Results from a new study show women who wait more than 60 days to begin treatment for advanced breast cancer face significantly higher risks of dying than women who start therapy shortly after diagnosis.
"We wanted to see whether delaying treatment affected disease progression, treatment complications and ultimately a woman's outcome," says Electra D. Paskett, associate director for population sciences at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC-James). "It's been shown that early detection and treatment can increase five year survival rates to as high as 98 percent. Until this study, we didn't know the profound effect delaying treatment could have," she said.
Paskett coauthored the study, which is published online by the Journal of Clinical Oncology. In the study, researchers retrospectively examined the cases of 1,786 women enrolled in North Carolina Medicaid system who were diagnosed with breast cancer from January 1, 2000 through December 31, 2002, using the linked North Carolina Cancer Registry-Medicaid Claims database. Follow-up data was available through July 31, 2006.
The median time from biopsy-confirmed diagnosis to the initiation of treatment was 22 days. Sixty-six percent of the women started treatment within 30 days, and nearly all (90 percent) started treatment within 60 days.There was no difference in survival rates for those treated within 30 or 60 days.
However, for one in ten women studied, treatment started more than 60 days after their cancer diagnosis. Among those who had advanced cases of breast cancer, that delay was associated with an 85 percent higher risk of breast cancer-related death, and a 66 percent higher risk of death overall, compared with women treated sooner.
"We're finding as we do research, it is really the lower income population that suffers the highest burden of all diseases," says Paskett. "This study suggests perhaps they can't get access to care, or it takes a longer time to get access to care."
Paskett says interventions to remove barriers and improve the timeliness of breast cancer treatment should include late-stage patients. Paskett recently published a study that confirmed patient navigators, often hospital employees, help patients negotiate the various complexities of the health care system and play a valuable role in helping breast cancer patients complete their treatment.
"This research shows we have an opportunity to improve breast cancer outcomes by helping women who are diagnosed at late-stage to get started with treatment sooner," says Paskett. "Even if the goal of treatment isn't curative, early treatment seems to prolong survival and improve quality of life."
¹Effect of Survival of Longer Intervals Between Confirmed-diagnosis and Treatment Initiation among Low-income Women with Breast Cancer, Journal of Clinical Oncology. Published online November 19, 2012: :http://jco.ascopubs.org/content/early/2012/11/16/JCO.2012.39.7695.full.pdf+html