Factors contributing to delays in breast cancer management.

Abstract

6070 Background: Patients with breast cancer (BC) often face delays in diagnosis, surgery, and onset of systemic or loco-regional treatment. While there is considerable literature on this third component, especially regarding delays in onset of radiation therapy, it is relevant to examine the entire continuum. We set out to quantify each component for both adjuvant and neoadjuvant patients, including potential factors for delay: hospital class, availability of prognostic markers, and the use of pre-operative MRI. Methods: We conducted a retrospective review of 949 BC patients referred to The Ottawa Hospital Cancer Centre (TOHCC) in 2008, of which 794 of which were included in this analysis. Dates of screening procedures (S), biopsies (B), marker reports (M), MRI scans, surgeries (Sx), and treatment initiation (chemotherapy [CT], radiation therapy [RT], and hormone therapy [HT]) were obtained and time intervals were calculated for all patients where data was available. Patients were stratified by referring hospital class (academic, nonacademic, or peripheral) and use of preoperative MRI. Analysis was carried out using chi-squared tests, and confirmed with ANOVA, Wilcoxon-Mann-Whitney, and Kruskal-Wallis tests, where appropriate. Results: The results are shown in the Table. Wait time intervals were compared between academic, nonacademic, and peripheral referring hospitals, and were significantly different. Approximately 35 percent of patients had a preoperative MRI. Impact of MRI was highly significant in terms of the number of mastectomies performed: 46.1% with MRI, 53.9% without (p=0.000), as well as the length of time to surgery: 54 days with MRI, 43 days without (p=0.000). Conclusions: Diagnostic and therapeutic delays have been identified in the care of women with early BC. The effect of these delays on outcome has not been determined but need to be considered in the overall management of these patients. S to B B to M B to MRI B to CT B to HT B to Sx Sx to M Sx to CT Sx to RT Sx to HT CT/HT to Sx Neoadjuvant Median 11 35 23 29 48 180 80th %ile 16 54 38 42 129 193 Adjuvant Median 18 48 24 55 74 58 80th %ile 32 67 34 68 95 97 No significant financial relationships to disclose.