title: Adjuvant treatment delay in breast cancer patients.
abstract: BACKGROUND
  to evaluate if time between surgery and the first adjuvant treatment (chemotherapy, radiotherapy or hormone therapy) in patients with breast cancer is a risk factor for lower overall survival (OS).
  
  
  METHODS
  data from a five-year retrospective cohort study of all women diagnosed with invasive breast cancer at an academic oncology service were collected and analyzed.
  
  
  RESULTS
  three hundred forty-eight consecutive women were included. Time between surgery and the first adjuvant treatment was a risk factor for shorter overall survival (HR=1.3, 95CI 1.06-1.71, p=0.015), along with negative estrogen receptor, the presence of lymphovascular invasion and greater tumor size. A delay longer than 4 months between surgery and the first adjuvant treatment was also associated with shorter overall survival (cumulative survival of 80.9% for delays ≤ 4 months vs. 72.6% for delays > 4 months; p=0.041, log rank test).
  
  
  CONCLUSIONS
  each month of delay between surgery and the first adjuvant treatment in women with invasive breast cancer increases the risk of death in 1.3-fold, and this effect is independent of all other well-established risk factors. Based on these results, we recommend further public strategies to decrease this interval.
authors.affiliation: Oncology Service, Hospital de Ensino Padre Anchieta, Santo André, SP, Brazil.
authors.forename: Damila Cristina
authors.initials: DC
authors.lastname: Trufelli
authors.affiliation: Faculdade de Medicina do ABC, Santo André, SP, Brazil.
authors.forename: Leandro Luongo de
authors.initials: LL
authors.lastname: Matos
authors.affiliation: Oncology Service, Hospital Estadual Mario Covas, Santo André, SP, Brazil.
authors.forename: Patricia Xavier
authors.initials: PX
authors.lastname: Santi
authors.affiliation: Faculdade de Medicina do ABC, Santo André, SP, Brazil.
authors.forename: Auro
authors.initials: A
authors.lastname: Del Giglio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D001943:Breast Neoplasms / Q000401:mortality / Q000628:therapy*; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D018734:Genes, erbB-2; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D018714:Radiotherapy, Adjuvant / Q000401:mortality; D011960:Receptors, Estrogen / Q000097:blood; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D061665:Time-to-Treatment
chemical_list: D011960:Receptors, Estrogen