Medical Oncology Department, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PP, United Kingdom; UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London WC1H 9JP, United Kingdom.
The Breast Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, United Kingdom.
Eur J Cancer. 2024 Oct;210:114301. doi: 10.1016/j.ejca.2024.114301. Epub 2024 Aug 25.
Inter-cycle delays to chemotherapy are often required to manage drug toxicity. The impact of delays on mortality is poorly characterised. This retrospective cohort study examined the association of treatment delay with all-cause mortality in early-stage breast cancer.
This real-world analytical study included adult women with stage 2 or 3 breast cancer receiving first-line (neo-)adjuvant chemotherapy between 01/01/2014 and 31/12/2015 in England. Inter-cycle delays > 7 days during the treatment period were calculated, and the association of treatment delay with 5-year all-cause mortality was investigated. Survival was compared between patients experiencing treatment delay and those completing treatment to schedule using landmark methodology and Kaplan-Meier (KM) estimator. Cox proportional hazards regression was used to investigate the impact of delay on survival, using inverse probability of treatment weighting to adjust for confounding variables.
8567 patients were included. 17 % (1448) experienced inter-cycle delay > 7 days during the treatment period. 1120 (13 %) women had died at the end of the 5-year follow up period. Median follow-up time was 5.5 years. Survival probability was significantly lower in patients experiencing treatment delay by KM estimator analysis (p < 0.0001). Cox proportional hazards regression demonstrated a significant positive association between delay and 5-year all-cause mortality (HR 1.33 95 % CI 1.12-1.61, p < 0.001).
This is the largest study of its kind demonstrating an association between treatment delay and all-cause mortality. These findings support interventions to improve toxicity management allowing completion of chemotherapy to schedule where patients experience treatment delay due to treatment-related toxicity or hospital capacity pressures.
为了处理药物毒性，通常需要在化疗周期之间进行延迟。但延迟对死亡率的影响尚未明确。本回顾性队列研究旨在探讨早期乳腺癌患者治疗延迟与全因死亡率之间的关系。
本真实世界分析性研究纳入了 2014 年 1 月 1 日至 2015 年 12 月 31 日期间在英格兰接受一线（新辅助）化疗的 2 期或 3 期乳腺癌成年女性患者。计算治疗期间每周期延迟>7 天的情况，并使用 landmark 方法和 Kaplan-Meier（KM）估计值研究治疗延迟与 5 年全因死亡率之间的关系。使用逆概率治疗加权法（IPTW）调整混杂因素后，通过 Cox 比例风险回归分析延迟对生存的影响。
共纳入 8567 例患者，17%（1448 例）患者在治疗期间经历了每周期延迟>7 天。1120 例（13%）女性在 5 年随访期末死亡。中位随访时间为 5.5 年。KM 估计值分析显示，经历治疗延迟的患者生存概率显著降低（p<0.0001）。Cox 比例风险回归显示，延迟与 5 年全因死亡率之间存在显著正相关（HR 1.33，95%CI 1.12-1.61，p<0.001）。
这是同类研究中规模最大的研究，证明了治疗延迟与全因死亡率之间存在关联。这些发现支持干预措施，以改善毒性管理，使因治疗相关毒性或医院容量压力而延迟治疗的患者能够按计划完成化疗。
