Time to Adjuvant Chemotherapy and Its Predictors Among Women with Breast Cancer at the University of Gondar Compressive Specialized Hospital: A Retrospective Follow-Up Study

Abstract

Background

Early adjuvant chemotherapy improves the outcomes of breast cancer patients by increasing the benefit provided by the cytotoxic systemic therapies. Despite these, the recommended time to adjuvant chemotherapy and its predictors is very limited. Therefore, this study was determining the time to adjuvant chemotherapy and its predictors among women with breast cancer at the University of Gondar Comprehensive Specialized Hospital.

Methods

An institution-based retrospective follow-up study was conducted at the University of Gondar Compressive Specialized Hospital from January 2015 to February 2019 among all women with breast cancer. Stata version 14 was used for data analysis. A stratified Cox regression model was fitted to identify the potential predictors. The adjusted hazard ratio (AHR) with a 95% confidence interval (CI) was reported to show the strength of the association. Cox–Snell residual test was used to check the goodness of fit.

Results

In this study, the median time to adjuvant chemotherapy was 67 days with an interquartile range of 34–102 days. More than three-fourth (79.9%) of patients received chemotherapy after 30 days. Of the total, 96.6% of patients with co-morbidity received adjuvant chemotherapy after 30 days. Regarding surgical complications, 97.0% of the patients with a surgical complications were received adjuvant chemotherapy after 30 days. Older patients (AHR= 0.34, 95% CI: 0.16,0.71), presence of co-morbidity (AHR= 0.43, 95% CI: 0.29, 0.62), positive surgical margin (AHR= 0.40, 95% CI: 0.25, 0.64), and presence of surgical complication (AHR= 0.55, 95% CI: 0.34, 0.88) were significantly associated with delayed time to adjuvant chemotherapy.

Conclusion

In this study, time to adjuvant chemotherapy among women was longer. Age, co-morbidity, surgical complications, and margin status were significant predictors of time to adjuvant chemotherapy. Close follow-up is important for women with surgical complications, co-morbidities, elder patients, and patients with a positive margin.

Keywords:

• adjuvant chemotherapy
• breast cancer
• survival analysis
• Gondar

Acknowledgments

We want to thank the University of Gondar Comprehensive Specialized Hospital for their cooperation and permitting data access. Our honest gratitude also goes to data collectors and chart room workers.

Abbreviations

AC, adjuvant chemotherapy; BMI, body mass index; BC, breast cancer; BCS, breast-conserving surgery; NCCN, National Comprehensive Cancer Network; TAC, time to adjuvant chemotherapy.

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethical Consideration

Ethical clearance and approval to conduct the research was obtained from the ethical review committee of the Institute of Public Health, College of Medicine and Health Science, University of Gondar. As the study was conducted through a review of medical records, the individual patient was not subject to harm and the official letter of co-operation to the University of Gondar Compressive Specialized Hospital was taken from the Institute of Public health. Permission was taken from the oncology unit head manager. To keep the confidentiality, name and other identifiers of patients and health care professionals were not recorded on the data extraction format.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests.