The Risk of Delayed Adjuvant Chemotherapy with Immediate Breast Reconstruction
*Amulya C. Alapati, *Aaron Fleishman, Ted A. James
Beth Israel Deaconess Medical center, Boston, MA
OBJECTIVE: The timely initiation of adjuvant chemotherapy (AC) is associated with a survival benefit in breast cancer, and has emerged as an important quality metric. Prior studies have identified immediate autologous reconstruction (IAR) as a significant risk factor leading to delay in AC. The purpose of this study was to evaluate demographic and clinical factors associated with delays in AC among patients undergoing mastectomy and IAR. .
DESIGN: Retrospective analysis of prospective national database
SETTING: Data were derived from de-identified National Cancer Data Base (NCDB) files. The NCDB is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society.
PATIENTS OR OTHER PARTICIPANTS: Female patients with stage 1-3 breast cancer diagnosed between 2010-2015 undergoing IAR and AC. Initiation of AC beyond 90 days was defined as delayed.
MAIN OUTCOME MEASURE(S): Multivariable logistic regression was performed to investigate associations between delayed AC and clinical/demographic factors.
RESULTS: Of 11,881 women undergoing IAR, 521(4.39%) had delay in adjuvant chemotherapy. Unplanned re-admissions (OR 2.42), non-Hispanic black and Hispanic ethnicities (OR 2.08, 1.96), age 55-69 (OR 1.55), low-medium volume (OR 1.43), multiple co-morbidity (OR 1.40), and treatment at an academic facility (OR 1.27) were associated with delay in AC (p<0.005). Unilateral vs. bilateral procedure, income level ,level, insurance, and tumor characteristics had no impact of timing of AC
CONCLUSIONS: Clinical and demographic factors associated with delay in AC following mastectomy and IAR were identified from a national cancer database. Given the impact of timeliness of systemic therapy on breast cancer survival, measures to identify and address ‘high risk’ patients undergoing IAR may result in improved outcomes.