Background: adjuvant chemotherapy is the standard of care for management of high-risk early breast cancer. The impact on disease-free and overall survival is most significant when started within four weeks of surgery, and is reduced for every four weeks that chemotherapy is delayed. The greatest benefit is in those with triple negative breast cancer (TNBC).
Aim: to identify delays in starting adjuvant chemotherapy for high-risk early breast cancer patients in Central Queensland.
Methods: clinical data for patients with invasive breast cancer that underwent surgery followed by adjuvant chemotherapy at Rockhampton and Gladstone hospitals between August 2017 to August 2022 was analysed. Time from last surgical procedure to commencement of adjuvant chemotherapy was grouped; <4 weeks, 4-8 weeks, 8-12 weeks, 12-16 weeks and >16 weeks.
Results: overall 98 patients were assessed; 98.9% were female, 14 (14.2%) had TNBC and 84 (85.7%) had non-TNBC. Mean age at diagnosis was 52.6 years, 48 (49%) required a second surgery and average distance to treatment centre was 104.4km. The average time from final surgery to commencement of adjuvant chemotherapy was 46.9 days (range: 16-118 days) for all patients and 45 days (range: 20-95 days) for the TNBC group. Overall, 10.2% of all patients and 14.3% of TNBC patients received adjuvant chemotherapy in less than 4 weeks from surgery, 71.4% within 4-8 weeks, 13.3% within 8-12 weeks, 4.1% within 12-16 weeks and 1.0% in more than 16 weeks. On average it took 13.9 days (range: 2-86 days) to refer to medical oncology from last surgery, 20 days (range: 1-64 days) for a medical oncology appointment and 17.3 days (range: 3-63 days) from appointment to commencement of chemotherapy.
Conclusion: this audit demonstrates that only a minority of high-risk early breast cancer patients commence adjuvant chemotherapy within the recommended period of less than 4 weeks following surgery, warranting further investigation into the causes for delays.