Association between initiation of adjuvant chemotherapy beyond 30 days after surgery and overall survival among patients with triple-negative breast cancer

Delayed time to chemotherapy (TTC) is associated with decreased outcomes of breast cancer patients. Recently, studies suggested that the association might be subtype-dependent and that TTC within 30 days should be warranted in patients with triple-negative breast cancer (TNBC). The aim of the current study is to determine if TTC beyond 30 days is associated with reduced 10-year overall survival in TNBC patients. We identified all TNBC patients diagnosed between 2006 and 2014 who received adjuvant chemotherapy in the Netherlands. We distinguished between breast-conserving surgery (BCS) vs. mastectomy given the difference in preoperative characteristics and outcomes. The association was estimated with hazard ratios (HRs) using propensity-score matched Cox proportional hazard analyses. In total, 3,016 patients were included. In matched patients who underwent BCS (n = 904), 10-year overall survival was favorable for patients with TTC within 30 days (84.4% vs. 76.9%, p = 0.001). Patients with TTC beyond 30 days were more likely than those with TTC within 30 days to die within 10 years after surgery (HR 1.69 (95% CI 1.22–2.34), p = 0.002). In matched patients who underwent mastectomy (n = 1,568), there was no difference in 10 years overall survival between those with TTC within or beyond 30 days (74.5% vs. 74.7%, p = 0.716), nor an increased risk of death for those with TTC beyond 30 days (HR 1.04 (95% CI 0.84–1.28), p = 0.716). Initiation of adjuvant chemotherapy beyond 30 days is associated with decreased 10 years overall survival in TNBC patients who underwent BCS. Therefore, timelier initiation of chemotherapy in TNBC patients undergoing BCS seems warranted

Discrepancies Between Surgical Oncologists and Plastic Surgeons in Patient Information Provision and Personal Opinions Towards Immediate Breast Reconstruction

Background Immediate breast reconstruction (IBR) may improve quality of life of patients receiving mastectomy. However, a significant hospital variation exists in the use of IBR due to various reasons. To better understand this variation, the present study investigated preoperative information provision to patients and personal opinions of surgical oncologists and plastic surgeons towards potential contra-indications for IBR. Methods An online survey (35 questions) was developed including questions on respondent demographics, information provision to the patient about IBR and potential contra-indications by IBR technique. Results One-hundred-eighty-nine physicians participated: 118 surgical oncologists and 71 plastic surgeons. All clinicians discussed the possibility of IBR with their patients. Complications (79% versus 100%, P 75 years, breast size >D-cup, BMI >40 kg/m(2), smoking (for implant reconstruction), pulmonary/cardiac comorbidities (for autologous reconstruction) and radiotherapy were considered a contra-indication more frequently by plastic surgeons. In contrast, surgical oncologists reported tumor stage (cT3), nodal stage (cN2) and chemotherapy more frequently to be a contra-indication for IBR. Conclusion We observed that all respondents discussed the possibility of IBR with their patients, whereas patient-tailored information was given more frequently by plastic surgeons. Physicians differed in their opinions towards contra-indications for IBR, with plastic surgeons reporting patient-related risk factors for wound healing problems and surgical oncologists reporting oncological contra-indications more frequently. Consensus between physicians regarding contra-indications for IBR may optimize patient counseling and shared decision-making

Cardiovascular Efficacy and Safety of Bococizumab in High-Risk Patients

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