title: Delay of adjuvant chemotherapy after elective mastectomy and immediate reconstruction in breast-conservation candidates: a matched-pair analysis.
abstract: OBJECTIVE
  To analyze factors that influence the timing of adjuvant chemotherapy in patients who are candidates for breast-conservation therapy (BCT) but elect mastectomy with immediate reconstruction (M-IR).
  
  
  METHODS
  We identified 35 consecutively treated patients with stage I or II breast cancer between 2004 and 2009 who underwent M-IR and adjuvant chemotherapy from the University of Louisville Cancer Registry. We matched these patients for age and AJCC stage to 35 controls who underwent BCT and adjuvant chemotherapy. We examined the timing and delay of initiation of chemotherapy using univariate logistic regression and McNemar test for matched pairs.
  
  
  RESULTS
  For the 70 patients evaluated, the median age was 46 years (range, 30 to 65 y), and the distribution for stage I, IIA, and IIB was 22.9%, 65.7%, and 11.4%, respectively. The 2 groups were well balanced in terms of race, rural/urban status, smoking, diabetes, insurance coverage, and histology. For BCT and M-IR, the median time to chemotherapy initiation was 38 days (range, 25 to 103 d) and 55 days (range, 30 to 165 d), respectively. Patients undergoing M-IR were more likely to experience any delay (>45 d; 54.3% vs. 22.9%; P<0.001) and/or significant delay (>90 d; 20.0% vs. 2.9%; P<0.001). On univariate logistic regression analysis, surgery type had a major impact on delay of chemotherapy (odds ratio=8.35; 95% confidence interval, 2.86-24.4; P<0.001).
  
  
  CONCLUSIONS
  The use of M-IR in breast-conservation candidates independently predicts for delay in initiation of adjuvant chemotherapy. Further study is needed to qualify the causes and clinical significance of these delays.
authors: Departments of *Radiation Oncology †Medical Oncology ‡Biostatistics and Epidemiology §Surgical Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY.
authors: Parul N
authors: PN
authors: Barry
authors: Elizabeth C
authors: EC
authors: Riley
authors: Jianmin
authors: J
authors: Pan
authors: John B
authors: JB
authors: Crew
authors: Kiwhoon
authors: K
authors: Lee
authors: Dharamvir
authors: D
authors: Jain
authors: Barbara
authors: B
authors: Kruse
authors: Amy R
authors: AR
authors: Quillo
authors: Shesh
authors: S
authors: Rai
authors: Anthony E
authors: AE
authors: Dragun
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000628:therapy*; D018270:Carcinoma, Ductal, Breast / Q000628:therapy*; D018275:Carcinoma, Lobular / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D015331:Cohort Studies; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D016015:Logistic Models; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods*; D015412:Mastectomy, Segmental / Q000379:methods*; D016555:Matched-Pair Analysis; D008875:Middle Aged; D012189:Retrospective Studies; D061665:Time-to-Treatment / Q000706:statistics & numerical data*