Post-Breast Cancer Diagnosis, Surgical Waiting Time Up Among Medicare Population

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(ChemotherapyAdvisor) – Surgical waiting time after a diagnosis of breast cancer—suggested as a quality measure—has increased in patients enrolled in Medicare, investigators reported in the Journal of Clinical Oncology online November 19.

Medicare claims linked to Surveillance Epidemiology and End Results data were reviewed “to provide the first data detailing associations between evaluation components, surgery type, and interval length from the first physician appointment to the first therapeutic surgical procedure,” noted Richard J. Bleicher, MD, of the Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, and colleagues.

“Although no specific delay threshold after diagnosis of breast cancer has been demonstrated to affect outcome, delays can cause anxiety.”

A total of 72,586 Medicare patients with nonmetastatic invasive breast cancer who did not receive neoadjuvant chemotherapy were identified. Median interval, or delay, between first physician visit and surgery was 29 days, increasing from 21 days in 1992 to 32 days in 2005.

“Women (29 days vs 24 days for men; P<0.001), younger patients (29 days; P<0.001), blacks and Hispanics (each 37 days; P<0.001), patients in the northeast (33 days; P<0.001), and patients in large metropolitan areas (32 days; P<0.001) had longer delays,” they found.

Women who had breast conservation had an adjusted median delay of 28 days; for those undergoing mastectomies, it was 30 days, with simultaneous reconstruction adding 12 days. Preoperative components—imaging modalities, biopsy type, and clinician visits—were each associated with additional delay.

“The specific contribution by each preoperative component has not previously been published to our knowledge, and our racial disparity findings provide specifics to previously noted delays,” Dr. Bleicher pointed out.

“As patient numbers grow and resources become fewer, increasing delays may require periodic assessment to ensure that there is no detrimental effect on breast cancer outcomes.”

Abstract

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