231.0% increase (P < .0001). Average time from last neo-adjuvant treatment to mastectomy was 44.4 days (SD 26.5); average TTM from diagnosis for patients not receiving neo-adjuvant chemotherapy was 58.5 days (SD 13.3). Patients with Medicaid waited 14.5% longer compared to patients with commercial insurance (94.0 vs 62.0 days, P = .0005). In our review of care across a large health care system, we identified multiple levels contributing to disparities in TTM. Identification of these disparities offers valuable insight into process improvement and intervention.
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Affiliation(s)
- Jenna C Bekeny
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Kyle Luvisa
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Peter Wirth
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Tanvee Singh
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Cara K Black
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Ian Greenwalt
- Division of Breast Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - David H Song
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Aviram M Giladi
- Department of Plastic and Reconstructive Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland
| | - Eleni A Tousimis
- Division of Breast Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Kenneth L Fan
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
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Gadgil A, Sauvaget C, Roy N, Muwonge R, Lucas E, Sankaranarayanan R. Setting up a Breast Cancer Awareness Project in Mumbai: Methodology, Experiences and Challenges. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:579-588. [PMID: 30863980 DOI: 10.1007/s13187-019-01500-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
More than two thirds of breast cancers in developing countries are diagnosed at a late stage. Awareness-based screening programmes, integrated into existing infrastructure, are the way forward for cancer control in these countries. We aim to describe a structured screening programme established in an urban community in Mumbai, India. We conducted a breast cancer awareness survey in this urban community covered by employees' health scheme. A brochure was designed to inform women about early signs of breast cancer and was posted for the women in the community. We described early signs and symptoms of breast cancer and encouraged the women to seek healthcare in the breast clinics specifically designed for early referral. A multidisciplinary team was established for further in-house care at the community hospital. A database of the detected cancers was maintained. A total of 22,500 brochures were sent in each round of mailing. Four such rounds were conducted in 3 years. A total of 3547 women reported for clinical breast examination (CBE) for various breast complaints or screening. Of these women, 53% were asymptomatic. CBE was normal in 2843 women, and 767 (21%) women were referred for further investigations. Eighty-three breast cancers were detected with 72% having early (stage I-II) cancers. Our exploratory study revealed that awareness-based screening programmes with organised infrastructure and referral pattern could lead to diagnosing early cancers.
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Affiliation(s)
- Anita Gadgil
- Department of Surgery, Bhabha Atomic Research Centre Hospital, WHO-CC for Surgical Care Delivery in LMIC, Mumbai, India
| | - Catherine Sauvaget
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon CEDEX 08, France.
| | - Nobhojit Roy
- Department of Surgery, Bhabha Atomic Research Centre Hospital, WHO-CC for Surgical Care Delivery in LMIC, Mumbai, India
| | - Richard Muwonge
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon CEDEX 08, France
| | - Eric Lucas
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon CEDEX 08, France
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Kovar A, Bronsert M, Jaiswal K, Murphy C, Wolverton D, Ahrendt G, Tevis S. The Waiting Game: How Long Are Breast Cancer Patients Waiting for Definitive Diagnosis? Ann Surg Oncol 2020; 27:3641-3649. [PMID: 32314153 DOI: 10.1245/s10434-020-08484-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Receiving a new breast cancer (BC) diagnosis can cause significant patient anxiety, which is amplified by delays in diagnosis. There is a lack of defined time periods for delays in the workup of BC. This study aims to evaluate national variations in timing from first abnormal mammogram to first biopsy and to determine independent predictors of delay in diagnosis. PATIENTS AND METHODS Data were derived from SEER-Medicare linked claims database from 2007 to 2013. Time intervals from abnormal mammogram, either screening or diagnostic, to biopsy were assessed. The fourth quartile for timing from first mammogram to first biopsy was utilized to define delay in diagnosis. Multivariate analyses were used to evaluate the association between clinicopathologic variables and delays in diagnosis. RESULTS We analyzed 53,758 patients with stage 0-II BC who underwent upfront surgery. Significant variations in timing of care were identified, with mean times from mammogram to biopsy, surgeon visit, and breast surgery of 23.3, 31.6, and 52.6 days, respectively. Over the study period, there was a decrease in delays from mammogram to biopsy. Non-White race, Northeast location, and earlier stage disease were found to be independent predictors of delays in the diagnosis of BC (p < 0.0001). CONCLUSIONS The study demonstrates significant variations in time to diagnostic biopsy. More efficient processes of care to address these delays should be implemented, and further studies are needed to determine whether improved efficiency decreases patient anxiety. The large variations in time to diagnosis speak to the need for consensus guidelines to establish a standard of care.
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Affiliation(s)
- Alexandra Kovar
- Department of Surgery, University of Colorado, Aurora, CO, USA
| | - Michael Bronsert
- University of Colorado School of Medicine, Surgical Outcomes and Applied Research (SOAR) Program and Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), Aurora, CO, USA
| | - Kshama Jaiswal
- Division of Breast Surgery, Denver Health Medical Center, Denver, CO, USA
| | - Colleen Murphy
- Department of Surgery, University of Colorado, Aurora, CO, USA
| | - Dulcy Wolverton
- Department of Radiology, University of Colorado, Aurora, CO, USA
| | | | - Sarah Tevis
- Department of Surgery, University of Colorado, Aurora, CO, USA.
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Bhutiani N, Hicks AC, Huang B, Chen Q, Tucker TC, McMasters KM, Ajkay N. Identifying factors influencing delays in breast cancer treatment in Kentucky following the 2014 Medicaid expansion. J Surg Oncol 2020; 121:1191-1200. [DOI: 10.1002/jso.25914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 03/08/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Neal Bhutiani
- Division of Surgical Oncology, Department of SurgeryUniversity of Louisville Louisville Kentucky
| | - Adam C. Hicks
- Division of Surgical Oncology, Department of SurgeryUniversity of Louisville Louisville Kentucky
| | - Bin Huang
- Department of BiostatisticsUniversity of Kentucky Lexington Kentucky
| | - Quan Chen
- Department of BiostatisticsUniversity of Kentucky Lexington Kentucky
| | - Thomas C. Tucker
- Department of Epidemiology, College of Public HealthUniversity of Kentucky Lexington Kentucky
| | - Kelly M. McMasters
- Division of Surgical Oncology, Department of SurgeryUniversity of Louisville Louisville Kentucky
| | - Nicolás Ajkay
- Division of Surgical Oncology, Department of SurgeryUniversity of Louisville Louisville Kentucky
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