Root Cause Analysis of Omissions and Delays in the Initiation of Neoadjuvant Chemotherapy in Eligible Patients with Breast Cancer in British Columbia, Canada

Patients with high-risk breast cancers may benefit from receiving neoadjuvant chemotherapy (NACT) to reduce tumour size and allow for breast conserving surgery. Response to NACT also informs prognosis and broadens adjuvant treatment options. According to international guidelines, NACT should commence within 28 days of diagnosis. We conducted a retrospective chart review of patients eligible for NACT at a Canadian provincial cancer centre to determine the incidence and root causes of omission or delay in initiation of NACT. Of 100 patients eligible for NACT, 73 received it, while 7 were not referred to medical oncology for consideration of NACT. Of the 73 patients who received NACT, only 15 (21%) started treatment within 28 days of diagnosis. The median diagnosis-to-NACT wait time was 40 days [IQR 30-53]. Of 54 delayed cases, 39 (72%) were due to patients waiting 21 days or more for a medical oncology consultation. Lack of, or delays in medical oncology consultation are the most prominent causes of both NACT omissions and delays. Improving triage of patients potentially eligible for NACT to medical oncology may be an effective intervention to improve patient outcomes.