Effect on Survival of Longer Intervals Between Confirmed Diagnosis and Treatment Initiation Among Low-Income Women With Breast Cancer
Effect on Survival of Longer Intervals Between Confirmed Diagnosis and Treatment Initiation Among Low-Income Women With Breast Cancer
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DOI：
10.1200/jco.2012.39.7695
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发表时间：
2012-12-20
影响因子：
45.3
通讯作者：
Paskett, Electra D.
中科院分区：
文献类型：
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作者：
McLaughlin, John M.;Anderson, Roger T.;Paskett, Electra D.
目的确定从活检证实的乳腺癌诊断到开始治疗(Dx2Tx)之间较长的时间对生存率的影响。患者和方法本研究是在链接的北卡罗来纳州中央癌症登记-医疗补助索赔数据库中对2000年1月1日至2002年12月31日期间被诊断为乳腺癌的北卡罗来纳州成年女性医疗补助登记的非干预性回顾分析。追踪数据截至2006年7月31日。建立COX比例风险回归模型来评估乳腺癌确诊后推迟治疗60天对生存的影响。结果研究队列包括1,786名平均年龄为61.6岁的低收入成年女性。患者中很大一部分(44.3%)是少数民族。从活检确诊到开始治疗的中位时间为22天。校正COX比例风险回归分析显示，虽然Dx2Tx长度不影响早期确诊患者的生存率，但在晚期患者中，从确诊到首次治疗的间隔时间=60天与显著较差的总体生存率(风险比[HR]，1.66；95%CI，1.00至2.77；P=0.05)和乳腺癌特定生存率(HR，1.85；95%CI，1.04至3.27；P=0.04)相关。在晚期患者中，等待60天开始治疗与总体和乳腺癌相关死亡风险分别显著增加66%和85%。旨在增加接受乳腺癌治疗的及时性的干预措施应以晚期患者为目标，临床医生应努力及时对晚期确诊的患者进行分诊并开始治疗。J Clin Oncol30：4493-4500。(C)2012年美国临床肿瘤学会
PurposeTo determine the impact of longer periods between biopsy-confirmed breast cancer diagnosis and the initiation of treatment (Dx2Tx) on survival.Patients and MethodsThis study was a noninterventional, retrospective analysis of adult female North Carolina Medicaid enrollees diagnosed with breast cancer from January 1, 2000, through December, 31, 2002, in the linked North Carolina Central Cancer Registry-Medicaid Claims database. Follow-up data were available through July 31, 2006. Cox proportional hazards regression models were constructed to evaluate the impact on survival of delaying treatment >= 60 days after a confirmed diagnosis of breast cancer.ResultsThe study cohort consisted of 1,786 low-income, adult women with a mean age of 61.6 years. A large proportion of the patients (44.3%) were racial minorities. Median time from biopsy-confirmed diagnosis to treatment initiation was 22 days. Adjusted Cox proportional hazards regression showed that although Dx2Tx length did not affect survival among those diagnosed at early stage, among late-stage patients, intervals between diagnosis and first treatment >= 60 days were associated with significantly worse overall survival (hazard ratio [HR], 1.66; 95% CI, 1.00 to 2.77; P=.05) and breast cancer-specific survival (HR, 1.85; 95% CI, 1.04 to 3.27; P=.04).ConclusionOne in 10 women waited >= 60 days to initiate treatment after a diagnosis of breast cancer. Waiting >= 60 days to initiate treatment was associated with a significant 66% and 85% increased risk of overall and breast cancer-related death, respectively, among late-stage patients. Interventions designed to increase the timeliness of receiving breast cancer treatments should target late-stage patients, and clinicians should strive to promptly triage and initiate treatment for patients diagnosed at late stage. J Clin Oncol 30:4493-4500. (C) 2012 by American Society of Clinical Oncology