Effect of longer health service provider delays on stage at diagnosis and mortality in symptomatic breast cancer

P. Murchie, E. A. Raja, A. J. Lee, D. H. Brewster, N. C. Campbell, N. M. Gray, L. D. Ritchie, R. Robertson, L. Samuel

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Abstract

Purpose: This study explored whether longer provider delays (between first presentation and treatment) were associated with later stage and poorer survival in women with symptomatic breast cancer. Methods: Data from 850 women with symptomatic breast cancer were linked with the Scottish Cancer Registry; Death Registry; and hospital discharge dataset. Logistic regression and Cox survival analyses with restricted cubic splines explored relationships between provider delays, stage and survival, with sequential adjustment for patient and tumour factors. Results: Although confidence intervals were wide in both adjusted analyses, those with the shortest provider delays had more advanced breast cancer at diagnosis. Beyond approximately 20 weeks, the trend suggests longer delays are associated with more advanced stage, but is not statistically significant. Those with symptomatic breast cancer and the shortest presentation to treatment time (within 4 weeks) had the poorest survival. Longer time to treatment was not significantly associated with worsening mortality. Conclusions: Poor prognosis patients with breast cancer are being triaged for rapid treatment with limited effect on outcome. Prolonged time to treatment does not appear to be strongly associated with poorer outcomes for patients with breast cancer, but the power of this study to assess the effect of very long delays (>25 weeks) was limited. Efforts to reduce waiting times are important from a quality of life perspective, but tumour biology may often be a more important determinant of stage at diagnosis and survival outcome.
Original languageEnglish
Pages (from-to)248-255
Number of pages8
JournalBreast
Volume24
Issue number3
Early online date7 Mar 2015
DOIs
Publication statusPublished - Jun 2015

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Health Services
Breast Neoplasms
Mortality
Survival
Therapeutics
Registries
Neoplasms
Logistic Models
Confidence Intervals

Keywords

  • breast cancer
  • diagnosis
  • delayed diagnosis
  • health services
  • survival
  • cancer staging

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Effect of longer health service provider delays on stage at diagnosis and mortality in symptomatic breast cancer. / Murchie, P.; Raja, E. A.; Lee, A. J.; Brewster, D. H.; Campbell, N. C.; Gray, N. M.; Ritchie, L. D.; Robertson, R.; Samuel, L. .

In: Breast, Vol. 24, No. 3, 06.2015, p. 248-255.

Research output: Contribution to journalArticle

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abstract = "Purpose: This study explored whether longer provider delays (between first presentation and treatment) were associated with later stage and poorer survival in women with symptomatic breast cancer. Methods: Data from 850 women with symptomatic breast cancer were linked with the Scottish Cancer Registry; Death Registry; and hospital discharge dataset. Logistic regression and Cox survival analyses with restricted cubic splines explored relationships between provider delays, stage and survival, with sequential adjustment for patient and tumour factors. Results: Although confidence intervals were wide in both adjusted analyses, those with the shortest provider delays had more advanced breast cancer at diagnosis. Beyond approximately 20 weeks, the trend suggests longer delays are associated with more advanced stage, but is not statistically significant. Those with symptomatic breast cancer and the shortest presentation to treatment time (within 4 weeks) had the poorest survival. Longer time to treatment was not significantly associated with worsening mortality. Conclusions: Poor prognosis patients with breast cancer are being triaged for rapid treatment with limited effect on outcome. Prolonged time to treatment does not appear to be strongly associated with poorer outcomes for patients with breast cancer, but the power of this study to assess the effect of very long delays (>25 weeks) was limited. Efforts to reduce waiting times are important from a quality of life perspective, but tumour biology may often be a more important determinant of stage at diagnosis and survival outcome.",
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author = "P. Murchie and Raja, {E. A.} and Lee, {A. J.} and Brewster, {D. H.} and Campbell, {N. C.} and Gray, {N. M.} and Ritchie, {L. D.} and R. Robertson and L. Samuel",
note = "The study was funded by an endowment award from NHS Grampian (project number 11/26). The University of Aberdeen acted as sponsor for the study. We also acknowledge the staff at ISD Scotland who linked the CRUX dataset to central databases. We also acknowledge the support of Dr Katie Wilde and her staff in the University of Aberdeen Data Management team who prepared our database for analysis.",
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AU - Raja, E. A.

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AU - Campbell, N. C.

AU - Gray, N. M.

AU - Ritchie, L. D.

AU - Robertson, R.

AU - Samuel, L.

N1 - The study was funded by an endowment award from NHS Grampian (project number 11/26). The University of Aberdeen acted as sponsor for the study. We also acknowledge the staff at ISD Scotland who linked the CRUX dataset to central databases. We also acknowledge the support of Dr Katie Wilde and her staff in the University of Aberdeen Data Management team who prepared our database for analysis.

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N2 - Purpose: This study explored whether longer provider delays (between first presentation and treatment) were associated with later stage and poorer survival in women with symptomatic breast cancer. Methods: Data from 850 women with symptomatic breast cancer were linked with the Scottish Cancer Registry; Death Registry; and hospital discharge dataset. Logistic regression and Cox survival analyses with restricted cubic splines explored relationships between provider delays, stage and survival, with sequential adjustment for patient and tumour factors. Results: Although confidence intervals were wide in both adjusted analyses, those with the shortest provider delays had more advanced breast cancer at diagnosis. Beyond approximately 20 weeks, the trend suggests longer delays are associated with more advanced stage, but is not statistically significant. Those with symptomatic breast cancer and the shortest presentation to treatment time (within 4 weeks) had the poorest survival. Longer time to treatment was not significantly associated with worsening mortality. Conclusions: Poor prognosis patients with breast cancer are being triaged for rapid treatment with limited effect on outcome. Prolonged time to treatment does not appear to be strongly associated with poorer outcomes for patients with breast cancer, but the power of this study to assess the effect of very long delays (>25 weeks) was limited. Efforts to reduce waiting times are important from a quality of life perspective, but tumour biology may often be a more important determinant of stage at diagnosis and survival outcome.

AB - Purpose: This study explored whether longer provider delays (between first presentation and treatment) were associated with later stage and poorer survival in women with symptomatic breast cancer. Methods: Data from 850 women with symptomatic breast cancer were linked with the Scottish Cancer Registry; Death Registry; and hospital discharge dataset. Logistic regression and Cox survival analyses with restricted cubic splines explored relationships between provider delays, stage and survival, with sequential adjustment for patient and tumour factors. Results: Although confidence intervals were wide in both adjusted analyses, those with the shortest provider delays had more advanced breast cancer at diagnosis. Beyond approximately 20 weeks, the trend suggests longer delays are associated with more advanced stage, but is not statistically significant. Those with symptomatic breast cancer and the shortest presentation to treatment time (within 4 weeks) had the poorest survival. Longer time to treatment was not significantly associated with worsening mortality. Conclusions: Poor prognosis patients with breast cancer are being triaged for rapid treatment with limited effect on outcome. Prolonged time to treatment does not appear to be strongly associated with poorer outcomes for patients with breast cancer, but the power of this study to assess the effect of very long delays (>25 weeks) was limited. Efforts to reduce waiting times are important from a quality of life perspective, but tumour biology may often be a more important determinant of stage at diagnosis and survival outcome.

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