How would you approach timing of adjuvant chemotherapy in a Stage 1 TNBC lost to follow up for >1 month since surgery?

Delayed initiation of adjuvant chemotherapy beyond 60-90 days has been linked to inferior outcomes in several studies (see for example Chavez-MacGregor et al., PMID 26659132). However, if this worse outcome is primarily due to time delays in chemotherapy or driven by other variables (e.g. ability to comply with therapy, comorbidities, etc) is hard to tease out despite best efforts.

In principle, as long as the occult disease remains microscopic adjuvant therapy has a chance to eradicate it.

The answer to this question depends on the time that has passed since surgery. If the patient is within 2-6 months of surgery I would recommend the same adjuvant therapy as if she were 2-6 weeks after surgery.

With longer delays, if there is concern for ra...