title: Time to Treatment: Measuring Quality Breast Cancer Care.
abstract: To optimize breast cancer care, several organizations have crafted guidelines to define best practices for treating breast cancer. In addition to recommended therapies, 'timeliness of treatment' has been proposed as a quality metric. Our study evaluates time to surgical treatment and its effect on overall survival (OS).
  
  
  
  The National Cancer Data Base (NCDB) was used to identify women diagnosed with invasive breast cancer between 2004 and 2012. Time from diagnosis to surgical treatment was calculated and grouped according to predetermined time intervals. Univariate and multivariate Cox proportional hazard models were used to assess patient and treatment factors related to OS.
  
  
  
  Overall, 420,792 patients initially treated with surgery were identified. Increased time to surgical treatment >12 weeks was associated with decreased OS [hazard ratio (HR) 1.14, 95 % confidence interval (CI) 1.09-1.20]. When stratified by pathologic stage, stage I patients treated at 8 to <12 weeks (HR 1.07, 95 % CI 1.02-1.13) and >12 weeks (HR 1.19, 95 % CI 1.11-1.28), as well as stage II patients treated at >12 weeks (HR 1.16, 95 % CI 1.08-1.25), had decreased OS compared with patients treated at <4 weeks. Other variables associated with decreased survival were treatment at a community cancer program, Medicaid or Medicare insurance, Black race, increasing age, mastectomy, moderately and poorly differentiated tumor grade, increasing T and N stage, and higher Charlson Index Group.
  
  
  
  The survival benefit of expedited time to initial surgical treatment varies by stage and appears to have the greatest impact in early-stage disease. Prior to establishing standard metrics, further quantification of the impact on patient outcomes is needed.
authors: City of Hope National Medical Center, Duarte, CA, USA.
authors: Amy C
authors: AC
authors: Polverini
authors: City of Hope National Medical Center, Duarte, CA, USA.
authors: Rebecca A
authors: RA
authors: Nelson
authors: City of Hope National Medical Center, Duarte, CA, USA.
authors: Emily
authors: E
authors: Marcinkowski
authors: City of Hope National Medical Center, Duarte, CA, USA.
authors: Veronica C
authors: VC
authors: Jones
authors: City of Hope National Medical Center, Duarte, CA, USA.
authors: Lily
authors: L
authors: Lai
authors: City of Hope National Medical Center, Duarte, CA, USA.
authors: Joanne E
authors: JE
authors: Mortimer
authors: City of Hope National Medical Center, Duarte, CA, USA.
authors: Lesley
authors: L
authors: Taylor
authors: City of Hope National Medical Center, Duarte, CA, USA.
authors: Courtney
authors: C
authors: Vito
authors: City of Hope National Medical Center, Duarte, CA, USA.
authors: John
authors: J
authors: Yim
authors: City of Hope National Medical Center, Duarte, CA, USA. LKruper@coh.org.
authors: Laura
authors: L
authors: Kruper
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000706:statistics & numerical data; D008484:Medicaid / Q000592:standards; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D019984:Quality Indicators, Health Care; D015996:Survival Rate; D061665:Time-to-Treatment / Q000592:standards / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D055815:Young Adult