Background and Aims: Despite the good prognosis for patients diagnosed with early breast cancer in Australia, the outcomes of those in non-metropolitan areas are worse than for their metropolitan peers. Some of this difference may be attributable to difficulties in care coordination over a geographically sparse environment. Cancer Australia’s Optimal Care Pathway (CAOCP) suggests that surgery should occur within 5 weeks of the decision to treat, and that any adjuvant chemotherapy commences within 6 weeks of surgery. The aim of this study was to determine whether patients in Western NSW met these referral pathway timelines.
Methodology: Small early breast cancer was defined as those with Stage 1-2 disease (AJCC). A retrospective cross sectional study identified 101 patients diagnosed with small early breast cancer who were referred to a regional cancer centre in 2018 and 2019. The timeliness of the key milestones of breast cancer treatment for these patients was analysed and compared to CAOCP.
Results: The median time from biopsy to surgery date was 34 days (interquartile range 27-44 days). The median time from surgery until medical oncology referral was 15 days and 35 days from surgery to being reviewed by a medical oncologist. The median time from surgery to first dose of adjuvant chemotherapy was 41 days, however the interquartile range was 34-47 days. Ten percent of patients waited more than 60 days for chemotherapy.
Conclusions: Whilst most patients met the suggested timeframes of CAOCP, a sizeable minority of patients do not. The time between medical oncologist review and commencement of chemotherapy is short, however the median times between surgery and referral to medical oncologist, as well as time from referral to being seen by medical oncologist are longer than expected. Further local studies reviewing workflows and work patterns may highlight processes which could be streamlined.