Impact Of Treatment Delay Research Articles

Association between time to treatment and bladder cancer survival: a population-based analysis.

Cancer treatment delay is a global health system issue. However, data concerning the impact of treatment delays on survival in bladder cancer remain controversial. This study sought to evaluate the impact of time from diagnosis to treatment on survival outcomes of bladder cancer patients in the US Surveillance, Epidemiology, and End Results (SEER) database. The SEER was searched from 2000 to 2020 for bladder cancer patients. Logistical regression was used to explore potential factors related to treatment delay. Kaplan-Meier curves were generated to investigate the overall and cancer-specific survival. Multivariate Cox proportional hazards regression models were used to evaluate the effects of covariables on survival outcomes in bladder cancer with treatment delay. There were 12,686 eligible patients included in this study. A total of 2,379 patients experienced an initial treatment delay. Initial treatment delay was related to worse survival. Sex, age, pathological grade, clinical stage, and surgery were associated with increased odds of initial treatment delay. In the patients with initial treatment delay, age, advanced stage, lymph node involvement, high pathological grades and metastasis were independent predictors of poor overall survival and cancer-specific survival, while marital status at diagnosis, surgery, chemotherapy, and radiotherapy were found to improve both overall survival and cancer-specific survival. Significant disparities in pathological/clinical variables could contribute to treatment delay. Surgery, chemotherapy, and radiotherapy benefited the survival of patients with treatment delays.

Impact of Treatment Delay on the Prognosis of Patients with Ovarian Cancer: A Population-based Study Using the Surveillance, Epidemiology, and End Results Database.

Purpose: This study aimed to assess the impact of treatment delay on prognosis in patients with ovarian cancer. Methods: A retrospective analysis of patients with ovarian cancer in the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015 was performed. Chi-square tests were used to assess baseline differences. The Kaplan-Meier method was used to evaluate the effect of different treatment intervals on survival outcomes in patients. Cox regression analyses were used to identify independent factors associated with ovarian cancer prognosis. Results: Of the 21,590 patients included, 15,675 (72.6%), 5,582 (25.9%), and 333 (1.54%) were classified into the immediate-treatment (<1 month after diagnosis), intermediate-delay (1-2 month delayed), and long-delay groups (≥3 months delayed), respectively. The 5-year probability of overall survival (OS) was 61.4% in the immediate-treatment group, decreasing to 36.4% and 34.8% in the intermediate- and long-delay groups, respectively. Similar survival differences were also reflected in cancer-specific survival (CSS), with 5-year CSS probabilities of 66.7%, 42.6%, and 41.8% in the aforementioned groups, respectively. Patients in the intermediate-delay group showed poorer OS (adjusted hazard ratio [HR], 1.06; 95% confidence interval [CI], 1.02-1.11; p=0.006) and CSS (adjusted HR, 1.06; 95% CI, 1.01-1.11; p=0.012) than immediate-treatment group. Conclusions: Patients with delayed treatment had poorer OS and CSS. The patient's waiting time from diagnosis to initial treatment should be within 1 month.

Abstract P1-06-04: IMPACTS OF TREATMENT DELAY ON BREAST CANCER MORTALITY AND BENEFIT OF TIMELY CARE IN BLACK AND NON-BLACK WOMEN

Abstract BACKGROUND: The impact of treatment delays on cancer outcomes has been well documented, but few published studies explicitly attempt to identify subgroups which would benefit the most from potential interventions improving timeliness of care. Using the state of North Carolina and breast cancer as an example, we sought to quantify race-specific associations between frontline treatment delay and breast cancer mortality, and estimate the potential impact of improvements in timeliness by racial sub-group. METHODS: We conducted a retrospective cohort study, utilizing multipayer insurance claims linked to cancer registry data from the Cancer Information and Population Health Resource, of females diagnosed with stage I-III breast cancer from 2004 to 2014. Our exposure of interest was treatment delay, defined as initial cancer directed therapy received ≥ 60 days after diagnosis. Our outcome was death certificate identified breast cancer mortality within 5-years of follow-up. To quantify the association between treatment delay and mortality we estimated hazard ratios (HR) and 95% confidence limits (CL) where non-breast cancer deaths were treated as competing events. We then simulated the effect of treating all patients within 60 days using inverse probability of treatment weighting (IPTW), and estimated the potential impact by comparing the simulated data with observed data. Models were adjusted for age and stage at diagnosis, tumor grade, hormone receptor status, and modality of first treatment. Models were stratified by race, dichotomized as Black or non-Black, and geographic subregion for evaluation. RESULTS: Our analytic cohort comprised 21,200 patients, of whom 19% were Black. Treatment delays &amp;gt;60 days were twice as frequent among Black compared with non-Black patients (13.5% vs. 6.5%). We found a positive association between treatment delay and breast cancer mortality in the overall cohort (HR=1.3; CL: 1.1, 1.6). The association differed between Black (HR=1.4; CL: 1.1, 1.8) and Non-Black (HR=1.2; CL: 0.9, 1.6) patient subgroups. For both racial groups, the strength of the relationship between treatment delay and mortality varied across geographic subregions. The estimated potential improvement in 5-year cumulative breast cancer mortality from delivering timely care to all patients differed in magnitude across sub-populations. The magnitude of potential improvement in breast cancer mortality at 5 years in the overall analytic cohort was 0.3% (5-year risk of breast cancer mortality in observed cohort: 7.2% vs 6.9% with simulated universal timely treatment). In the Black subcohort, the potential decrease in mortality for timely treatment was 1.0% (observed: 12.3% vs simulated: 11.4%), while in the non-Black population the potential decrease was 0.1% (observed: 6.1% vs simulated: 5.9%). CONCLUSIONS: The magnitude of association between delayed treatment of stage I-III breast cancer and breast cancer mortality differed between Black and non-Black patients, highlighting that interventions to avert treatment delays may have a meaningful impact for this group. Further research is needed to identify factors underlying this difference, which may include a direct effect of differences in timeliness, or downstream differences in the intensity and quality of cancer care beyond the 60-day landmark for delayed patients. Our findings suggest that comprehensive intervention at the state level to improve the timeliness of breast cancer treatment could potentially reduce breast cancer mortality, and that targeting such intervention to patient groups with larger projected benefit, such as Black patients, may be a more efficient use of resources. We have illustrated how a counterfactual approach may be useful in identifying subgroups where focused intervention efforts may yield greater improvements in outcomes. Citation Format: Bradford Jackson, Stephanie Wheeler, Juan Yanguela, Matthew LeBlanc, Tzy-Mey Kuo, Christopher Baggett, Katherine Reeder-Hayes. IMPACTS OF TREATMENT DELAY ON BREAST CANCER MORTALITY AND BENEFIT OF TIMELY CARE IN BLACK AND NON-BLACK WOMEN [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-06-04.

The Impact of Delay in Treatment on Survival in Surgically Managed Sinonasal Undifferentiated Carcinoma.

Background Sinonasal undifferentiated carcinoma (SNUC) is a rare, aggressive malignancy with a poor prognosis, and multimodal therapy is the standard of care. We sought to characterize treatment delays in SNUC managed with surgery and adjuvant radiation and to determine the impact on survival using the National Cancer Database (NCDB). Methods This was a retrospective, population-based cohort study of patients with SNUC between 2004 and 2016 in the NCDB. The intervals of diagnosis to surgery (DTS), surgery to radiation (SRT), and radiation duration (RTD) were examined. Recursive partitioning analysis (RPA) was performed to identify the variables with the greatest impact on survival. The association between treatment delay and overall survival (OS) was then assessed using multivariate Cox proportional hazards regression. Results Of 173 patients who met inclusion criteria, 65.9% were male, average age at diagnosis was 56.6 years, and 5-year OS was 48.1%. Median durations of DTS, SRT, and RTD were 18, 43, and 46 days, respectively. Predictors of treatment delay included Black race, government insurance excluding Medicare/Medicaid, and positive margins. RPA-derived optimal thresholds were 29, 28, and 38 days for DTS, SRT and RTD, respectively. On multivariate analysis, positive margins (hazard ratio [HR]: 4.82; 95% confidence interval [CI]: 2.28-10.2) and DTS less than 29 days (HR: 2.41; 95% CI: 1.23-4.73) were associated with worse OS. Conclusion Our results likely reflect the aggressive nature of the disease with surgeons taking more invasive disease to the operating room more quickly. Median treatment intervals described may serve as relevant national benchmarks.

Racial, Ethnic, and Socioeconomic Disparities in Treatment Delay Among Patients With Hepatocellular Carcinoma in the United States

Failures have been reported across the cancer care continuum in patients with hepatocellular carcinoma (HCC); however, the impact of treatment delays on outcomes has not been well-characterized. We described the prevalence of treatment delays in a racially and ethnically diverse cohort of patients and its association with overall survival. Using the Surveillance, Epidemiology, and End Results-Medicare database, we identified patients diagnosed with HCC between 2001 and 2015. We performed multivariable logistic regression analysis to identify factors associated with treatment delay (ie, receipt of HCC-directed therapy >3 months after diagnosis). Cox proportional hazards regression analysis with a 5-month landmark was used to characterize the association between treatment delay and overall survival, accounting for immortal time bias. Of 8450 patients with treatment within 12 months of HCC diagnosis, 1205 (14.3%) experienced treatment delays. The proportion with treatment delays ranged from 6.8% of patients undergoing surgical resection to 21.6% of those undergoing liver transplantation. In multivariable analysis, Black patients (odds ratio, 1.96; 95% confidence interval [CI], 1.21-3.15) and those living in high poverty neighborhoods (odds ratio, 1.55; 95% CI, 1.25-1.92) were more likely to experience treatment delays than white patients and those living in low poverty neighborhoods, respectively. Treatment delay was independently associated with worse survival (hazard ratio 1.15, 95% CI, 1.05-1.25). Nearly 1 in 7 patients with HCC experience treatment delays, with higher odds in Black patients and those living in high poverty neighborhoods. Treatment delays are associated with worse survival, highlighting a need for interventions to improve time-to-treatment.

PREDICTING DIABETES MELLITUS USING CATBOOST CLASSIFIER AND SHAPLEY ADDITIVE EXPLANATION (SHAP) APPROACH

Diabetes mellitus as a metabolic disease characterized by hyperglycemia can be dangerous if it cannot be handled properly. Early detection of existing symptoms can reduce the impact of delays in treatment. This study aims to carry out early-detection patients with diabetes mellitus using a machine learning approach through data from MIT’s GOSSIS (Global Open Source Severity of Illness Score). By using Shapley Additive Explanation (SHAP) which enables prioritization of feature that determine compound classification, this study shows that the CatBoost classifier has 14 features that significantly can be used for classification with feature ‘d1_glucose_max’ or the highest glucose concentration of the patient in their serum or plasma during the first 24 hours of their unit stay has the highest impact to classify diabetes mellitus patients, then followed by age and glucose APACHE. The selected features are then classified and get the validation AUC score of 86.86%.

Chemotherapy delays in children with acute lymphoblastic leukemia might influence the outcome of treatment

Introduction: Acute lymphoblastic leukemia (ALL) is one of the most commonly occurring cancers among children with one of the highest survival rates, thanks to its very strict treatment protocol. In this paper, the impact of delays in treatment during the induction phase was assessed. Material and methods: Retrospective single center analysis of 127 patients treated between years 2003 and 2015 was performed. Patients were categorized by their respective gender, age, leukemia variant, risk group and chemotherapy protocol used. The delays were measured using protocol milestones as reference points. The associations between treatment delay intervals and event-free survival (PFS) or overall survival (OS) were evaluated using Kaplan-Meier curves and univariate Cox proportional hazards regression models. Results: Delays in treatment which occurred before the 8th day were associated with a 30% increase in the risk of death ( p &lt; 0.01) and a 33% increase in the risk of relapse or death ( p &lt; 0.01). The influence of delays after the 8 th day was statistically insignificant. Delays were proven to have the most influence on outcome in the high-risk group, especially before the 8 th day. Conclusions: The ALL treatment protocols should be strictly followed as any delay may lead to worse patients’ survival.

Preoperative wait times in high-grade endometrial cancer: do surgical delays impact patient survival?

<h3>Objectives:</h3> Practice guidelines advocating for the regionalization of endometrial cancer surgery to gynecologic oncologists practicing in designated gynecologic oncology centres were released by Cancer Care Ontario in June 2013. We sought to determine the impact this policy had on contemporary surgical wait times. Moreover, a discussion about the impact of delays in treatment has never been more timely than in the context of the current COVID19 pandemic, which has burdened health care systems around the world. Our primary objective was to establish whether longer wait time to surgery is a predictor of survival in patients with high grade endometrial cancer. <h3>Methods:</h3> This was a retrospective cohort study, which included patients diagnosed with non-endometrioid high-grade endometrial cancer (serous, carcinosarcoma, clear cell, and undifferentiated) between 2003 and 2017. A total of 2 regionalization periods were defined, before and after January 2014 to allow 6 months for knowledge translation after guideline publication. Patients were identified in population-based administrative provincial data sources. Multivariable Cox proportional hazards regression with a spline function was used to model the relationship between wait time and overall survival, as measured from time of surgery. <h3>Results:</h3> We identified 3518 patients with high grade endometrial cancer. Median wait time between diagnosis and surgery for the entire cohort did not significantly change with regionalization of care (50 vs 52 days, p=0.14). Patients who had surgery with a gynecologic oncologist had a median surgical wait time from diagnosis to hysterectomy of 55 days compared to 59 days pre-regionalization (p=0.0002), and from first gynecologic oncology consultation to hysterectomy of 29 days compared to 32 days pre-regionalization (p=0.0006). Survival was worst for patients who had surgery within 14 days of diagnosis (HR death 2.7, 95% CI 1.61-4.51 for 1-7 days and HR death 1.96, 95% CI 1.5-2.57 for 8-14 days), indicating disease severity. Decreased survival occurred with surgical wait times of more than 45 days from the patient's first gynecologic-oncology appointment (HR death 1.19, 95% CI 1.04-1.36 for 46-60 days and HR death 1.42, 95% CI 1.11-1.82). <h3>Conclusions:</h3> Regionalization of surgery for high grade endometrial cancer has not had a negative impact on surgical wait times. Impact on survival is seen with patients who have surgery more than 45 days after surgical consultation.

Commentary on "The Impact of Treatment Delay on Malunion and Nonunion After Open Reduction of Mandible Fractures" by Lander et al: Sooner than Later.

Commentary on "The Impact of Treatment Delay on Malunion and Nonunion After Open Reduction of Mandible Fractures" by Lander et al: Sooner than Later.

The Impact of Treatment Delay on Hepatitis C Liver Transplant Outcomes

Background: Direct-acting antivirals for the treatment of hepatitis C virus (HCV) have improved outcomes in liver transplant recipients (LTRs). However, the timing of HCV treatment and approach to treating rejection have not been well described. Additionally, pharmacists’ roles in these comprehensive areas have not been investigated. Methods: This single-center, retrospective, cohort review compared 1-year graft and patient survival between HCV-positive and HCV-negative LTRs. Secondary endpoints included 1-year rejection rates, HCV sustained virologic response and time to HCV treatment. Results: Ninety-two HCV Nucleic Acid Amplification Test (NAT)-positive LTRs were matched 1:1 to HCV-seronegative LTRs. One-year graft and patient survival were similar between groups. HCV-positive LTRs were more likely to experience biopsy-proven acute rejection (BPAR), and despite treatment with pulse steroids, there was no impact on graft survival or occurrence of fibrosing cholestatic hepatitis (FCH). Time to HCV treatment was 5.4–6.4 months post-transplant, with no treatment failures or impact on graft or patient survival. Conclusions: No difference was seen in graft survival at 1 year between HCV-positive and HCV-seronegative LTRs. Delayed time to treatment of HCV and treatment of rejections in the HCV-positive cohort did not impact outcomes. However, pharmacist-driven protocols could ensure more efficient initiation of HCV treatment in the future.

Impact of treatment delays on outcome of acute testicular torsion: a 15-year retrospective study

Introduction Preservation of the testicle is directly associated with the duration of torsion. The aim in this retrospective study was to identify factors that influence pre-and in-hospital times and measure the extent to which these times affect testicle survival. Patients and methods A retrospective review of 116 patients who underwent exploration for testicular torsion between 2000 and 2015. Patients were divided into orchiectomy and salvaged testicle groups. Times in patient management and clinical features were compared with Mann–Whitney, chi-squared, and Fisher exact tests. Multivariate logistical regression was used to identify independent factors associated with orchiectomy. Results The median prehospital time of 48 h (15.4–138 h) in the orchiectomy group was longer than the 2.4 h (1.6 h–5.2h) in the salvaged group. Patients examined by a general practitioner (GP) prior to presenting at hospital had a median prehospital time of 48 h, compared to 3 h for patients not examined before presentation at hospital. In-hospital times between admission and operation room, as well as times between ultrasonography and operation room, were also longer in the orchiectomy group. Previous GP consultation (OR = 27.26, 95% CI 2.32–320.59, p = .009), prehospital time (OR = 1.04, 95% CI 1.01–1.07, p = .003) and nausea (OR = 9.25, 95% IC 1.33–64.52, p = .025) were independent predictive factors associated with orchiectomy. Conclusion Prehospital time was a determining factor in orchiectomy. For each extra hour of prehospital delay, the risk of orchiectomy increased by 4%. The rate of orchiectomy was higher among patients who first consulted a GP.

Can non-contrast head CT and stroke severity be used for stroke triage? A population-based study.

Acute ischemic stroke (AIS) patients may benefit from endovascular thrombectomy (EVT) up to 24h since last known normal (LKN). Advanced imaging is required for patient selection. Small or rural hospitals may not have sufficient CT technician and radiology support to rapidly acquire and interpret images. We estimated transfer rates using non-contrast head CT and stroke severity to select patients to be transferred to larger centers for evaluation. We identified all AIS among residents of the study region in 2010. Only cases age≥18 with baseline mRS 0-2 that presented to an ED were included. Among cases that presented between 6 and 24h from LKN, those without evidence of acute infarct on head CT and with initial NIHSS ≥6 or≥10 were identified. Of 1359 AIS cases, 448 (33.0%) presented between 6 and 24h, of which 383 (85.5%) showed no evidence of acute infarct on CT. Of cases with no acute infarct on CT, 89/383 (23.2%) had NIHSS ≥6, of which 66 (74.2%) initially presented to a hospital without thrombectomy capabilities; and 51/383 (13.3%) had NIHSS ≥10, of which 40 (78.4%) presented to a non-thrombectomy hospital. In our population, 40-66 AIS patients annually (0.8-1.3/week, or 3-5 patients/100,000 persons/year) may present to non-thrombectomy hospitals and need to be transferred using non-contrast CT and stroke severity as screening tools. Such an approach may sufficiently mitigate the impact of delays in treatment on outcomes, without overburdening the referring nor accepting hospitals.

Management of Muscle-Invasive Bladder Cancer During a Pandemic: Impact of Treatment Delay on Survival Outcomes for Patients Treated With Definitive Concurrent Chemoradiotherapy.

IntroductionDuring the coronavirus disease 2019 (COVID-19) pandemic, providers and patients must engage in shared decision making to ensure that the benefit of early intervention for muscle-invasive bladder cancer exceeds the risk of contracting COVID-19 in the clinical setting. It is unknown whether treatment delays for patients eligible for curative chemoradiation (CRT) compromise long-term outcomes.Patients and MethodsWe used the National Cancer Data Base to investigate whether there is an association between a ≥ 90-day delay from transurethral resection of bladder tumor (TURBT) in initiating CRT and overall survival. We included patients with cT2-4N0M0 muscle-invasive bladder cancer from 2004 to 2015 who underwent TURBT and curative-intent concurrent CRT. Patients were grouped on the basis of timing of CRT: ≤ 89 days after TURBT (earlier) vs. ≥ 90 and < 180 days after TURBT (delayed).ResultsA total of 1387 (87.5%) received earlier CRT (median, 45 days after TURBT; interquartile range, 34-59 days), and 197 (12.5%) received delayed CRT (median, 111 days after TURBT; interquartile range, 98-130 days). Median overall survival was 29.0 months (95% CI, 26.0-32.0) versus 27.0 months (95% CI, 19.75-34.24) for earlier and delayed CRT (P = .94). On multivariable analysis, delayed CRT was not associated with an overall survival difference (hazard ratio, 1.05; 95% CI, 0.87-1.27; P = .60).ConclusionAlthough these results are limited and require validation, short, strategic treatment delays during a pandemic can be considered on the basis of clinician judgment.

PD49-01 THE IMPACT OF DELAY IN CARE ON RENAL CELL CARCINOMA OUTCOMES: ANALYSIS BASED ON TUMOR SIZE

INTRODUCTION AND OBJECTIVE:Impact of delay in treatment for localized renal cell carcinoma (RCC) is controversial. We sought to determine the survival impact of time to definitive surgical treatmen...

Does delay in time to surgery impact outcome in renal cell carcinoma: Analysis based on tumor size utilizing the National Cancer Database.

664 Background: The impact of delay in treatment for localized renal cell carcinoma (RCC) is controversial. We sought to determine the survival impact of time to definitive surgical treatment stratified by tumor size in a group of young, healthy patients from the National Cancer Database (NCDB). Methods: The NCDB was queried for cases of localized RCC (cT1-T3N0M0) in patients &lt;60 years of age with Charlson comorbidity score of 0 from 2004-2015. Quartiles were formed from the range of time to surgery of the entire cohort in days, with delayed treatment as the fourth quartile. Tumors were stratified into size of &lt;2 cm, 2-4 cm, 4-7 cm and &gt;10 cm. Overall survival (OS) between early and delayed groups was calculated with Kaplan-Meier analysis (KMA) and multivariable cox proportional hazards (MVA) and stratified by tumor size. Logistic regression was performed to determine factors associated with delay in surgical care. Results: 44,149 patients were analyzed. Median time to treatment was 35 days (IQR 19-61). Early (n = 33,144) and delayed (&gt;61 days, n =11,005) groups had a mean follow-up of 61.5 and 57.5 months, respectively (p &lt; 0.001). KMA showed worse 5-yr OS in patients with surgery delay versus no delay for tumors 2-4 cm in size (5-yr OS 49% vs. 54%; p&lt;0.001), 4-7 cm (5-yr OS 47% vs. 53%; p&lt;0.001), &gt;7 cm (5-yr OS 45% vs. 49%;p=0.0002), but not for tumors &lt;2 cm (5 yr OS 49% vs. 51%: p=0.5848). MVA showed worse OS with surgery delay compared to no surgery delay in patients with tumor size 2-4 cm (HR 1.24; 95%CI 1.09-1.42), 4-7 cm (HR 1.32; 95%CI 1.16- 1.50) and &gt;7 cm (HR 1.14; 95%CI 1.01-1.30) but not tumors &lt;2 cm (HR 0.83; 95% CI 0.65-1.05). Delay in treatment was higher with older age (OR 1.01; p&lt;0.001), male gender (1.11; p&lt;0.001), non-private insurance (OR 1.44; p&lt;0.001), black race (OR 1.60; p&lt;0.001), decreased education (OR 1.11; p&lt;0.001) and tumors &gt;2 cm (OR 1.23; p&lt;0.001). Conclusions: In patients &lt;60 years of age and CCI of 0, delay in treatment was associated with worse OS for tumors &gt;2 cm but not for RCC &lt;2 cm in size. While these findings support data suggesting that active surveillance for RCC &lt; 2 cm in size is appropriate even in young and healthy patients, caution should be exercised in patients with tumors &gt; 2 cm.

Impact of Treatment Delays on Outcomes of Ruptured Abdominal Aortic Aneurysm Repair

Impact of Treatment Delays on Outcomes of Ruptured Abdominal Aortic Aneurysm Repair

IMPACT OF TREATMENT DELAYS IN EWINGS SARCOMA IN A LOW RESOURSE SETTING

Abstract Background Ewing’s sarcoma is the second most common primary malignant bone cancer in children and adolescents. Outcome of the children with Ewing sarcoma (ES) is worse in Low and Middle Income Countries (LMIC) compared to High Income Countries (HIC). In HIC only factor that had a significant impact on outcome was the presence of metastasis at presentation whereas treatment delay is a recognized factor contributing to poorer outcome evident by the studies especially done in LMIC. The situation in Sri Lanka has not been described before. We analyzed the clinical features and the impact of treatment delays on 5 year Event Free Survival (EFS) in Sri Lanka. Method All children with histologically proven Ewing sarcoma registered at the paediatric department from 01.01.2006 to 31.12.2011 were included. Demographic data, dates of first registration,chemotherapy, surgery, last contact and date of an event (Death, recurrence, progressive disease)were extracted from clinic records. EFS was calculated with Kaplan Meir curves and log rank test were used to calculate the level of significance. Results Out of 49 patients commonest site of presentation was leg (n = 19) followed by chest wall (n = 16). 10% had metastasis (n = 5) at presentation. 65% (n = 32) had surgery as local treatment (LT) and rest had radiotherapy while 4 defaulted treatment before LT. Out of extremity tumours only 21% (5/23) had limb preservation surgery. 5 year EFS in the entire cohort were 23.8%. Mean delay in neoadjuvant chemotherapy (NAC), LT and adjuvant chemotherapy (AC) were 6, 5.59 and 9.69 weeks respectively. NAC (p = 0.035) and LT(p = 0.004) delays significantly impacted EFS. Conclusions In spite of demographic and pathological data are similar to published data, 5 year EFS was is inferior to the accepted international standards. Delays in NAC and LT is the likely reason for inferior outcome.

P1740Clinical impact of symptom onset-to-balloon time and door-to-balloon time on 1-year adverse event in patients with ST-segment elevation myocardial infarction

Abstract Background and objectives The impact of treatment delays to reperfusion on patient mortality after primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI) is controversial. we evaluated the relation between the delay in the time to reperfusion during primary PCI and the 1-year clinical outcome of patients with STEMI treated by primary angioplasty. Methods The study enrolled 6,676 patients (age, 62.5±12.6 years; 26.5% female) with STEMI who underwent primary angioplasty onset between November 2005 and March 2012 from the KAMIR and KorMI Registry. The patients were divided into three groups according to the symptom onset-to-balloon (STB) time: group I, II, III (≤180 minutes, &gt;180 ∼ ≤360 minutes, &gt;360 minutes), and divided into three groups according to the door-to-balloon (DTB) time: group A, B, C (≤90 minutes, &gt;90 ∼ ≤120 minutes, &gt;120 minutes). The 1-year cardiac death and major adverse cardiac event (MACE) rates were compared among the three groups of time variables Results The cardiac death rate was 7.9% and MACE rate was 16.9% at one year follow-up. The 1-year cardiac death rate among STB time groups were significantly higher in group II (95% CI=1.05–2.60:p=0.030) and group III (95% CI=1.14–2.74:p=0.011), while that among DTB time groups were not significantly different based on a multivariate Cox proportional analysis, which was adjusted by age, sex, diabetes mellitus, hypertension, systolic blood pressure, left ventricular ejection fraction, peak level of CK-MB, anterior myocardial infarction. The 1-year MACE rate were not significantly different among STB time groups and DTB time group A, B, but was significantly higher in group C (95% CI=1.08–1.58:p=0.006). Conclusions These results suggest that, in patient with STEMI treated by primary angioplasty, STB time rather than DTB time was related 1-year clinical outcome especially cardiac death after adjustment for baseline characteristics. Therefore, all efforts should be made to shorten the total ischemic time in patients with acute myocardial infarction

The Impact of Treatment Delay on Outcome in the International Subarachnoid Aneurysm Trial (ISAT): Additional Analyses Comparing Neurosurgical Clipping vs. Endovascular Coiling

Background: ISAT demonstrated that 1 year after aneurysmal subarachnoid haemorrhage (aSAH), coiling resulted in a significantly better clinical outcome (death or dependency at 1 year) than clipping. After 5 years, this difference did not reach statistical significance but mortality (secondary endpoint) was still higher in the clipping group. Here, we present additional analyses, reporting the outcome after excluding pre-treatment death and/or re-bleeding. Methods: Outcome measures were death or dependency, and death alone, 1 and 5 years after treatment. We investigated outcome after i. exclusion of all pre-treatment deaths ii. exclusion of all pre-treatment rebleedings iii. 'as-treated' analysis and iv. as-treated analysis including good-grade patients (WFNS 0-2). Treatment differences were assessed using relative risks. Exploratory analyses were used to investigate the relation between treatment delay and outcome. Findings: After exclusion of pre-treatment deaths, coiling was favourable over clipping at 1-year follow-up for death or dependency (RR 0·77; 95%CI 0·67-0·89), but not for death alone (RR 0·88; 95%CI 0·66-1·19). After 5 years, no significant differences were observed, neither for death or dependency (RR 0·88; 95%CI 0·77-1·02), nor death alone (RR 0·82; 95%CI 0·64-1·05). Analyses ii. and iii showed a similar picture. In good-grade patients coiling remained favourable over clipping in long-term. Time between randomisation and treatment was significantly longer in the clipping arm (mean 1·7 versus 1·1 days; p<0·0001), in which respectively 17 patients died because of rebleeding vs. 6 in the endovascular arm (RR=2·81; 95%CI 1·11-7·11). Interpretation: These additional analyses support the conclusion of ISAT that at 1-year follow-up after aSAH, coiling leads to a better outcome than clipping. After 5 years however, with pre-treatment deaths and/or re-bleedings excluded, the difference between coiling and clipping was no longer significant. The high number of pre-treatment deaths in the clipping group highlights the importance of urgent aneurysm treatment to prevent early rebleeding. Funding: None. Declaration of Interest: None. Ethical Approval: All procedures performed in the study involving human participants were in accordance with the ethical standards of the participating institutions and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The protocol was approved by local Institutional Review Boards, and all patients (or representatives) provided written informed consent prior to participation.

Effect of Surgery Type on Time to Adjuvant Chemotherapy and Impact of Delay on Breast Cancer Survival: A National Cancer Database Analysis

Timeliness of care is emerging as a quality indicator for breast cancer care. We sought to evaluate the impact of surgical treatment type on time to adjuvant chemotherapy and impact of treatment delay on survival. Patients with stage I-III breast cancer treated with both surgery and adjuvant chemotherapy from 2010 to 2014 were identified from the National Cancer Database (NCDB). Delay in treatment was defined as > 120days from diagnosis to chemotherapy. Multivariable analysis was performed to assess factors associated with delay in treatment and the effect of treatment delay on overall survival. Of 172,043 patients identified, 89.5% initiated chemotherapy within 120days of diagnosis. Median time from diagnosis to surgery was shorter in patients undergoing breast conservation (25days) than mastectomy (29days, p < 0.001) and within mastectomy patients was shorter for mastectomy without reconstruction (26 versus 35days, p < 0.001). Time from diagnosis to surgery showed larger differences between surgical groups than time from surgery to chemotherapy. On multivariable analysis of mastectomy patients, reconstruction remained significantly associated with delay to chemotherapy [odds ratio (OR) 1.7, p < 0.001]. For all patients regardless of type of surgery, after adjusting for patient, clinical, and treatment factors, delay of > 120days from diagnosis to chemotherapy was associated with worse overall survival [hazard ratio (HR) 1.29, p < 0.001]. Initiation of chemotherapy greater than 120days after diagnosis was associated with poorer overall survival. Time interval from diagnosis to surgery had the greatest impact on time from diagnosis to chemotherapy, with reconstruction resulting in the greatest delay.