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The impact of breast reconstruction on the delivery of chemotherapy
Author(s) -
Alderman Amy K.,
Collins E. Dale,
Schott Anne,
Hughes Melissa E.,
Ottesen Rebecca A.,
Theriault Richard L.,
Wong YuNing,
Weeks Jane C.,
Niland Joyce C.,
Edge Stephen B.
Publication year - 2010
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.24891
Subject(s) - medicine , mastectomy , chemotherapy , breast cancer , breast reconstruction , breast conserving surgery , stage (stratigraphy) , body mass index , multivariate analysis , proportional hazards model , surgery , total mastectomy , cancer , oncology , paleontology , biology
BACKGROUND: The purpose of this study was to evaluate the impact of postmastectomy breast reconstruction on the timing of chemotherapy. METHODS: The authors included stage I‐III breast cancer patients from 8 National Comprehensive Cancer Network institutions for whom guidelines recommended chemotherapy. Surgery type was categorized as breast‐conserving surgery (BCS), mastectomy alone, mastectomy with immediate reconstruction (M + IR), or mastectomy with delayed reconstruction (M + DR). A Cox regression analysis was used to assess the association between surgery type and timing of chemotherapy initiation. RESULTS: Of the 3643 patients, only 5.1% received it ≥8 weeks from surgery. In the multivariate analysis, higher stage, Caucasian and Hispanic race/ethnicity, lower body mass index, and absence of comorbid conditions were all significantly associated with earlier time to chemotherapy. There was also significant interaction among age, surgery, and chemotherapy delivery. Among women <60, time to chemotherapy was shorter for all surgery types compared with M + IR (statistical significant for all surgery types in the youngest age group and for BCS in women 40 to <50 years old). In contrast, among women ≥60, time to chemotherapy was shorter among women receiving M + IR or M + DR compared with those undergoing BCS or mastectomy alone, a difference that was statistically significant for the M + IR versus BCS comparison. CONCLUSIONS: Immediate postmastectomy breast reconstruction does not appear to lead to omission of chemotherapy, but it is associated with a modest, but statistically significant, delay in initiating treatment. For most, it is unlikely that this delay has any clinical significance. Cancer 2010. © 2010 American Cancer Society.