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Bleicher RJ , Ruth K , Sigurdson ER , Ross E , Wong YN , Patel SA , Boraas M , Topham NS , Egleston BL
Preoperative Delays in the US Medicare Population With Breast Cancer
J Clin Oncol. 2012 Dec 20;30(36) :4485-92
PMID: 23169513    PMCID: PMC 3518727    URL: http://www.ncbi.nlm.nih.gov/pubmed/23169513
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Abstract
PURPOSE Although no specific delay threshold after diagnosis of breast cancer has been demonstrated to affect outcome, delays can cause anxiety, and surgical waiting time has been suggested as a quality measure. This study was performed to determine the interval from presentation to surgery in Medicare patients with nonmetastatic invasive breast cancer who did not receive neoadjuvant chemotherapy and factors associated with a longer time to surgery. METHODS Medicare claims linked to Surveillance, Epidemiology, and End Results data were reviewed for factors associated with delay between the first physician claim for a breast problem and first therapeutic surgery. Results Between 1992 and 2005, 72,586 Medicare patients with breast cancer had a median interval (delay) between first physician visit and surgery of 29 days, increasing from 21 days in 1992 to 32 days in 2005. Women (29 days v 24 days for men; P < .001), younger patients (29 days; P < .001), blacks and Hispanics (each 37 days; P < .001), patients in the northeast (33 days; P < .001), and patients in large metropolitan areas (32 days; P < .001) had longer delays. Patients having breast conservation and mastectomies had adjusted median delays of 28 and 30 days, respectively, with simultaneous reconstruction adding 12 days. Preoperative components, including imaging modalities, biopsy type, and clinician visits, were also each associated with a specific additional delay. CONCLUSION Waiting times for breast cancer surgery have increased in Medicare patients, and measurable delays are associated with demographics and preoperative evaluation components. If such increases continue, periodic assessment may be required to rule out detrimental effects on outcomes.
Notes
Bleicher, Richard J Ruth, Karen Sigurdson, Elin R Ross, Eric Wong, Yu-Ning Patel, Sameer A Boraas, Marcia Topham, Neal S Egleston, Brian L United States Journal of clinical oncology : official journal of the American Society of Clinical Oncology J Clin Oncol. 2012 Dec 20;30(36):4485-92. doi: 10.1200/JCO.2012.41.7972. Epub 2012 Nov 19.