Time to Treatment Initiation for Breast Cancer During the 2020 COVID-19 Pandemic

PURPOSE: The COVID-19 pandemic has posed significant pressures on healthcare systems, raising concern that related care delays will result in excess cancer-related deaths. Because data regarding the impact on patients with breast cancer are urgently needed, we aimed to provide a preliminary estimate of the impact of COVID-19 on time to treatment initiation (TTI) for patients newly diagnosed with breast cancer cared for at a large academic center. METHODS: We conducted a retrospective study of patients with newly diagnosed early-stage breast cancer between January 1, 2020, and May 15, 2020, a time period during which care was affected by COVID-19, and an unaffected cohort diagnosed between January 1, 2018 and May 15, 2018. Outcomes included patient volume, TTI, and initial treatment modality. Adjusted TTI was compared using multivariable linear regression. RESULTS: Three hundred sixty-six patients were included. There was an 18.8% decrease in patient volume in 2020 (n = 164) versus 2018 (n = 202). There was no association between time of diagnosis (pre-COVID-19 or during COVID-19) and adjusted TTI ( P = .926). There were fewer in situ diagnoses in the 2020 cohort ( P = .040). There was increased use of preoperative systemic therapy in 2020 (43.9% overall, 20.7% chemotherapy, and 23.2% hormonal therapy) versus 2018 (16.4% overall, 12.4% chemotherapy, and 4.0% hormonal therapy) ( P < .001). CONCLUSION: TTI was maintained among patients diagnosed and treated for breast cancer during the COVID-19 pandemic at a single large academic center. There was a decrease in patient volume, specifically in patients with in situ disease and a shift in initial therapy toward the use of preoperative hormonal therapy.

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The Impact of a Line Probe Assay Based Diagnostic Algorithm on Time to Treatment Initiation and Treatment Outcomes for Multidrug Resistant TB Patients in Arkhangelsk Region, Russia

PLoS ONE ◽

10.1371/journal.pone.0152761 ◽

2016 ◽

Vol 11 (4) ◽

pp. e0152761 ◽

Cited By ~ 10

Author(s):

Platon Eliseev ◽

Grigory Balantcev ◽

Elena Nikishova ◽

Anastasia Gaida ◽

Elena Bogdanova ◽

...

Keyword(s):

Treatment Outcomes ◽

Treatment Initiation ◽

Diagnostic Algorithm ◽

Multidrug Resistant ◽

Line Probe Assay ◽

Time To Treatment ◽

Arkhangelsk Region ◽

Probe Assay ◽

Time To Treatment Initiation ◽

The Impact

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Time to treatment initiation with oral antihyperglycaemic therapy in US patients with newly diagnosed type 2 diabetes

Diabetes Obesity and Metabolism ◽

10.1111/j.1463-1326.2011.01498.x ◽

2011 ◽

Vol 14 (2) ◽

pp. 149-154 ◽

Cited By ~ 16

Author(s):

Q. Zhang ◽

S. Rajagopalan ◽

E. Marrett ◽

M. J. Davies ◽

L. Radican ◽

...

Keyword(s):

Type 2 Diabetes ◽

Treatment Initiation ◽

Newly Diagnosed ◽

Time To Treatment ◽

Time To Treatment Initiation

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Impact of telemedicine adoption on accessibility and time to treatment in patients with thoracic malignancies during the COVID-19 pandemic

BMC Cancer ◽

10.1186/s12885-021-08819-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Vivek Nimgaonkar ◽

Charu Aggarwal ◽

Abigail T. Berman ◽

Peter Gabriel ◽

Lawrence N. Shulman ◽

...

Keyword(s):

Systemic Therapy ◽

Treatment Initiation ◽

Office Visit ◽

Initial Visit ◽

Time To Treatment ◽

Safe Delivery ◽

Time To Treatment Initiation ◽

New Diagnosis ◽

Thoracic Malignancies ◽

The Impact

Abstract Background To ensure safe delivery of oncologic care during the COVID-19 pandemic, telemedicine has been rapidly adopted. However, little data exist on the impact of telemedicine on quality and accessibility of oncologic care. This study assessed whether conducting an office visit for thoracic oncology patients via telemedicine affected time to treatment initiation and accessibility. Methods This was a retrospective cohort study of patients with thoracic malignancies seen by a multidisciplinary team during the first surge of COVID-19 cases in Philadelphia (March 1 to June 30, 2020). Patients with an index visit for a new phase of care, defined as a new diagnosis, local recurrence, or newly discovered metastatic disease, were included. Results 240 distinct patients with thoracic malignancies were seen: 132 patients (55.0%) were seen initially in-person vs 108 (45.0%) via telemedicine. The majority of visits were for a diagnosis of a new thoracic cancer (87.5%). Among newly diagnosed patients referred to the thoracic oncology team, the median time from referral to initial visit was significantly shorter amongst the patients seen via telemedicine vs. in-person (median 5.0 vs. 6.5 days, p < 0.001). Patients received surgery (32.5%), radiation (24.2%), or systemic therapy (30.4%). Time from initial visit to treatment initiation by modality did not differ by telemedicine vs in-person: surgery (22 vs 16 days, p = 0.47), radiation (27.5 vs 27.5 days, p = 0.86, systemic therapy (15 vs 13 days, p = 0.45). Conclusions Rapid adoption of telemedicine allowed timely delivery of oncologic care during the initial surge of the COVID19 pandemic by a thoracic oncology multi-disciplinary clinic.

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The hidden curve behind COVID-19 outbreak: the impact of delay in treatment initiation in cancer patients and how to mitigate the additional risk of dying – the head and neck cancer model

10.21203/rs.3.rs-119756/v1 ◽

2020 ◽

Author(s):

Leandro L. Matos ◽

Carlos Henrique Q. Forster ◽

Gustavo N. Marta ◽

Gilberto Castro Junior ◽

John A. Ridge ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Treatment Initiation ◽

Additional Risk ◽

Time To Treatment ◽

Time To Treatment Initiation ◽

Risk Of Cancer ◽

The Impact

Abstract Purpose: The rapid spread of the SARS-CoV-2 pandemic around the world caused most healthcare services to turn substantial attention to treatment of these patients and also to alter the structure of healthcare systems to address an infectious disease. As a result, many cancer patients had their treatment deferred during the pandemic, increasing the time to treatment initiation, the number of untreated patients (which will alter the dynamics of healthcare delivery in the post-pandemic era) and increasing their risk of death. Hence, we analyzed the impact on global cancer mortality considering the decline in oncology care during the COVID-19 outbreak using head and neck cancer, a known time-dependent disease, as a model. Methods: An online practical tool capable of predicting the risk of cancer patients dying due to the COVID-19 outbreak and also useful for mitigation strategies after the peak of the pandemic has been developed, based on a mathematical model. The scenarios were estimated by information of 15 oncological services worldwide, given a perspective from the five continents and also some simulations were conducted at world demographic data. Results: The model demonstrates that the more that cancer care was maintained during the outbreak and also the more it is increased during the mitigation period, the shorter will be the recovery, lessening the additional risk of dying due to time to treatment initiation. Conclusions: This impact of COVID-19 pandemic on cancer patients is inevitable, but it is possible to minimize it with an effort measured by the proposed model.

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Impact of the COVID-19 pandemic on treatment patterns for US patients with metastatic solid cancer

10.1101/2021.09.22.21263964 ◽

2021 ◽

Author(s):

Ravi B Parikh ◽

Samuel U Takvorian ◽

Daniel Vader ◽

E. Paul Wileyto ◽

Amy S. Clark ◽

...

Keyword(s):

Treatment Initiation ◽

Treatment Patterns ◽

Solid Cancer ◽

Newly Diagnosed ◽

First Line ◽

Difference In Differences ◽

Selection For ◽

Time To Treatment Initiation ◽

The Impact ◽

Percentage Point Difference

Background: The COVID-19 pandemic has led to delays in patients seeking care for life-threatening conditions; however, its impact on treatment patterns for patients with metastatic cancer is unknown. We assessed the impact of the COVID-19 pandemic on time to treatment initiation (TTI) and treatment selection for patients newly diagnosed with metastatic solid cancer. Methods: We used an electronic health record-derived longitudinal database curated via technology-enabled abstraction to identify 14,136 US patients newly diagnosed with de novo or recurrent metastatic solid cancer between January 1 and July 31 in 2019 or 2020. Patients received care at ~280 predominantly community-based oncology practices. Controlled interrupted time series analyses assessed the impact of the COVID-19 pandemic period (April-July 2020) on TTI, defined as the number of days from metastatic diagnosis to receipt of first-line systemic therapy, and use of myelosuppressive therapy. Results: The adjusted probability of treatment within 30 days of diagnosis [95% confidence interval] was similar across periods: January-March 2019 41.7% [32.2%, 51.1%]; April-July 2019 42.6% [32.4%, 52.7%]; January-March 2020 44.5% [30.4%, 58.6%]; April-July 2020 46.8% [34.6%, 59.0%]; adjusted percentage-point difference-in-differences 1.4% [-2.7%, 5.5%]. Among 5,962 patients who received first-line systemic therapy, there was no association between the pandemic period and use of myelosuppressive therapy (adjusted percentage-point difference-in-differences 1.6% [-2.6%, 5.8%]). There was no meaningful effect modification by cancer type, race, or age. Conclusions: Despite known pandemic-related delays in surveillance and diagnosis, the COVID-19 pandemic did not impact time to treatment initiation or treatment selection for patients with metastatic solid cancers.

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Reducing time to treatment and patient costs with breast cancer: The impact of patient visits.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e19407 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e19407-e19407

Author(s):

Sarah Sittenfeld ◽

Zachary Greenberg ◽

Zahraa Alhilli ◽

Jame Abraham ◽

Halle C. F. Moore ◽

...

Keyword(s):

Breast Cancer ◽

Continuous Improvement ◽

Surgical Procedure ◽

Treatment Initiation ◽

Time To Treatment ◽

Patient Costs ◽

Continuous Improvement Process ◽

Improvement Process ◽

Number Of Visits ◽

The Impact

e19407 Background: The purpose of this study was to evaluate the impact of a continuous improvement process aimed at reducing time to treatment on minimizing the number of days spent to complete pre-treatment visits and the associated costs for patients with non-metastatic breast cancer. Methods: System-wide initiatives were implemented in 2015 to minimize time to treatment initiation (TTI), by incorporating lean process strategies and enhanced coordination. Patient and treatment information was obtained through an IRB-approved registry for the years 2015 and 2018. Average number of days spent to complete visits, TTI, and associated patient costs including driving expenses, parking, food, childcare, and lost wages were calculated and compared between the years 2015 and 2018. Results: In 2015, the median TTI was 43.5 days and the average number of separate days spent to attend multidisciplinary visits prior to first treatment was 1.86. These were reduced to 29 days and 1.52 visits, respectively, in 2018 (p < 0.0001 for both). When evaluating treatment visits by surgical procedure, the average number of visits was reduced regardless of surgical procedure. The average number of visits was highest for patients undergoing mastectomy with reconstruction (2.34 in 2015, reduced to 1.65 in 2018, p < 0.0001). A single visit to complete treatment planning was associated with patient costs of $249 as compared with multiple trips costing $491 for 2 visits and up to $1,226 for 5 visits. Conclusions: In breast cancer patients, implementing a continuous improvement process to reduce time to treatment was associated with fewer visits required prior to treatment initiation, resulting in lower patient costs.

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Shorter Time To Treatment Initiation Does Not Improve Survival in Patients with Newly Diagnosed Small Cell Lung Cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2019.01.056 ◽

2019 ◽

Vol 104 (1) ◽

pp. 248

Author(s):

A.G. Azzouqa ◽

R. Manochakian ◽

Y. Lou ◽

R. Chen

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Treatment Initiation ◽

Small Cell ◽

Newly Diagnosed ◽

Small Cell Lung ◽

Time To Treatment ◽

Time To Treatment Initiation

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Impact of Time from Diagnosis to Initiation of Curative-Intent Chemotherapy on Clinical Outcomes in Patients with Hodgkin Lymphoma

Blood ◽

10.1182/blood.v122.21.4237.4237 ◽

2013 ◽

Vol 122 (21) ◽

pp. 4237-4237

Author(s):

Edward G. Brooks ◽

Joseph M. Connors ◽

Laurie H. Sehn ◽

Randy D. Gascoyne ◽

Kerry J. Savage ◽

...

Keyword(s):

Hodgkin Lymphoma ◽

Clinical Outcomes ◽

Treatment Initiation ◽

Performance Status ◽

Treatment Delay ◽

Curative Intent ◽

Time To Treatment ◽

Cancer Agency ◽

Time To Treatment Initiation ◽

The Impact

Abstract Introduction Hodgkin lymphoma is a highly curable lymphoid malignancy when treated with multi-agent chemotherapy regimens such as doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). The optimal timing of curative intent chemotherapy and the impact of treatment delay on clinical outcomes in Hodgkin lymphoma are currently unknown. Patients and Methods Adult patients diagnosed with Hodgkin lymphoma in British Columbia (BC) between January 1999 and December 2010 were identified in the BC Cancer Agency Centre for Lymphoid Cancer Database. Patients were included if they received at least one cycle of ABVD with curative intent. Patients treated with regimens other than ABVD and those treated with palliative intent were excluded. Additional demographic data were obtained from the BC Cancer Registry. Chemotherapy administration data, including drugs, dates administered, and treatment center, were obtained from the BC Cancer Agency provincial pharmacy database. Time to treatment initiation was defined as the time between the date of definitive histological confirmation of Hodgkin lymphoma and date of the first dose of ABVD. We then evaluated the effect of time to treatment initiation on overall survival (OS) and progression-free survival (PFS) at 5 years. Results A total of 879 patients were identified: 110 (13%) received ABVD within 2 weeks of diagnosis, 260 (30%) within 3 – 4 weeks, 405 (46%) within 5 – 8 weeks, and 104 (12%) beyond 8 weeks. Inpatient chemotherapy, elevated LDH, poor performance status, advanced stage, B symptoms, and bulky disease were all associated with treatment initiation within 2 weeks (p<0.01 for all factors). Age >45 and nodular lymphocyte predominant histology were significantly associated with treatment initiation >8 weeks (p<0.01 for all factors). Residence in a rural location at the time of diagnosis or the need to travel more than 200 km in order to receive initial chemotherapy were not associated with time to treatment (P = 0.26 and P = 0.90, respectively). Reasons for treatment initiation >8 weeks included systematic delays in the process of referral, staging, and scheduling of treatment (n=66), uncontrolled comorbidities (n=13), patient refusal of earlier treatment (n=9), pregnancy (n=5), revised pathological diagnosis (n=4), unknown cause of delay (n=4), and social or substance abuse factors (n=3). With a median follow-up of 5.6 years (range 1 month – 14 years) in living patients, the 5-year OS estimates were 90% (standard error (SE) 3%) for time to treatment<2 weeks, 93% (SE 2%) for 3-4 weeks, 92% (SE 1%) for 5-8 weeks, and 84% (SE 4%) for >8 weeks (P = 0.012). Five-year PFS estimates were 82% (SE 4%) for time to treatment<2 weeks, 79% (SE 3%) for 3-4 weeks, 86% (SE 2%) for 5-8 weeks, and 84% (SE 4%) for >8 weeks (P = 0.198). In multivariate analysis, age, gender, performance status, stage, and time to treatment were significantly associated with OS, while only age and stage were significantly associated with PFS. Conclusions In a publicly funded healthcare system with universal access to cancer treatment and standardized diagnostic review, initiation of ABVD beyond 8 weeks appears to be associated with worse OS but not PFS. Reasons for treatment delay in this group are heterogeneous and may be responsible for the detrimental effect on OS. Nonetheless, clinicians should make every effort possible to initiate curative-intent chemotherapy as soon as a diagnosis of Hodgkin lymphoma is established. Disclosures: No relevant conflicts of interest to declare.

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