title: Effect on survival of longer intervals between confirmed diagnosis and treatment initiation among low-income women with breast cancer.
abstract: OBJECTIVE
  To determine the impact of longer periods between biopsy-confirmed breast cancer diagnosis and the initiation of treatment (Dx2Tx) on survival.
  
  
  METHODS
  This 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.
  
  
  RESULTS
  The 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).
  
  
  CONCLUSIONS
  One 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.
authors.affiliation: The Ohio State University, Columbus, OH, USA. mclaugj1@gmail.com
authors.forename: John M
authors.initials: JM
authors.lastname: McLaughlin
authors.forename: Roger T
authors.initials: RT
authors.lastname: Anderson
authors.forename: Amy K
authors.initials: AK
authors.lastname: Ferketich
authors.forename: Eric E
authors.initials: EE
authors.lastname: Seiber
authors.forename: Rajesh
authors.initials: R
authors.lastname: Balkrishnan
authors.forename: Electra D
authors.initials: ED
authors.lastname: Paskett
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D008327:Mammography / Q000191:economics; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States; D014850:Waiting Lists