Division of Breast Services, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
Breast J. 2020 Oct;26(10):1995-2001. doi: 10.1111/tbj.14046. Epub 2020 Sep 13.
Studies have shown that in the United States, there is an increasing time from breast cancer diagnosis to first treatment (time to treatment or "TTT"), with concern that such delays may worsen oncologic outcomes. A component of TTT is the time from the initial diagnosis to initial surgical consultation (SC). We sought to identify patient-related factors associated with time to initial SC, and evaluate how this interval is associated with overall total time to treatment (TTT).
A prospective database of women diagnosed with breast cancer at our institution from 2015 to 2016 was reviewed. Time from initial breast cancer diagnosis to SC and overall TTT was collected from the electronic medical record. Documented patient-identified preferences regarding scheduling the first surgical appointment were reviewed. A multivariate analysis was performed to determine clinical and patient factors associated with TTT.
Of 553 breast cancer patients included in the study, 27% of women opted for the earliest appointment while 73% chose a later date. The median time from diagnosis to SC was 8.5 ± 4.7 days. Patients who accepted a first available SC waited an average of 5.6 ± 3.4 days, while those who deferred waited 9.5 ± 4.6 days (P < .001). Patients who deferred the earliest available SC were older, with a median age of 67 versus 63 years, (P = .018), and had a preference for a specific location in the geographical hospital region (P = .003). Patients who deferred the first available SC also had a longer TTT (33 vs. 28 days, P = .027).
Among newly diagnosed breast cancer patients, there is a substantial population that defers the first available SC. These patients are also more likely to have a prolonged TTT. Future follow-up of this cohort is necessary to determine the delays on TTT affect cancer outcomes and overall survival.
研究表明，在美国，从乳腺癌确诊到首次治疗（治疗时间或“TTT”）的时间越来越长，人们担心这种延迟可能会恶化肿瘤学结果。TTT 的一个组成部分是从最初诊断到初始手术咨询（SC）的时间。我们试图确定与初始 SC 时间相关的患者相关因素，并评估该间隔与总治疗时间（TTT）的整体相关性。
回顾了 2015 年至 2016 年在我们机构诊断为乳腺癌的女性的前瞻性数据库。从电子病历中收集了从最初的乳腺癌诊断到 SC 和总体 TTT 的时间。审查了有关安排首次手术预约的患者确定的首选方案的记录。进行了多变量分析以确定与 TTT 相关的临床和患者因素。
在研究的 553 名乳腺癌患者中，27%的女性选择了最早的预约时间，而 73%的女性选择了较晚的日期。从诊断到 SC 的中位时间为 8.5±4.7 天。接受首次可用 SC 的患者平均等待 5.6±3.4 天，而推迟的患者则等待 9.5±4.6 天（P<.001）。推迟最早可用 SC 的患者年龄较大，中位年龄为 67 岁，而 63 岁（P=.018），并且对地理医院区域内的特定位置有偏好（P=.003）。推迟首次可用 SC 的患者的 TTT 也更长（33 天与 28 天，P=.027）。
在新诊断的乳腺癌患者中，有相当一部分患者推迟了首次可用的 SC。这些患者也更有可能延长 TTT。需要对这一队列进行进一步随访，以确定 TTT 的延迟是否会影响癌症结果和总体生存率。
