Factors Associated With the Delay of Chemotherapy Initiation Among Patients Receiving Neoadjuvant or Adjuvant Chemotherapy for Breast Cancer

Background Neoadjuvant and adjuvant breast cancer chemotherapy have been shown to improve survival outcomes, highlighting the importance of timely therapy. Objective The study described the time to initiation of neoadjuvant or adjuvant chemotherapy among women with early-stage breast cancer and identified correlates of delay, including demographics, social determinants of health, patient factors, and symptom distress. Methods The study utilized baseline data from the Symptom Experience and Management of cancer Outcomes According to Race and Social Demographics of Health, a multisite, longitudinal study that racially compared the time to chemotherapy initiation with consideration of social determinants of health. Logistic regression models analyzed the factors influencing chemotherapy initiation within the recommended timeframes (35 days for neoadjuvant therapy and 60 days for adjuvant therapy) after biopsy (neoadjuvant) or surgery (adjuvant). Results Of the 256 patients included in the study, 56.5% (n = 145), received neoadjuvant therapy, and among them, 55.2% (n = 80) initiated chemotherapy within 35 days of biopsy. In the study, 43.4% (n = 111) received adjuvant therapy, with 77.5% (n = 86) initiating chemotherapy within 60 days. In univariate analysis, patients who began neoadjuvant therapy within 35 days had significantly higher Interpersonal Support Evaluation List appraisal scores. In multivariate regression analysis, symptom distress emerged as a significant predictor of the delay in initiation of adjuvant chemotherapy. Conclusion Social support and symptom distress are considerations in chemotherapy initiation delay. Implications for Practice Targeted interventions to alleviate symptom distress and enhance interpersonal support may facilitate timely chemotherapy initiation.