Murchie P, Raja E A, Lee A J, Brewster D H, Campbell N C, Gray N M, Ritchie L D, Robertson R, Samuel L
Division of Applied Health Science, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
Division of Applied Health Science, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
Breast. 2015 Jun;24(3):248-55. doi: 10.1016/j.breast.2015.02.027. Epub 2015 Mar 7.
This study explored whether longer provider delays (between first presentation and treatment) were associated with later stage and poorer survival in women with symptomatic breast cancer.
Data from 850 women with symptomatic breast cancer were linked with the Scottish Cancer Registry; Death Registry; and hospital discharge dataset. Logistic regression and Cox survival analyses with restricted cubic splines explored relationships between provider delays, stage and survival, with sequential adjustment for patient and tumour factors.
Although confidence intervals were wide in both adjusted analyses, those with the shortest provider delays had more advanced breast cancer at diagnosis. Beyond approximately 20 weeks, the trend suggests longer delays are associated with more advanced stage, but is not statistically significant. Those with symptomatic breast cancer and the shortest presentation to treatment time (within 4 weeks) had the poorest survival. Longer time to treatment was not significantly associated with worsening mortality.
Poor prognosis patients with breast cancer are being triaged for rapid treatment with limited effect on outcome. Prolonged time to treatment does not appear to be strongly associated with poorer outcomes for patients with breast cancer, but the power of this study to assess the effect of very long delays (>25 weeks) was limited. Efforts to reduce waiting times are important from a quality of life perspective, but tumour biology may often be a more important determinant of stage at diagnosis and survival outcome.
本研究探讨了在有症状的乳腺癌女性中，更长的医疗服务提供者延迟时间（从首次就诊到接受治疗之间）是否与疾病晚期及较差的生存率相关。
850例有症状乳腺癌女性的数据与苏格兰癌症登记处、死亡登记处及医院出院数据集相链接。采用逻辑回归和Cox生存分析，并结合受限立方样条，探讨医疗服务提供者延迟时间、疾病分期和生存率之间的关系，并对患者和肿瘤因素进行序贯调整。
尽管在两项校正分析中置信区间较宽，但医疗服务提供者延迟时间最短的患者在诊断时乳腺癌分期更高。超过约20周后，趋势表明延迟时间越长与分期越晚相关，但无统计学意义。有症状乳腺癌且从就诊到治疗时间最短（4周内）的患者生存率最差。更长的治疗时间与死亡率恶化无显著关联。
预后较差的乳腺癌患者正在接受快速治疗分流，但对治疗结果影响有限。延长治疗时间似乎与乳腺癌患者较差的治疗结果并无强烈关联，但本研究评估极长延迟时间（>25周）影响的效能有限。从生活质量角度来看，努力减少等待时间很重要，但肿瘤生物学特征可能往往是诊断时分期及生存结果的更重要决定因素。
