Recent National Trends in Time to Breast Cancer Surgery Before and After the COVID-19 Pandemic Onset and Predictors of Failure to Receive Timely Surgery.

Abstract

Background: Time to surgery (TTS) for breast cancer has been increasing for decades, with delays associated with worse survival. A 2022 Commission on Cancer (CoC) quality measure requires upfront surgery within 60 days after diagnosis (BCSdx). The long-term effects of the COVID-19 pandemic on TTS and compliance with BCSdx are unknown.

Methods: Using the National Cancer Database, the study identified 520,967 women with a diagnosis of clinical stages I to III invasive breast cancer from 2014 to 2023 who underwent upfront surgery. Time to surgery was defined as days from diagnosis to definitive surgery. Diagnosis year was modeled continuously and categorically (pre-pandemic 2014-2019, pandemic onset 2020, post-pandemic onset 2021-2023). Linear and logistic regression were used to identify factors associated with TTS and odds of not having surgery in ≤ 60 days.

Results: Between 2014 and 2023, the mean TTS increased from 37 to 50 days (+ 13 days). Compared with 2014-2019, the 2021-2023 period was associated with + 7.51 mean days (95% confidence interval [CI], 7.35-7.67 days) and 1.90 times (95% CI, 1.87-1.94 times) increased odds of not meeting BCSdx in the multivariable analysis. Longer TTS also was associated with immediate reconstruction (β = + 8.27 days), uninsured status (β = + 7.99 days), and diagnosis at another facility (β = + 6.55 days). The proportion of patients with a TTS of ≤ 60 days declined from 88% to 74%. The strongest predictors of noncompliance were uninsured status (odds ratio [OR], 2.10), diagnosis at another facility (OR, 1.81), immediate reconstruction (OR, 1.81), black race (OR, 1.72), and Hispanic ethnicity (OR, 1.70).

Conclusions: The increase in TTS for breast cancer accelerated after the onset of the COVID-19 pandemic, with a concomitant decrease in BCSdx compliance. Strategies to improve care coordination, particularly for at-risk populations, are needed to address this quality measure.