Minimizing Time Between Diagnosis and End of Treatment Improves Breast Cancer Survival, Study Says

Cancer

It comes as no surprise that timely treatment is an important factor in the survivability of breast cancer. However, you may be a bit more surprised to hear that getting done with treatment quickly can also promote survival.

Researchers at the Cleveland Clinic and Cleveland Clinic Abu Dhabi found that there was a notable increase in patient survival rates when all the patients’ treatments, regardless of which types of treatments are used, are completed within 38 weeks from the date of diagnosis.

The study involved more than 28,000 breast cancer patients, all of whom were registered in the American National Cancer Database. Researchers measured the five-year survival of each patient and found that 89.9 percent survived for at least five years when their treatment time was less than 38 weeks, compared to 83.3 percent survival among patients whose treatment took longer than 38 weeks to complete.

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Previous studies have established poorer outcomes and less survivability among patients who experience a delay between their diagnosis and their first treatment. For example, the time between diagnosis and the first surgical treatment should be less than 90 days, and the time to first adjuvant chemotherapy should be less than 120 days. However, this is the first study to establish a change in survival rates based on the time it takes for treatments to be concluded.

“The biggest difference in our study from others that have looked at time to treat was that we looked at the time from diagnosis to the completion of the multimodality treatment, not only at one individual part, to identify the 38-week window to improve survival rate for patients with breast cancer,” says Debra Pratt, M.D., director of the Breast Center at Cleveland Clinic Fairview Hospital and the lead author of the study.

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In breast and other cancers, patients don’t only get surgery, but may also require chemotherapy and radiation therapy,” Dr. Pratt continues. “This becomes a complicated system to navigate and there are multiple reasons why delays arise in treatment being completed. This analysis helps us identify opportunities for improving care within the delivery systems.”

The researchers say their study demonstrates that optimal treatment completion times are actually shorter than the currently recommended completion times.

“What we found is that the optimal time for treatment completion is 99 days shorter than C3PR quality indicators,” Dr. Pratt says. “We have so much more data now to reassess these quality indicators and determine what those metrics should be.”

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The authors of the study recommend that healthcare systems take a careful look at when and why delays in the treatment process are occurring and work on minimizing them. There are often valid medical, personal, and systemic reasons for delaying treatments, but decreasing delays and shortening treatment times could greatly improve outcomes for patients. Adequate staffing, reduction in insurance delays, and other improved systems that increase ease of access could help achieve this goal.

“What we see happen traditionally in the U.S. and even in the U.A.E. is that the patient has to visit multiple specialists – first a surgeon, then a medical oncologist for chemotherapy followed by a radiation oncologist – all of which are scheduled weeks apart and in different places,” says Stephen Grobmyer, M.D., chair of the Oncology Institute at Cleveland Clinic Abu Dhabi, an integral part of Mubadala Health, and a co-author on the study. “There is this phenomenon of ‘serial care,’ rather than coordinated and planned care.”

Further studies should look into which treatment types result in the greatest delays and what could be changed to minimize those delays.

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