How Soon To Start Chemo

You just had breast cancer surgery, and your doctor wants you to follow it up with chemo. But your son’s wedding is in six weeks. What should you do?

In a previous blog, we wrote that prolonging the Time to Surgery (TTS) from diagnosis reduces the overall survival for women with breast cancer.

How long after surgery you should start chemo, or the Time to Chemotherapy (TTC) is another commonly asked question, and many recent studies are attempting to provide answers.

Although there isn’t universal agreement on the optimal TTC, there is agreement that time matters, and that women for whom chemo is recommended shouldn’t wait too long before starting treatment.Most large academic medical centers recommend a TTC of no more than 8 weeks after the date of surgery. It takes on average 4 weeks to recover from the anesthesia and incisions from surgery. If there are complications, like infections, it could take longer.

Does that mean that women should not have immediate breast reconstruction (IBR) before starting chemo?  Should they wait until afterward because the recovery might take longer, thereby prolonging TTC, which might and impact their overall survival?  No, according to a group in the Netherlands who found that having IBR did not prolong TTC or negatively impact survival. They compared women who had only mastectomy to those undergoing IBR and found that they had virtually the same TTC.   The researchers concluded that “in general IBR is a valid option for non-metastatic breast cancer patients,” and likely will not delay further therapy.

One study found that the optimal TTC might actually even be comfortably longer than 8 weeks. A study looking at patients treated at MD Anderson Medical Center published in 2015, the median TTC was 46 days.  However, the study found that there was no real difference in survival between groups whose TTC was 90 days (almost 13 weeks) or less, but patients whose TTC was more than 90 days had a lower survival rate.  High risk or triple negative women fared worse the longer the TTC. The study concluded that physicians should stress and implement more timely care, especially for groups at risk.

Yet another study, published in the BMC Cancer Journal, found a 15% decrease in survival for every 4 weeks of additional delay to TTC after the initial 4 week recovery after surgery.

The authors of a European study give a similar takeaway that “time matters.”  They concluded that the risk of the cancer returning (relapse) is not related to a pre-specified cut-off date for the interval between surgery and chemo, but this risk increases steadily as time passes.  The European study looked at survival as long as 8 years after diagnosis and concluded that women with breast cancer benefit with improved survival when their chemotherapy begins 7 weeks or earlier after surgery.

The message here is that the sooner after surgery that you start chemo, the better. If you feel the need to seek a second opinion on treatment plans (which I have always felt is a good idea) go ahead–but do so in a timely fashion.  Don’t put off what needs to be done when your life and well-being are at stake.

But before you start chemo, make sure you order our popular Chemo Pack. Available in versions for him and for her, it contains all the essentials for a comfortable chemo experience.

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