Delays In Cancer Treatment Research Articles

Random-start ovarian stimulation does not negatively impact egg yield/quality and produces high quality embryos in cancer patients

Since 2011, we have been initiating ovarian stimulation (random-start), at the time of the initial fertility preservation (FP) consultation, to minimize delays in cancer treatment. In this study, we aim to determine if random-start controlled ovarian stimulation (COS) is an effective method for FP, and if starting stimulation during a particular phase in the menstrual yields different results. Retrospective cohort. From 6/2011 to 3/2018, 1120 cancer patients were referred to our clinic for FP. All referred patients with no prior chemotherapy treatment, who underwent emergent FP treatment with an antagonist protocol, were included. Three hundred and eight patients met the inclusion criteria, with a total of 110 cycles initiated in the early follicular phase and 150 and 106 cycles initiated during the late follicular and luteal phases, respectively. ANOVA, T test and descriptive statistics were used to analyze the data as appropriate. There was no difference in age, BMI and AFC across the groups. Number of dominant follicles (≥13mm) on the day of trigger, mature oocytes retrieved, maturity rate (MII/total oocyte ratio) and mature oocyte yield (MII/AFC ratio) were similar across the groups (Table). There were significantly higher fertilization rates in random-start COS cycles compared to early follicular start. Additionally, number of high quality embryos frozen on Day 3 per MII oocyte retrieved was significantly higher in random-start cycles compared with early follicular start. The peak estradiol levels per mature follicle measured was significantly lower in random-start COS cycles. Ovarian Stimulation throughout the menstrual cycle yields similar oocyte maturity/developmental competence and high quality embryos. To minimize delays in cancer treatment, random-start COS should be considered the standard of care for patients undergoing emergent FP.Tabled 1Comparison between early, late follicular and luteal phase COS; means (SEM). NS: not significant.Oocyte & Embryo CryopreservationEarly Follicular Start (n=110)Late Follicular Start (n=150)Luteal Start (n=106)p valueTotal Stim Dose3594 (112)3817 (97)4191 (128)0.0016Days of Stim9.8 (0.2)10.2 (0.1)10.8 (0.2)<0.001Follicles ≥ 13 mm12.9 (0.7)14.0 (0.7)14.6 (0.8)NSMature Oocytes (MII) Retrieved12.3 (0.7)12.3 (0.8)12.8 (0.9)NSMII Oocyte / Total Oocyte Ratio0.75 (0.03)0.73 (0.02)0.74 (0.02)NSMII Oocyte / AFC Ratio0.98 (0.06)1.00 (0.07)0.99 (0.06)NSOocyte & Embryo Cryopreservation w/out LetrozoleEarly Follicular Start (n=40)Late Follicular Start (n=63)Luteal Start (n=41)p valueEstradiol / Follicles ≥ 13 mm216 (18)212 (10)168 (10)0.0175Embryo CryopreservationEarly Follicular Start (n=62)Late Follicular Start (n=54)Luteal Start (n=46)p valueFertilization Rate (2PN/MII)0.72 (0.03)0.84 (0.04)0.87 (0.03)0.0034Frozen Embryos / MII Oocyte0.60 (0.03)0.75 (0.05)0.81 (0.03)0.0008 Open table in a new tab

Prognostic data in fertility preservation: the role of preimplantation genetic testing for aneuploidy (PGT-A) among cancer patients undergoing embryo banking (EB)

Patients with cancer may overestimate FP success rates a. PGT-A aids in embryo selection and may provide a more accurate picture of future reproductive potential among banked embryos. We investigated the use of PGT-A among patients undergoing EB cycles for FP prior to cancer treatment. Retrospective cohort study of medical EB cycles between 1/2014 and 4/2018. Analysis of medical EB cycles performed in patients with cancer. PGT-A performed using trophectoderm biopsy with aCGH or NGS. Exclusive oocyte cryopreservation cycles were excluded. Data analyzed using student’s T-test, chi square, and Fishers Exact test (mean ± SD, p<0.05). 58 medical EB cycles were identified and compared; 34 cycles (59%) utilized PGT-A. 67% of patients banking embryos for breast cancer (18/27) utilized PGT-A; patients with lymphoma, endometrial ca, ovarian ca, and other cancers were evenly divided between PGT-A and no-PGT. PGT-A utilization increased over the study period. PGT-A and no-PGT groups were similar when comparing age (y) at FP cycle start (34.2±4 vs 35.5 ± 6), days of stimulation (11.8 ±2 vs. 11.1 ± 2), days from initial FP consultation to initiation of cancer treatment (36.9 ± 26 vs 36.4 ± 28), and timing of EB cycle start including day-2 or random-start protocol (p>0.05). Equal patients in each group cryopreserved both oocytes and embryos (n=5 PGT-A vs n=3 no-PGT). Groups were similar in no. oocytes retrieved (19 ±15 vs 17.5 ±14), 2PN zygotes (10.7 ± 9 vs 10 ± 9), and blastocysts (7.2 ± 7 vs 6.7 ± 5) excluding 6 patients in the no-PGT group who cryopreserved 2pn zygotes and 4 who froze an average of an additional 10.8 un-biopsied embryos (p>0.05). 5 PGT-A patients underwent a 2nd EB cycle (vs 2 among no-PGT); 2 for poor response, 3 for low or no euploidy. 6 in the no-PGT group cryopreserved 2PN zygotes; 3 were BRCA-positive and intended future PGT-M. Among PGT-A patients, 6.7 ± 5 blastocysts underwent PGT-A with 3.5 ± 3 (48.2%) euploid embryos available for future frozen embryo transfer (FET). Overall, PGT-A patients understood their final “usable” embryo number to be 3.5 ± 3 euploid embryos vs 7.2 ± 7 untested embryos in the non-PGT group. 2 breast cancer survivors in the PGT-A group have since undergone FET with 1 livebirth and 1 ongoing pregnancy; 2 others intend an upcoming FET. PGT-A in medical EB cycles provides critical information about future embryo potential and may be a helpful counseling tool. In some cases, poor PGT-A results informed patients to pursue a 2nd EB cycle without delaying cancer treatment. FP patients without PGT-A have a greater number of vitrified embryos but with unknown reproductive potential; patients may thus overestimate future success rates with devastating consequences. PGT-A results may require patients to prematurely address a terminal fertility diagnosis. The knowledge gained from PGT-A must thus be weighed against the financial cost and possible emotional toll; additional psychosocial support should be offered given the potential magnitude of information gained.

The assessment, management, and reporting of falls, and the impact of falls on cancer treatment in community-dwelling older patients receiving cancer treatment: Results from a mixed-methods study

Falls are major health issues among older adults and even more so in those with cancer due to cancer and its treatment. Delays in cancer treatment caused by fall injuries may have significant implications on disease trajectory and patient outcomes. However, it is not known how falls impact cancer treatment in this population. We conducted a convergent-parallel mixed-methods study at the Princess Margaret Cancer Centre in Toronto, Canada, to examine how falls impact cancer treatment in community-dwelling cancer patients aged ≥ 65, patients' fall reporting, and how falls were assessed and managed in oncology clinics. Data were collected by self-reported survey, chart review, and open-ended interviews. One hundred older adults and fourteen oncologists participated. Falls were not commonly reported by patients to their oncologists (72 of 168 falls [43%] reported to researchers by patients were also reported to oncologists). One of fourteen oncologists routinely assessed falls. In 7% of all 72 reported falls, cancer treatment was impacted (e.g. treatment delay/cessation, dose reduction). Fifty-seven patients perceived their fall as minor incident not worth mentioning (amounted to a total of 72 falls not reported). When a participant reported their fall to the oncologist, actions were taken to assess and manage the fall. Oncologists indicated that the majority of patients were not forthcoming in reporting falls. One in twenty who fall appear to lead to change in cancer management. However, falls were not commonly reported by patients nor prioritized by oncologists. Incorporating routine fall assessment in oncology clinic appointments may help identify those at risk for falls so that timely interventions can be triggered.

Timing and Delays in Breast Cancer Evaluation and Treatment.

Even small delays in the treatment of breast cancer are a frequently expressed concern of patients. Knowledge about this subject is important for clinicians to counsel patients appropriately and realistically, while also optimizing care. Although data and quality measures regarding time to chemotherapy and radiotherapy have been present for some time, data regarding surgical care are more recent and no standard exists. This review was written to discuss our current knowledge about the relationship of treatment times to outcomes. The published medical literature addressing delays and optimal times to treatment was reviewed in the context of our current time-dependent standards for chemotherapy and radiotherapy. The surgical literature and the lack of a time-dependent surgical standard also were discussed, suggesting a possible standard. Risk factors for delay are numerous, and tumor doubling times are both difficult to determine and unhelpful to assess the impact of longer treatment times on outcomes. Evaluation components also have a time cost and are inextricable from the patient's workup. Although the published literature has lack of uniformity, optimal times to each modality are strongly suggested by emerging data, supporting the current quality measures. Times to surgery, chemotherapy, and radiotherapy all have a measurable impact on outcomes, including disease-free survival, disease-specific survival, and overall survival. Delays have less of an impact than often thought but have a measurable impact on outcomes. Optimal times from diagnosis are < 90days for surgery, < 120days for chemotherapy, and, where chemotherapy is administered, < 365days for radiotherapy.

An assessment of delay in national 31-day cancer treatment and breach targets in colorectal cancer patients undergoing colonoscopy to obtain definitive histological diagnosis

An assessment of delay in national 31-day cancer treatment and breach targets in colorectal cancer patients undergoing colonoscopy to obtain definitive histological diagnosis

Reducing Wait Time for Lung Cancer Diagnosis and Treatment: Impact of a Multidisciplinary, Centralized Referral Program

BackgroundA multidisciplinary, centralized referral program was established at our institution in 2014 to reduce delays in lung cancer diagnosis and treatment following diagnostic imaging observed with the traditional, primary care provider–led referral process. The main objectives of this retrospective cohort study were to determine if referral to a Thoracic Triage Panel (TTP): 1) expedites lung cancer diagnosis and treatment initiation; and 2) leads to more appropriate specialist consultation. MethodsPatients with a diagnosis of lung cancer and initial diagnostic imaging between March 1, 2015, and February 29, 2016, at a Memorial University–affiliated tertiary care centre in St John's, Newfoundland, were identified and grouped according to whether they were referred to the TTP or managed through a traditional referral process. Wait times (in days) from first abnormal imaging to biopsy and treatment initiation were recorded. Statistical analysis was performed using the Wilcoxon rank-sum test. ResultsA total of 133 patients who met inclusion criteria were identified. Seventy-nine patients were referred to the TTP and 54 were managed by traditional means. There was a statistically significant reduction in median wait times for patients referred to the TTP. Wait time from first abnormal imaging to biopsy decreased from 61.5 to 36.0 days (P < .0001). Wait time from first abnormal imaging to treatment initiation decreased from 118.0 to 80.0 days (P < .001). The percentage of specialist consultations that led to treatment was also greater for patients referred to the TTP. ConclusionsA collaborative, centralized intake and referral program helps to reduce wait time for diagnosis and treatment of lung cancer.

Timeliness of treatment initiation in newly diagnosed breast cancer patients.

e18637Background: Delays in breast cancer treatment lead to poor clinical outcomes. Evidence-based timeliness benchmarks have been established to assess quality of care. However, few studies have e...

Delays in initial breast cancer treatment among black and white women in Boston.

e18620Background: The Boston Breast Cancer Equity Coalition was founded in 2014 to address the persistent mortality gap between black and white women with breast cancer living in Boston. Since dela...

A comprehensive evaluation of breast cancer treatment delays by race among Women's Health Initiative participants.

e18579Background: Breast cancer (BC) mortality is higher in Black vs White women, attributed in some studies to treatment delay. However, prior studies evaluated delay to initial treatment, leaving...

Chemotherapy and Optimal Timing of Delivery for Women with Triple Negative Breast Cancer [16D

INTRODUCTION: Data are limited regarding the optimal management of breast malignancy in pregnancy, particularly for the more aggressive subtype of triple negative breast cancer (TNBC). We sought to compare strategies for the management of TNBC and to determine the optimal gestational age for induction in regards to chemotherapy status and maternal-fetal outcomes. METHODS: A decision-analytic model was designed for women with TNBC at 20 weeks electing to continue their pregnancies, comparing 32 different strategies for scheduled delivery between 24-39 weeks gestation, with chemotherapy induction either at 24 weeks or delayed until after delivery. Baseline estimates of stage-specific mortality and the impact of delayed cancer treatment on 5-year survival rates were obtained from the literature. Outcomes factored into the model included the risk of intrauterine fetal demise, spontaneous delivery, respiratory distress syndrome, cerebral palsy, and neonatal demise at each gestational age. RESULTS: For women assigned to antepartum chemotherapy, overall QALYs were maximized with delivery at term, with minimal additional benefit beyond 37 weeks. For women with TNBC deferring chemotherapy until the postpartum period, 5-year survival was maximized by immediate delivery, although maternal QALYs were maximized with delivery at 36 weeks for stage I, 31 weeks for stage II, and 26 weeks for stage III disease. Our model was heavily driven by the baseline probability of maternal death within 5 years, in addition to the expected progression of disease and decrease in survival rates with each week of non-treatment, and remained robust across reasonable ranges for all variables of interest. CONCLUSION: For women with TNBC diagnosed in early pregnancy, initiation of chemotherapy and delivery at 37 weeks should be considered.

Delays in definitive cervical cancer treatment: An analysis of disparities and overall survival impact

ObjectiveDelays in time to treatment initiation (TTI) with definitive radiation therapy (RT) or chemotherapy and RT (CRT) for cervical cancer could lead to poorer outcomes. This study investigates disparities in TTI and the impact of TTI on overall survival (OS). MethodsAdult women with non-metastatic cervical squamous cell carcinoma diagnosed between 2004 and 2014, treated with definitive RT or CRT, and reported to the National Cancer Database were included. TTI was defined as days from diagnosis to start of RT or CRT. The impact of TTI on OS in patients treated with concurrent CRT which included brachytherapy was then assessed. ResultsOverall, 14,924 patients were included (84.7% CRT, 15.3% RT). TTI was significantly longer for Non-Hispanic Black (NHB) (RR, 1.14; 95% CI, 1.11 to 1.18) and Hispanic women (RR, 1.19; 95% CI, 1.15 to 1.24) compared to Non-Hispanic White (NHW) women. Expected TTI (eTTI) for NHW, NHB, and Hispanic women were 38.1, 45.2, and 49.4days. eTTI rose from 36.2days in 2004 to 44.3days by 2014. Intensity-modulated radiation therapy (IMRT) was associated with increased eTTI of 46.5days versus 40.0days for non-IMRT. Longer TTI was not associated with inferior OS in patients treated with concurrent CRT. ConclusionsDelays in starting RT/CRT for cervical cancer increased from 2004 to 2014. Delays disproportionately affect NHB and Hispanic women. However, increased TTI was not associated with increased mortality for women receiving CRT. Further study of TTI's impact on other endpoints is warranted to determine if TTI represents an important quality indicator.

Factors that influence delays in health care seeking, diagnosis and treatment for breast cancer patients in Uganda

Background: Cancer is a group of diseases characterized by uncontrolled growth and spread of abnormal cells, on this noted therefore breast cancer has now become the most commonly diagnosed cancer and the second leading cause of cancer related deaths among women in the Sub- Saharan Africa. The cancer incidence rate of (24%) and 50,000 deaths annually, stated that for the case of Uganda, breast cancer incidence rates almost doubled over the past 20 years. There is limited evidence on the factors which influence health care for breast cancer in Uganda. The purpose of the study was to explore the factors that influenced patient and system-related delays in health seeking, diagnosis and breast cancer treatment in Uganda.

Breast Cancer Diagnosis and Treatment After High-Deductible Insurance Enrollment.

Purpose High-deductible health plans (HDHPs) require substantial out-of-pocket spending and might delay crucial health services. Breast cancer treatment delays of as little as 2 months are associated with adverse outcomes. Methods We used a controlled prepost design with survival analysis to assess timing of breast cancer care events among 273,499 women age 25 to 64 years without evidence of breast cancer before inclusion. Women were included if continuously enrolled for 1 year in a low-deductible ($0 to $500) plan followed by up to 4 years in a HDHP (at least $1,000 deductible) after an employer-mandated switch. Study inclusion was on a rolling basis, and members were followed between 2003 and 2012. The comparison group comprised 2.4 million contemporaneously matched women whose employers offered only low-deductible plans. Measures were times to first diagnostic breast imaging (diagnostic mammogram, breast ultrasound, or breast magnetic resonance imaging), breast biopsy, incident early-stage breast cancer diagnosis, and breast cancer chemotherapy. Outcomes were analyzed by using Cox models and adjusted for age-group, morbidity score, poverty level, US region, index date, and employer size. Results After the index date, HDHP members experienced delays in receipt of diagnostic imaging (adjusted hazard ratio [aHR], 0.95; 95% CI, 0.94 to 0.96), biopsy (aHR, 0.92; 95% CI, 0.89 to 0.95), early-stage breast cancer diagnosis (aHR, 0.83; 0.78 to 0.90), and chemotherapy initiation (aHR, 0.79; 95% CI, 0.72 to 0.86) compared with the control group. Conclusion Women switched to HDHPs experienced delays in diagnostic breast imaging, breast biopsy, early-stage breast cancer diagnosis, and chemotherapy initiation. Additional research should determine whether such delays cause adverse health outcomes, and policymakers should consider selectively reducing out-of-pocket costs for key breast cancer services.

Abstract P4-10-15: Impact of delay in breast cancer diagnosis and treatment according to health insurance status in southwest Brazil and Houston, Texas

Abstract Background: Access to medical care vary across the world and is related to different health systems with an impact in recurrence.Objective: To evaluate disparities in breast cancer(BC) diagnosis and treatment between public and private services in southwest Brazil and at two public safety net hospitals in Houston, Texas.Methods: Women diagnosed with BC stages I-III between 2009 to 2011, and treated at the four hospitals in Brazil and two health centers in US were included. All statistical analyses were performed in R studio software, and p&amp;lt;0.05 was considered significant.Results: 1245 women were included: 967 from public health system (PHS) (20.3% from Houston, Texas) and 274 from private system(PS). Recurrence rate was higher in PHS (14.6% vs. 2.6%, p&amp;lt;0.001) Table 1. Clinical and demographic characteristics of the patientsCharacteristicsPublic (%), n=967Private (%), n=274pDiscovery of BC By patient530 (54.8)92 (33.5) Routine exam87 (9)109 (39.8) Screening mammography270 (27.9)23 (8.4) Other80 (8.3)50 (18.3)&amp;lt;0.001Initial treatment Surgery687 (71)241 (88) Neo-adjuvant chemotherapy224 (23.2)27 (9.8) Neo-adjuvant hormone therapy23 (2.3)27 (9.8) Not available33 (3.4)3 (1.1)&amp;lt;0.001Clinical Stage I293 (30.3)113 (41.2) II342 (35.4)52 (19) III271 (28)15 (5.5) Unknown61 (6.3)94 (34.3)&amp;lt;0.001Subtype HR+/HER2 -561 (58)192 (70.1) HR-/HER2+108 (11.1)29 (10.6) HR-/HER2+76 (7.9)14 (5.1) Triple negative149 (15.4)28 (10.2) Unknown73 (7.6)11 (4)0.012Symptomatic at Diagnosis Yes591 (61.1)100 (36.5) No306 (31.6)97 (35.4) Unknown70 (7.2)77 (28.1)&amp;lt;0.001Recurencen=772n=146 No719 (74.4)193 (70.4) Yes142 (14.6)7 (2.6) Unknown106 (11)74 (27)&amp;lt;0.001 . Considering the interval in weeks: symptoms to diagnosis, diagnosis to first treatment (either surgery or neoadjuvant chemotherapy), diagnosis to first systemic treatment, diagnosis to surgical treatment and diagnosis to radiotherapy were longer in public patients (24.1 vs. 8.7; 11.1 vs. 3.5; 18.6 vs. 9.8; 16.9 vs. 5.6; 51.4 vs. 26.1; p&amp;lt;0.001). Table 2. Delay disparities between public and private health system PublicPrivatepSymptoms to diagnosis Number of patients575146 Time (weeks)24.1 (0.4-104.9)8.7 (0.0-43.7)&amp;lt;0.001Diagnosis to first treatment Number of patients663180 Time (weeks)11.1 (2.0-31.5)3.5 (0.0-11.0)&amp;lt;0.001Diagnosis to first systemic treatment Number of patients526106 Time (weeks)18.6 (2.6-44.7)9.8 (1.9-29.3)&amp;lt;0.001Diagnosis to surgical treatment Number of patients657178 Time (weeks)16.9 (3.4-45.6)5.6 (0.0-32.9)&amp;lt;0.001Diagnosis to radiotherapy Number of patients465127 Time (weeks)51.4 (18.7-88.4)26.1 (5.6-66.4)&amp;lt;0.001 In multivariate analysis, PHS (HR 1.72; 95% CI 1.34-1.88; p adj=0.003), presence of symptoms (HR 2.29; 95% CI 1.39-3.78; p adj=0.001), clinical stage III (HR 1.62; 95% CI 1.35-1.93; p adj&amp;lt;0.001), and triple negativity and HER2neu positivity (1.18; 95% CI 1.03-1.35; p adj=0.021) were all associated with a higher recurrence rate.Conclusions: There were significant disparities between PHS and PS. Women in the PHS presented higher rates of recurrence, advanced clinical stages at diagnosis, symptoms and more aggressive subtypes by IHC. additionally, the interval between symptoms to diagnosis and diagnosis to treatments was longer in PHS. Citation Format: NematiShafaee M, Natal RA, Ramalho S, Dória MT, Conz L, Cabello V, Pavanello M, Mano MS, Linck RDM, Batista LS, Pedro EP, Bines J, de Paula BH, Zucca-Matthes G, Bondy ML, Ellis MJ, Podany E, Debord L, Makawita S, Stewart K, Cabello C. Impact of delay in breast cancer diagnosis and treatment according to health insurance status in southwest Brazil and Houston, Texas [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-15.

Abstract P4-10-16: Impact of delay in breast cancer diagnosis and treatment in public health according to nationality: Brazil vs US

Abstract Background: Delays in diagnosis and treatment is associated with recurrence. Access to medical care in public health systems (PHS) may vary across Southwest Brazil and Houston, Texas. Objective: To evaluate disparities in breast cancer (BC) diagnosis and treatment between public services in southwest Brazil and at a public safety net hospital in Houston, Texas. Methods: Women diagnosed with BC stages I-III between 2009 to 2011, and treated at thefour hospitals in Brazil and two health centers in US were included. All statistical analyses was performed in R studio, and p&amp;lt;0.05 was considered significant. Results: 967 women from PHS were included: 778 from Brazil and 189 from US. Recurrence rates were not significantly different (15.9% vs. 9.5%, p=0.233) Table 1. Clinical and demographic characteristics of the patientsCharacteristicsBrazil (%), n=778US (%), n=189pDiscovery of BC By patient443 (56.9)87 (46) Routine exam82 (10.5)5 (2.7) Screening mammography207 (26.6)63 (33.4) Other46 (6)34 (17.9)&amp;lt;0.001Initial treatment Surgery587 (75.4)100 (52.9) Neo-adjuvant chemotherapy176 (22.6)48 (25.4) Neo-adjuvant hormone therapy9 (1.1)14 (7.4) Unknown6 (0.9)27 (14.3)&amp;lt;0.001Clinical Stage I234 (30.1)59 (31.2) II289 (36.8)56 (29.7) III239 (30.7)32 (16.9) Unknown19 (2.4)42 (22.2)0.027IHQ Subtype HR+/HER2 -467 (60)94 (49.7) HR+/HER2+91 (11.7)17 (9) HR-/HER2+66 (8.5)10 (5.3) Triple negative123 (15.8)26 (13.8) Unknown31 (4)42 (22.2)0.853Symptoms Yes492 (63.2)99 (52.4) No248 (31.9)58 (30.7) Unknown38 (4.9)32 (16.9)0.410Recurence No599 (77)120 (63.5) Yes124 (15.9)18 (9.5) Unknown55 (7.1)51 (27.0)0.233 . Considering the interval in weeks: symptoms to diagnosis, diagnosis to first systemic therapy and diagnosis to radiotherapy were longer in Brazil PHS patients (24.4 vs. 22.8; 18.9 vs. 16.1 and 51.8 vs. 47.8 p&amp;lt;0.001). Table 2. Delay disparities in public health system between Brazil and US BrazilUSpSymptoms to diagnosis Number of patients473102 Time (weeks)24.4 (0.5-102.6)22.8 (0.1-124.8)&amp;lt;0.001Diagnosis to first treatment Number of patients546117 Time (weeks)10.8 (1.9-31.7)12.2 (3.1-26.4)&amp;lt;0.001Diagnosis to first systemic treatment Number of patients45967 Time (weeks)18.9 (2.4-45.6)16.1 (3.3-38.6)&amp;lt;0.001Diagnosis to surgical treatment Number of patients541116 Time (weeks)16.4 (3.1-43.1)19.2 (4.5-51.2)&amp;lt;0.001Diagnosis to radiotherapy Number of patients41352 Time (weeks)51.8 (19.4-89.7)47.8 (14.9-84.8)&amp;lt;0.001 However, considering the interval in weeks: diagnosis to first treatment (either surgery or neoadjuvant chemotherapy) and diagnosis to surgical treatment were shorter in Brazil PHS patients (10.8 vs. 12.2 and 16.4 vs. 19.2, p&amp;lt;0.001). When considering surgery as initial treatment, treatment in Brazil PHS and stage III disease at diagnosis were associated with worse prognosis (HR: 1.91, 95%CI: 1.38 – 1.99, padj=0.015; HR 1.44, 95%CI:1.11-1.87, padj=0.006). Conclusions: There were significant disparities between Brazil and US PHS. Women in Brazil PHS presented higher rates of advanced clinical stages at diagnosis and diagnosis by routine exam, while US PHS present higher rates of diagnosis by screening mammography. When considering surgery as initial treatment, Houston PHS women had a better prognosis. Citation Format: Ramalho S, Dória MT, Natal RA, Conz L, Cabello V, Pavanello M, Cabello C, Mano MS, Linck RD, Batista LS, Pedro EP, Bines J, de Paula BH, Zucca-Matthes G, Ellis MJ, Podany E, Debord L, Makawita S, Stewart K, NematiShafaee M, Bondy ML. Impact of delay in breast cancer diagnosis and treatment in public health according to nationality: Brazil vs US [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-16.

Abstract P4-10-01: Race, place and delays in breast cancer treatment across the care continuum in the Carolina breast cancer study

Abstract Black women have a persistent disparity in breast cancer survival after controlling for clinical factors, suggesting that differential receipt or efficacy of treatment may contribute to poorer outcomes. Delays in initiating treatment and subsequent spillover effects into time to completion are one proposed mechanism by which these survival disparities may occur. The Carolina Breast Cancer Study Phase III is a large population-based study of North Carolina women with incident breast cancer. For this analysis, we included black (n=1328) and white (n=1331) women with stage I-III disease whose treatment included surgery with or without adjuvant therapies. Patients were grouped by treatment pathway (surgery only, surgery + chemotherapy, surgery + radiation, or all three modalities). We investigated the association of race with delays in treatment initiation, duration and completion. Delays in initiation of first treatment were modeled in two ways: i) time to initiation &amp;gt;30 days from diagnosis, and ii) time to initiation above the 75th percentile. Extended duration and delay in completion were defined as being &amp;gt; 75th percentile in days between initiation and end of treatment (duration) or days from diagnosis to end of treatment (completion) compared to others in the same pathway. Models controlled for treatment pathway, age, and tumor characteristics. Additional models controlled for demographic factors (marital status, income, education, insurance) and county-level factors related to care access (% urban and health professional shortage area status). In analyses adjusted only for age at diagnosis, black women had a significantly higher risk of treatment delays whether measured by delay&amp;gt;30 days (risk ratio (RR) 1.24, 95% CI 1.12-1.37) and or by highest quartile of time to initiation (RR 1.23, 95% CI 1.07-1.40) compared to whites. They were also at higher risk of extended treatment duration (RR 1.47, 95% CI 1.29-1.69) and time to completion (RR 1.58, 95% CI 1.37-1.81) compared to others in the same pathway. Interestingly, adjustment for tumor characteristics did not impact effect estimates. While adjustment for demographic factors had little impact on the association of race with delays in initiation, it attenuated the association of race with delays in treatment duration and completion. Further adjustment for care access factors slightly attenuated the association of race with treatment initiation and completion, but did not impact associations with treatment duration. Significant racial disparities remained in delay across all phases of care after adjustment for clinical, demographic and access factors. Overall, black women were at higher risk of delays in treatment initiation, extended duration and time to completion than white women receiving similar treatment, and these disparities appear to be compounded over the care continuum. These findings suggest that racial differences in income, education and insurance may partly explain observed disparities in treatment duration and time to completion, whereas care access factors may have more impact on disparities in treatment initiation, and interventions that target both patient-level and care access barriers may be needed to improve timely delivery across the care continuum. Citation Format: Reeder-Hayes KE, Mayer SE, Olshan A, Carey LA, Wheeler SB, Tse C-K, Troester M. Race, place and delays in breast cancer treatment across the care continuum in the Carolina breast cancer study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-01.

Abstract PD7-08: Economic and time-related burden in young breast cancer patients wishing to preserve their fertility before undergoing cancer treatment

Abstract Background: Treatment-related infertility is one of many issues facing young breast cancer patients. Fertility preservation, using artificial reproductive therapy (ART), is a recommended method to maintain future reproductive function among cancer patients. However, medical costs for fertility preservation are often too expensive for young cancer patients who can be less economically secure, in addition to the costs of cancer treatment. Moreover, the ART process requires several weeks or more, and time spent in fertility preservation may potentially delay treatment. Pink Ring is a patient advocacy group for young breast cancer patients, established in Japan in 2012, which has been working on the issue of onco-fertility. We conducted a cross sectional web-based survey exploring the economic and time-related burden of young cancer patients in the reproductive age group. This study was supported by a research grant from the Foundation to Promote Cancer Research. Method: Pink Ring conducted a web-based survey, and 343 young breast cancer patients who responded were enrolled. We performed descriptive analysis of the data. Result: Among 343 young breast cancer patients, the mean age at the time of the survey was 38 years (20-49) and the mean age at breast cancer diagnosis was 34 years (20-49). At diagnosis, 167 (49%) of the women were married and 171 (50%) were single. At diagnosis, 99 (29%) women had had a child or children and 236 (63%) were childless. Regarding treatment-related infertility, 193 patients (56%) had had discussions with a medical health provider. However, 58 (17%) patients underwent a fertility preservation procedure. Among patients who underwent fertility preservation, 35 patients (60%) underwent embryo preservation, 23 (40%) underwent oocyte cryopreservation, and 4 (7%) underwent ovarian tissue cryopreservation. According to medical payment for a fertility preservation procedure, 26 patients (45%) paid less than $5000, 21 patients (36%) paid between $5000 and $10000 and 10 patients (17%) paid over $10000. Regarding cost-effectiveness, 51 patients (88%) considered that the medical payment was expensive. According to the duration of the fertility preservation procedure, 7 patients (12%) were treated up to 2 weeks, 8 patients (31%) were treated between 2 and 4 weeks, 21 patients (36%) were treated between 1 and 2 months, and 7 patients (12%) were treated longer than 2 months. Twenty-eight patients (48%) answered that planned cancer treatment was delayed because of a fertility preservation procedure. According to cancer treatment delay, 4 patients (14%) were delayed up to 4 weeks, 14 patients (50%) were delayed between 1 and 2 months, and 10 patients (36%) were delayed longer than 2 months. Among 285 patients who did not proceed with fertility preservation, the major reasons given for their decision were as follows: lack of awareness regarding treatment-related infertility and fertility preservation options (29%), economic-related burden (25%), and time-related burden (25%). Discussion: This survey revealed that fertility preservation was a burden not only for economic reasons but also in terms of time required for treatment for young breast cancer patients of reproductive age. Citation Format: Kitano A, Mifune M, Suzuki A, Hashizume A, Nakayama C, Motofuji Y, Suzuki H, Ichioka E. Economic and time-related burden in young breast cancer patients wishing to preserve their fertility before undergoing cancer treatment [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD7-08.

Associations of psychiatric disorders with delay in diagnosis and treatment of cancer

Associations of psychiatric disorders with delay in diagnosis and treatment of cancer

Analysis of Delays in Breast Cancer Treatment and Late-Stage Diagnosis in Kazakhstan

Objective:Although Kazakhstan has made significant investments to improve health and life expectancy of its population, high cancer rates persist, with breast cancer being the most prevalent type. Factors contributing to delays in treatment and late staging for breast cancer patients were assessed.Methods:A retrospective follow-up study with registry data identified 4,248 breast cancer patients in sixteen regions of Kazakhstan in 2014. We used logistic regressions to estimate (i) associations of treatment delays with patient demographics and cancer center regions; and (ii) associations of late-stage (III and IV) cancer diagnosis with patient demographics and cancer center regions, with and without controlling for treatment delays.Results:Breast cancer patients treated in regions located further away from Almaty City had higher risks of treatment delays. However, the risks of late-stage cancer diagnosis were greater for patients treated in Almaty City and those with treatment delays.Conclusion:The main driver of delayed treatment is cancer center region. Residents of Almaty City, a major urban area of Kazakhstan, may have a better access to a tertiary cancer center, resulting in less treatment delays. Referrals of sicker patients from neighboring regions to Almaty City for cancer treatment is likely to increase risks of late-stage diagnosis. New or upgraded cancer centers may reduce treatment delays, but their case-mix is likely to increase.

Delays in Breast Cancer Detection and Treatment in Developing Countries.

Breast cancer is the most common cancer in women in both developed and developing countries and the second most common cancer in the world. Developing countries are increasingly adopting a Western lifestyle, such as changes in diet and delayed first childbirth, lower parity, and shorter periods of breastfeeding, which are important determinants of a higher incidence of breast cancer among those regions. Low- and middle-income countries (LMICs) represent most of the countries with the highest mortality rates, ranging from 40% to 60%. Furthermore, developing countries account for scarce survival data, and the few data available coincide with the observed incidence and mortality differences. Five-year survival rates for breast cancer are much worse for LMICs countries such as Brazil, India, and Algeria in comparison with the United States and Sweden. Paucity of early detection programs explain these poor survival rates, which results in a high proportion of women presenting with late-stage disease, along with lack of adequate diagnosis and treatment facilities. Emphasis is urgently needed on health education, to promote early diagnosis of breast cancer, highlighting the importance of creating more public facilities that provide treatment, which are key components for the improvement in breast cancer care in developing countries.