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Time to Treatment: Measuring Quality Breast Cancer Care

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

To optimize breast cancer care, several organizations have crafted guidelines to define best practices for treating breast cancer. In addition to recommended therapies, ‘timeliness of treatment’ has been proposed as a quality metric. Our study evaluates time to surgical treatment and its effect on overall survival (OS).

Methods

The National Cancer Data Base (NCDB) was used to identify women diagnosed with invasive breast cancer between 2004 and 2012. Time from diagnosis to surgical treatment was calculated and grouped according to predetermined time intervals. Univariate and multivariate Cox proportional hazard models were used to assess patient and treatment factors related to OS.

Results

Overall, 420,792 patients initially treated with surgery were identified. Increased time to surgical treatment >12 weeks was associated with decreased OS [hazard ratio (HR) 1.14, 95 % confidence interval (CI) 1.09–1.20]. When stratified by pathologic stage, stage I patients treated at 8 to <12 weeks (HR 1.07, 95 % CI 1.02–1.13) and >12 weeks (HR 1.19, 95 % CI 1.11–1.28), as well as stage II patients treated at >12 weeks (HR 1.16, 95 % CI 1.08–1.25), had decreased OS compared with patients treated at <4 weeks. Other variables associated with decreased survival were treatment at a community cancer program, Medicaid or Medicare insurance, Black race, increasing age, mastectomy, moderately and poorly differentiated tumor grade, increasing T and N stage, and higher Charlson Index Group.

Conclusion

The survival benefit of expedited time to initial surgical treatment varies by stage and appears to have the greatest impact in early-stage disease. Prior to establishing standard metrics, further quantification of the impact on patient outcomes is needed.

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Authors and Affiliations

  1. City of Hope National Medical Center, Duarte, CA, USA

    Amy C. Polverini MD, Rebecca A. Nelson PhD, Emily Marcinkowski MD, Veronica C. Jones MD, Lily Lai MD, Joanne E. Mortimer MD, Lesley Taylor MD, Courtney Vito MD, John Yim MD & Laura Kruper MD

Authors
  1. Amy C. Polverini MD
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  2. Rebecca A. Nelson PhD
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  3. Emily Marcinkowski MD
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  4. Veronica C. Jones MD
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  5. Lily Lai MD
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  6. Joanne E. Mortimer MD
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  7. Lesley Taylor MD
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  10. Laura Kruper MD
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Corresponding author

Correspondence to Laura Kruper MD.

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Polverini, A.C., Nelson, R.A., Marcinkowski, E. et al. Time to Treatment: Measuring Quality Breast Cancer Care. Ann Surg Oncol 23, 3392–3402 (2016). https://doi.org/10.1245/s10434-016-5486-7

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  • DOI: https://doi.org/10.1245/s10434-016-5486-7

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