Defining the impact of delays in breast cancer care is a difficult task. Although the question—“when should I undergo treatment?”—is simple, necessary, and asked by patients every day, our understanding of its therapeutic implications is incomplete. Prospective trials comparing longer vs shorter pretreatment intervals would not be ethically acceptable to patients or clinicians, and will not be performed. Therefore, we rely on retrospective and observational data. Numerous factors confound analysis of the correlation between treatment delay and survival outcomes, and many of these (including level of comorbidity, treatment compliance, social support, and access to health care) are impossible to capture fully even with highly granular data sets and sophisticated statistical models. However, despite the inherent pitfalls of retrospective analyses, the articles by Bleicher et al1 and Chavez-MacGregor et al2 in this issue of JAMA Oncology are an important step toward defining the risks of delay.
Waks AG, King TA, Winer EP. Timeliness in Breast Cancer Treatment—The Sooner, the Better. JAMA Oncol. 2016;2(3):302–304. doi:10.1001/jamaoncol.2015.4506
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