PURPOSE Delays in adjuvant breast cancer (BC) therapy have been shown to worsen outcomes. However, thus far studies have only evaluated delays to initial treatment, or a particular modality, such as chemotherapy, leaving uncertainty about the role of delay to subsequent therapy and the effects of cumulative delay, on outcomes. We investigated the associations of delays across treatment modalities with survival. METHODS We included 3368 women with incident stage I-III BC in the Women's Health Initiative (WHI) enrolled in fee-for-service Medicare who underwent definitive surgery. This prospective analysis characterized treatment delays by linking WHI study records to Medicare claims. Delays were defined as > 8 weeks to surgery, chemotherapy, and radiation from diagnosis or prior treatment. We used Cox proportional hazards models to estimate BC-specific mortality (BCSM) and all-cause mortality (ACM) in relation to treatment delays. RESULTS We found 21.8% of women experienced delay to at least one therapy modality. In adjusted analysis, delay to chemotherapy was associated with a higher risk of BCSM (HR = 1.71; 95% CI 1.07-2.75) and ACM (HR = 1.39; 95% CI 1.02-1.90); delay in radiation increased BCSM risk (HR = 1.49; 95% CI 1.00-2.21) but not ACM risk (HR = 1.19; 95% CI 0.99-1.42). Delays across multiple treatment modalities increased BCSM risk threefold (95% CI 1.51-6.12) and ACM risk 2.3-fold (95% CI 1.50-3.50). CONCLUSIONS A delay to a single treatment modality and delay to a greater extent an accumulation of delays were associated with higher BCSM and ACM after BC. Timely care throughout the continuum of breast cancer treatment is important for optimal outcomes.

中文翻译：

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乳腺癌患者治愈性治疗延迟与生存的关联：妇女健康倡议的发现。

目的 辅助乳腺癌 (BC) 治疗的延迟已被证明会使结果恶化。然而，迄今为止的研究仅评估了对初始治疗或特定方式（如化疗）的延迟，从而对延迟对后续治疗的作用以及累积延迟对结果的影响留下了不确定性。我们调查了不同治疗方式的延迟与生存的关联。方法 我们在女性健康倡议 (WHI) 中纳入了 3368 名患有 I-III 期 BC 事件的女性，这些女性参加了按服务收费的医疗保险并接受了根治性手术。这项前瞻性分析通过将 WHI 研究记录与医疗保险索赔联系起来来表征治疗延迟。延迟定义为从诊断或先前治疗到手术、化疗和放疗的时间 > 8 周。我们使用 Cox 比例风险模型来估计与治疗延迟相关的 BC 特异性死亡率 (BCSM) 和全因死亡率 (ACM)。结果 我们发现 21.8% 的女性经历了至少一种治疗方式的延迟。在调整后的分析中，延迟化疗与 BCSM（HR = 1.71；95% CI 1.07-2.75）和 ​​ACM（HR = 1.39；95% CI 1.02-1.90）的高风险相关；放疗延迟会增加 BCSM 风险（HR = 1.49；95% CI 1.00-2.21），但不会增加 ACM 风险（HR = 1.19；95% CI 0.99-1.42）。多种治疗方式的延迟使 BCSM 风险增加三倍 (95% CI 1.51-6.12)，ACM 风险增加 2.3 倍 (95% CI 1.50-3.50)。结论 对单一治疗方式的延迟和更大程度上的延迟累积延迟与 BC 后更高的 BCSM 和 ACM 相关。