Annals of Surgical Oncology

, Volume 23, Issue 10, pp 3392–3402 | Cite as

Time to Treatment: Measuring Quality Breast Cancer Care

  • Amy C. Polverini
  • Rebecca A. Nelson
  • Emily Marcinkowski
  • Veronica C. Jones
  • Lily Lai
  • Joanne E. Mortimer
  • Lesley Taylor
  • Courtney Vito
  • John Yim
  • Laura Kruper
Breast Oncology



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.


Overall Survival National Cancer Data Base Breast Cancer Care Medicare Insurance Preoperative Breast Magnetic Resonance Image 
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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Amy C. Polverini
    • 1
  • Rebecca A. Nelson
    • 1
  • Emily Marcinkowski
    • 1
  • Veronica C. Jones
    • 1
  • Lily Lai
    • 1
  • Joanne E. Mortimer
    • 1
  • Lesley Taylor
    • 1
  • Courtney Vito
    • 1
  • John Yim
    • 1
  • Laura Kruper
    • 1
  1. 1.City of Hope National Medical CenterDuarteUSA

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