Regional differences in neo/adjuvant chemotherapy timing in patients with early-stage triple-negative breast cancer in England

Abstract

PURPOSE: Triple-negative breast cancer (TNBC) is an aggressive breast cancer histological type that is predictive of poor outcomes, shorter remission periods and reduced survival. TNBC is treated with surgery and neo/adjuvant chemotherapy, with evidence of association between longer periods from surgery to adjuvant chemotherapy (time to chemotherapy, TTC) and poorer survival outcomes. This study investigated regional differences in TTC period between regions and ethnic groups to evaluate equity of care in the English TNBC population. Time from neoadjuvant chemotherapy to surgery (time to surgery, TTS) was also compared between groups. METHODS: This retrospective cohort study compared TTC and TTS periods in TNBC patients in England over a two-year period. TTC and TTS were compared by English region and ethnicity, testing for significant differences in treatment pathway timing by these demographics. RESULTS: 1347 TNBC patients were included in the study. Significant regional differences in TTC were observed, with the longest median period of 50 days (IQR 36, 83) in the Midlands compared to 38 days (IQR 27, 55) in the North West (p < 0.001). No significant differences in TTS were observed between regions. Ethnicity was not significantly associated with timeliness of neo/adjuvant chemotherapy initiation (p > 0.05). CONCLUSION: These findings suggest regional differences in TTC for patients treated with surgery and chemotherapy for TNBC. Given evidence of increased mortality risk as the TTC period increases, the causes of regional disparities warrant further investigation. This study can inform targets for improvement in the delivery of adjuvant chemotherapy in cancer treatment centres in England.