The Sequence and Reconstructive Modality of Breast Cancer Treatments Affects Wait Times to Adjunctive Therapies in Patients Undergoing Mastectomy with Immediate Breast Reconstruction

Abstract

Introduction: Breast cancer care requires both oncologists and plastic surgeons. Coordinating these specialists and combining extirpative and reconstructive procedures before adjunctive therapies can cause delays in care. For patients with less advanced disease, surgery is performed before adjunctive therapies, requiring early specialist coordination and the possibility of surgical complications. We compare these patients to those with more advanced disease requiring adjunctive therapies before surgery. Methods: A retrospective chart review identified 337 post-mastectomy + immediate breast reconstruction (IBR) patients. Patients were divided into surgery first (SF) and neoadjuvant chemotherapy (NC) first groups with reconstructive subgroups. Wait times between care pathway milestones were compiled and compared to national standards. Results: SF experienced longer wait times from consultation to treatment initiation (47 ± 51.5 vs 22 ± 22, P<.001) and from first to second treatment modality (62 ± 35 vs 39 ± 17, P<.001). Furthermore, only 29% of SF met the standard of receiving treatment within 4 weeks from consultation compared to 63% of NC ( P<.001). Within subgroups, SF alloplastic reconstructions had shorter wait times compared to SF autologous reconstructions. For SF, only 31% of alloplastic and 24% of autologous reconstruction initiated treatment within 4 weeks of consultation. Conclusion: In this cohort of Canadian breast cancer patients, those receiving surgery first experienced prolonged wait times to treatment, particularly with autologous reconstruction. Patients should be informed of the potential impact on adjunctive therapies when considering reconstructive modality.