Figure 1.

Timing of treatments in breast cancer therapy, based upon current quality measures. Current standards specify time to chemotherapy within 120 days of diagnosis, while time to radiotherapy specifies administration within 365 days of diagnosis. With >98% of surgeries in the United States occurring within 90 days, and a drop in overall survival by an absolute 3.1–4.6%, this threshold seems appropriate as it allows one month to begin chemotherapy by the current quality measure. The 365-day quality measure for radiotherapy allows for sufficient time to undergo chemotherapy regimens of varying lengths, while allowing a short time to begin simulation and planning (panel 1a). When chemotherapy is not administered, however, the radiotherapy standard provides an excess of time, even when using 20 weeks postoperative, which is the longest interval found to not confer a survival decline (panel 1b). This suggests that a second standard, measured from time of surgery when chemotherapy is not administered, might optimize care.

Dx = diagnosis; OS = Overall Survival; Sim = simulation; hypoFx = hypofractionation; WBXRT = whole breast radiotherapy; TC = taxotere and cyclophosphamide; DDAC = dose dense doxorubicin and cyclophosphamide; + T = paclitaxel; CMF = cyclophosphamide, methotrexate, and 5-fluorouracil.