Abstract P1-12-08: Factors associated with delays in chemotherapy initiation among patients with breast cancer

Abstract

Abstract Background: National guidelines endorse time-dependent quality metrics for breast cancer care. We examined factors associated with delays in chemotherapy initiation at an NCI designated comprehensive cancer center. Methods: We identified 523 patients who received post-operative adjuvant chemotherapy between January 2011 and December 2013 at our center. We defined 28 days from last definitive surgery (LDS) to chemotherapy as the target timeframe, and unacceptable delay in chemotherapy initiation (UCD) as more than 42 days from LDS. Multivariate regression models were used to identify factors associated with UCD and the impact of Oncotype testing in HR+ patients. Results: Median days between LDS and chemotherapy initiation was 34 (IQR 15), with 30% of patients starting within 28 days of LDS and 23% having UCD (Table 1). Tumor characteristics such as subtype and stage affected UCD; patients with HR+ or HER2+ tumors were more likely to be delayed compared to those with TNBC. Patients with stage I disease were more likely to be delayed as well as patients undergoing mastectomy or mastectomy with reconstruction. Patients whose pathology sign-out was more than 10 days post-operatively were more likely to be delayed. A higher proportion of UCD was found in HR+ patients (31%) who received an Oncotype recurrence score compared to those who did not (20%). Table 1: Factors associated with delays in chemotherapy initiation N% DelayOdds Ratio95% CITotal52323 Age<4068191.00.5-2.340 to 49165161.0--50 to 59150252.01.1-3.660 to 69113282.51.3-5.070+27374.11.4-12.3RaceWhite424221.0--Non-White79271.50.8-2.7Missing20251.10.4-3.3InsurancePrivate419211.0--Public104321.60.8-2.9StageI208211.0--II243281.30.8-2.1III72110.30.1-0.7Tumor SubtypeHER2-/HR-105151.0--HR+HER2-264242.11.1-4.2HER2+154272.01.0-3.9Surgery TypeLumpectomy265161.0--Mastectomy89292.51.3-4.5Mastectomy with Immediate Reconstruction169313.31.9-5.6Pathology Sign-Out (>10 days)No331191.0--Yes192322.01.3-3.2Post-Op ComplicationsNo506221.0--Yes17412.20.7-6.6Clinical trial considerationNo435231.0--Yes88240.90.5-17 Conclusions: This study provides insight into populations that may be at risk to experience delays in chemotherapy initiation, directing interventions to improve the timeliness of care. Citation Format: Losk K, Vaz Duarte Luis I, Camuso K, Lloyd M, Kadish S, Hirshfield-Bartek J, Cutone L, Golshan M, Lin N, Bunnell C. Factors associated with delays in chemotherapy initiation among patients with breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-12-08.