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Research Article
Rajesh Balkrishnan
University of Virginia School of Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9363-9257
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Introduction: The relationship between survival and time to the start of adjuvant chemotherapy (AC) among breast cancer patients is unclear. Most breast cancer patients start adjuvant chemotherapy within a few weeks after surgery, but it is still unclear whether a delay in the initiation of chemotherapy will lead to adverse outcomes.
Methods: Women diagnosed between 2004 and 2016 with invasive breast cancer (stages I-III) and treated with surgery and adjuvant chemotherapy were selected from the National Cancer Database (n= 443,100). We evaluated factors associated with prolonged time to start adjuvant chemotherapy (≥60, ≥90, and ≥120 days after surgical resection) using multivariable log binomial models to estimate risk ratios (RRs) and 95% CIs. Cox proportional hazards model was used to investigate the effect of delay on survival.
Results: The average time to adjuvant chemotherapy was 47.93 days (±29.17 days). Non-Hispanic African American patients had higher risk of 60-day delay (RR, 1.41; 95% CI, 1.38 to 1.43), 90-day delay (RR, 1.55; 95% CI, 1.50 to 1.60), and 120-day delay (RR, 1.69; 95% CI, 1.61 to 1.78) compared with non-Hispanic white patients. Early initiation of chemotherapy, less than 1 month (RR, 0.893; 95% CI, 0.86 to 0.92), 1-2 month (RR, 0.80; 95% CI, 0.77 to 0.82), and 2-3 month (RR, 0.87; 95% CI, 0.84 to 0.90); was associated with decreased overall mortality. Non-Hispanic African Americans (RR, 1.16; 95% CI, 1.13 to 1.19) were associated with increased overall mortality compared to non-Hispanic whites.
Conclusion: Black breast cancer patients experience clinically relevant delays in the initiation of adjuvant chemotherapy more often than white patients, which may in part explain the increased mortality observed among black patients. Efforts should be made to reduce the time to surgery when possible to enhance overall survival.
Keywords
Breast Cancer, Treatment Delay, United States, Disparities, Ethnicity, Surgery
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A new preprint design is coming!
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This preprint is under consideration at Breast Cancer Research and Treatment. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Rajesh Balkrishnan
University of Virginia School of Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9363-9257
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 15 Mar, 2021
No community comments so far
Reviewers invited
Invitations sent on 09 Mar, 2021
Reviews received
Received 09 Mar, 2021
Editor assigned
On 04 Mar, 2021
First submitted
On 01 Mar, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Introduction: The relationship between survival and time to the start of adjuvant chemotherapy (AC) among breast cancer patients is unclear. Most breast cancer patients start adjuvant chemotherapy within a few weeks after surgery, but it is still unclear whether a delay in the initiation of chemotherapy will lead to adverse outcomes.
Methods: Women diagnosed between 2004 and 2016 with invasive breast cancer (stages I-III) and treated with surgery and adjuvant chemotherapy were selected from the National Cancer Database (n= 443,100). We evaluated factors associated with prolonged time to start adjuvant chemotherapy (≥60, ≥90, and ≥120 days after surgical resection) using multivariable log binomial models to estimate risk ratios (RRs) and 95% CIs. Cox proportional hazards model was used to investigate the effect of delay on survival.
Results: The average time to adjuvant chemotherapy was 47.93 days (±29.17 days). Non-Hispanic African American patients had higher risk of 60-day delay (RR, 1.41; 95% CI, 1.38 to 1.43), 90-day delay (RR, 1.55; 95% CI, 1.50 to 1.60), and 120-day delay (RR, 1.69; 95% CI, 1.61 to 1.78) compared with non-Hispanic white patients. Early initiation of chemotherapy, less than 1 month (RR, 0.893; 95% CI, 0.86 to 0.92), 1-2 month (RR, 0.80; 95% CI, 0.77 to 0.82), and 2-3 month (RR, 0.87; 95% CI, 0.84 to 0.90); was associated with decreased overall mortality. Non-Hispanic African Americans (RR, 1.16; 95% CI, 1.13 to 1.19) were associated with increased overall mortality compared to non-Hispanic whites.
Conclusion: Black breast cancer patients experience clinically relevant delays in the initiation of adjuvant chemotherapy more often than white patients, which may in part explain the increased mortality observed among black patients. Efforts should be made to reduce the time to surgery when possible to enhance overall survival.
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