Timing in adjuvant chemotherapy (CTX) initiation among women with breast cancer (BC) at National Comprehensive Cancer Network (NCCN) centers: An analysis from the NCCN Outcomes Database.

Abstract

6022 Background: Receipt of quality care has two important dimensions: that patients receive both appropriate and timely care. The primary aim was to examine time from BC diagnosis to CTX and identify factors associated with longer time. Methods: In the NCCN Outcomes Database, we identified 5,583 women with stage I-III BC diagnosed in 2003-2008 who received adjuvant CTX at 10 NCCN centers within 32 weeks (wks) of diagnosis. Patients with neoadjuvant therapy were excluded. Multivariate ANCOVA models were constructed to examine adjusted mean Time to Chemotherapy (TTC) from the date of pathological diagnosis. Results: Mean TTC was 11.8 wks. Many sociodemographic and clinical factors were associated with longer TTC. Factors with the largest effects are listed in Table 1. Minimal prolongation of TTC was associated with initial mastectomy versus lumpectomy (3 day greater TTC, p=0.01). Greater prolongation of TTC was observed between Caucasian and African American (AA) women diagnosed at another center prior to presentation (2.1 wks, p<0.001) than at the NCCN center (1.0 wk, p=0.13), and among patients with Medicare (2.7 wks, p<0.001) versus Managed Care (MCO, 1.2 wks, p<0.001) or Medicaid (0.9 wks, p=0.99). Interactions were significant between ethnicity and both insurance (p=0.03) and diagnosing institution (p=0.02). Conclusions: Some delay in TTC associated with clinical factors (21 gene RT PCR assay or number of excisions) may be unavoidable but should be minimized. Opportunities for improvement at the system level (insurance and transfers in care) were observed. Observed disparity in TTC for AA women appears to be exacerbated by transferring care and insurance related issues. % patients Mean TTC difference, wks Race/ethnicity Caucasian 78 Ref Hispanic 7 +0.7** AA 9 +1.6*** Asian 4 0.5 Other 2 0.0 Insurance MCO 78 Ref Medicare 10 +0.6* Medicaid 7 +2.6*** Other 4 0.4 Diagnosing institution NCCN 26 Ref Non-NCCN 74 +1.2*** Excisional procedures 1 64 Ref 2 31 +2.1*** ≥3 5 +5.6*** Reconstruction prior to CTX No 82 Ref Yes 18 +2.5*** 21-gene RT PCR assay No 94 Ref Yes 6 +2.2*** *p<0.05, **p<0.01, ***p<0.001