title: Factors Associated With Delays in Chemotherapy Initiation Among Patients With Breast Cancer at a Comprehensive Cancer Center.
abstract: National guidelines endorse time-dependent quality metrics for breast cancer care. We examined factors associated with delays in chemotherapy initiation at an NCI-Designated Comprehensive Cancer Center.
  
  
  
  We identified 523 patients who received postoperative adjuvant chemotherapy between January 2011 and December 2013 at our center. We defined 28 days from last definitive surgery (LDS) to chemotherapy as the target time frame, and an unacceptable delay in chemotherapy initiation (UCD) as greater than 42 days from LDS. Multivariate regression models were used to identify factors associated with UCD and the impact of Oncotype DX testing in patients with hormone receptor (HR)-positive breast cancer.
  
  
  
  Median days between LDS and chemotherapy initiation was 34 (interquartile range, 15), with 30% of patients starting within 28 days of LDS and 26.9% having UCD. Tumor characteristics such as subtype and stage affected UCD; patients with HR-positive or HER2-positive tumors were more likely to be delayed compared with those with triple-negative breast cancer. Patients with stage I disease, those undergoing mastectomy with or without immediate reconstruction, and those whose pathology sign-out was greater than 10 days postoperatively were more likely to be delayed. A higher proportion of UCD was found in HR-positive patients (31%) for whom Oncotype DX testing was ordered compared with those in whom it was not ordered (20%).
  
  
  
  This study provides insight into subpopulations that may be at risk to experience delays in chemotherapy initiation, directing interventions to improve the timeliness of care.
authors.affiliation: From Department of Medical Oncology and Quality and Patient Safety, Dana-Farber Cancer Institute, Boston, Massachusetts; Oncoclinicas, Sao Paulo, Brazil; Department of General Surgery, Istanbul Medical School, Istanbul, Turkey; and Department of Surgery, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Katya
authors.initials: K
authors.lastname: Losk
authors.affiliation: From Department of Medical Oncology and Quality and Patient Safety, Dana-Farber Cancer Institute, Boston, Massachusetts; Oncoclinicas, Sao Paulo, Brazil; Department of General Surgery, Istanbul Medical School, Istanbul, Turkey; and Department of Surgery, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Ines
authors.initials: I
authors.lastname: Vaz-Luis
authors.affiliation: From Department of Medical Oncology and Quality and Patient Safety, Dana-Farber Cancer Institute, Boston, Massachusetts; Oncoclinicas, Sao Paulo, Brazil; Department of General Surgery, Istanbul Medical School, Istanbul, Turkey; and Department of Surgery, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Kristen
authors.initials: K
authors.lastname: Camuso
authors.affiliation: From Department of Medical Oncology and Quality and Patient Safety, Dana-Farber Cancer Institute, Boston, Massachusetts; Oncoclinicas, Sao Paulo, Brazil; Department of General Surgery, Istanbul Medical School, Istanbul, Turkey; and Department of Surgery, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Rafael
authors.initials: R
authors.lastname: Batista
authors.affiliation: From Department of Medical Oncology and Quality and Patient Safety, Dana-Farber Cancer Institute, Boston, Massachusetts; Oncoclinicas, Sao Paulo, Brazil; Department of General Surgery, Istanbul Medical School, Istanbul, Turkey; and Department of Surgery, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Max
authors.initials: M
authors.lastname: Lloyd
authors.affiliation: From Department of Medical Oncology and Quality and Patient Safety, Dana-Farber Cancer Institute, Boston, Massachusetts; Oncoclinicas, Sao Paulo, Brazil; Department of General Surgery, Istanbul Medical School, Istanbul, Turkey; and Department of Surgery, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Tukenmez
authors.affiliation: From Department of Medical Oncology and Quality and Patient Safety, Dana-Farber Cancer Institute, Boston, Massachusetts; Oncoclinicas, Sao Paulo, Brazil; Department of General Surgery, Istanbul Medical School, Istanbul, Turkey; and Department of Surgery, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Mehra
authors.initials: M
authors.lastname: Golshan
authors.affiliation: From Department of Medical Oncology and Quality and Patient Safety, Dana-Farber Cancer Institute, Boston, Massachusetts; Oncoclinicas, Sao Paulo, Brazil; Department of General Surgery, Istanbul Medical School, Istanbul, Turkey; and Department of Surgery, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Nancy U
authors.initials: NU
authors.lastname: Lin
authors.affiliation: From Department of Medical Oncology and Quality and Patient Safety, Dana-Farber Cancer Institute, Boston, Massachusetts; Oncoclinicas, Sao Paulo, Brazil; Department of General Surgery, Istanbul Medical School, Istanbul, Turkey; and Department of Surgery, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Bunnell
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D015331:Cohort Studies; D003191:Comprehensive Health Care / Q000379:methods*; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D011182:Postoperative Care / Q000379:methods; D017410:Practice Guidelines as Topic; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D061665:Time-to-Treatment
chemical_list: D011960:Receptors, Estrogen; D011980:Receptors, Progesterone