On Monday, 23 March 2020, Nigeria recorded its first mortality from the novel global COVID-19 outbreak. Before this, the country reported 36 confirmed cases (at the time of writing) and has discharged home two cases after weeks of care at a governmentapproved isolation centre in Lagos State. This first mortality was that of a 67-year-old man with a history of multiple myeloma, a type of blood cancer. He was undergoing chemotherapy and had just returned to Nigeria following medical treatment in the United Kingdom. The novel COVID-19 pandemic has grounded several global activities including the provision of health care services to people with chronic conditions such as cancer. Evidence from China suggests that cancer patients with COVID-19 infection are a vulnerable group, with a higher risk of severe illness resulting in intensive care unit admissions or death, particularly if they received chemotherapy or surgery. This letter is an attempt to suggest practicable interventions such as the use of existing digital health platforms to limit patients' and oncology professionals' physical interactions as a way of reducing the risk of COVID-19 infection transmission amongst cancer patients and oncologists, as well as outlining effective strategies to ensure that cancer care is not completely disrupted during the outbreak.

Background: Breast cancer in African women differs from the Caucasian. Understanding the profile of Nigerian women with breast cancer will help with preventive measures and treatment. This study focused on the clinico-pathological characteristics, with risk factors of breast cancer patients in Nigeria. Methods: Newly diagnosed female patients with breast cancer were assessed over 12 months. Patients were reviewed using a predesigned proforma which focused on socio-demographic information, clinical information, risk factors and tumor biology. Results: A total of 251 women were identified; their mean age was 46 years. More than half (62.5%) are premenopausal at presentation, 37.8% with Eastern Cooperative Oncology Group (ECOG) score of 0 and right side (50.2%) as the most common primary site of disease. Less than half of them (43.0%) are estrogen receptor (ER) positive, 27.9% are progesterone receptor (PR) positive, 43.8% and 47.4% are hormone receptor positive and triple negative, respectively. Most patients presented at the latter stage of the disease, stage III (66.9%) and stage IV (18.3%). Only 15.9% are well differentiated and almost all (92.8%) had invasive ductal histological type. Obesity (66.2%) and physical inactivity (41.9%) are the most common risk factors for the disease. A significant relationship was found between immunohistochemistry status and family history of breast cancer, tumor site, previous breast surgery, previous lump and alcohol intake. Conclusion: Findings from this study showed that Nigerian breast cancer patients differ from their counterparts in the high human development index (H-HDI) countries in terms of the patients and disease characteristics. In view of this, prevention and treatment options should consider this uniqueness to ensure better outcome.

This study assessed the incidence of chemotherapy-induced neutropenia and febrile neutropenia (FN) while identifying their associated factors. Methods: A prospective cross-sectional study was conducted among 113 female chemotherapy-naïve breast cancer patients over a 2-year period. Socio-demographic, clinical and haematological data were obtained via semi-structured interviews and from medical case files. Blood samples for complete blood count parameters were collected 2 weeks after each course of chemotherapy. The National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03 was used to assess FN, neutropenia and their severity. Results: The incidence of neutropenia and FN among the patients was 31.9% and 5.3%, respectively. Throughout all courses of chemotherapy (n = 502), there were 57 (11.4%) neutropenic episodes with 6.6% mild, 3.4% moderate and 1.4% severe neutropenia. The incidence of neutropenia decreased with increasing chemotherapy courses, with a rate of 14.2% and 4.9% after the first and last course, respectively. Factors associated with the risk of developing neutropenia include increasing age (p = 0.014), Eastern Cooperative Oncology Group performance score ≥ 1 at presentation (p = 0.033) and presence of bone metastasis (p = 0.002). Conclusion: One in three breast cancer patients in this study developed neutropenia while on chemotherapy but no independent risk factors were identified for FN among these patients. This study has, therefore, provided the preliminary data necessary for further independent validation of the identified risk factors for FN in a more robust and well-designed study within our clinical practice setting in Nigeria.

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e12523 Background: Neutropenia and febrile neutropenia are major dose-limiting adverse effects of systemic cancer chemotherapy. It has been associated with significant morbidity and mortality, and high costs of management, and treatment breaks in cancer patients especially in resource-limited environments leading to poorer outcomes. Chemotherapy-induced neutropenia is an established complication of breast cancer treatment, however, there is paucity of information on the exact magnitude of the condition. This study assessed the prevalence of neutropenia and febrile neutropenia, while identifying their associated factors. Methods: A cross-sectional study was conducted among 113 female chemotherapy-naïve breast cancer patients over a two-year period. Sociodemographic, clinical and haematological data was obtained via semi-structured interviews and from medical case files. Blood samples for complete blood count parameters were collected after each course of chemotherapy. The National Cancer Institute Common Terminology CTCAE version 4.03 was used to assess febrile neutropenia, neutropenia and its severity. Results: The prevalence of neutropenia and febrile neutropenia among the patients was 31.9% and 5.3% respectively. Throughout all courses of chemotherapy, there were neutropenic episodes 11.4% (57/502) with mild neutropenia 6.6%, moderate 3.4% and severe 1.4%. Prevalence of neutropenia decreased with increasing chemotherapy courses, with prevalence after first course being 14.2% and last course 4.9%. Associated risk factors for developing neutropenia include increasing age ( p = 0.014), ECOG performance score > 1 at presentation (p = 0.033) and presence of bone metastasis (p = 0.002). Conclusions: One in three breast cancer patients developed neutropenia while on chemotherapy. The use of prophylactic G-CSF after each course of chemotherapy should be a routine practice, especially among elderly patients, unstable patients, and those with bone metastasis.