Posted online October 2, 2006 on www.jco.org .
In an analysis of more than 2,500 patient records, Canadian researchers have found that it appears to be safe for women with early-stage breast cancer to wait up to 12 weeks after surgery to begin chemotherapy. However, they also reported for the first time that a delay of more than 12 weeks can increase the risk of breast cancer recurrence and reduce overall survival, compared with starting treatment within 12 weeks of surgery.
The researchers reviewed data on 2,594 women receiving chemotherapy (including treatment with the drugs doxorubicin, cyclophosphamide, epirubicin, methotrexate, and/or 5-fluorouracil) after surgery for stage I and II breast cancer between 1989 and 1998 at the British Columbia Cancer Agency. Five years after diagnosis, the likelihood of cancer returning and overall survival were similar among women starting chemotherapy within 12 weeks of surgery, but among those who waited more than 12 weeks, the risk of recurrence increased and survival was significantly reduced.
Among women who started chemotherapy between 4 and 12 weeks after surgery, 84-89% were alive 5 years after diagnosis. However, 5-year survival dropped to 78% among women who did not receive chemotherapy until more than 12 weeks following surgery.
What Does This Mean for Patients?
These findings suggest that women with early-stage breast cancer can take some time before they start chemotherapy to gather information, consider their options, and be actively involved in treatment decision-making. Such steps have been shown to reduce anxiety and depression associated with breast cancer. However, to achieve the full benefit of chemotherapy, patients should not delay further, and should ensure that they start treatment within three months of surgery. Patients should always discuss their best course of action with their doctors.