Breast Cancer Management During the COVID-19 Pandemic: the Radiation Oncology Perspective

Abstract

Purpose of Review The coronavirus disease 19 (COVID-19) pandemic has caused disruption in healthcare throughout the world. The limitations placed on hospital resources and the need to limit potential exposure to SARS-CoV-2 for both patients and healthcare staff have affected oncologic care for patients with breast cancer (BC), including radiation therapy (RT). This review highlights published guidelines regarding the provision of radiotherapy for BC patients and their adoption by radiation oncology centers. Recent Findings Multiple international and national consortiums plus select institutions have published formal recommendations regarding radiation therapy for BC during the COVID-19 pandemic. They embody the principles of limiting in-person visits, proper triage, and the judicious use of delay, abbreviation, or omission of RT as appropriate. Summary Since the start of the pandemic, multiple publications have provided guidance regarding RT for BC during this challenging time. The pandemic has led to increased use of telemedicine and abbreviated radiation therapy courses in the setting of BC, which are likely to persist. Future research is needed to establish the effect of these changes on oncologic outcomes.

Management of Breast Cancer during COVID-19 Pandemic: Trends of the Intervals to Radiotherapy in a Single Center Cohort

“…The mean unadjusted TTI in 2018 was 45 days (median 41, Interquartile Range (IQR) 29-55) versus 44 days (median 36, IQR 27-52) in 2020 cohort. In the 2020 cohort, the mean time from presentation to histologic diagnosis was 38 days (median 23, IQR 13-48), from histologic diagnosis to initial appointment 17 days (median 14, IQR 8-21), and from initial appointment to first treatment start 27 days (median 22, IQR [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. Histologic diagnosis was defined as the date of the histologic result and initial treatment was the recorded date when a patient received their first step in treatment (surgery, chemotherapy, hormonal therapy, or radiation therapy).…”

“…Depending on risk factors, a delay from 6 to 12 weeks is acceptable for patients with positive lymph nodes, positive margins, young age; a delay between 16-20 weeks could be acceptable for early-stage BC with negative margins, hormone receptor + and age >50. Only patients with inflammatory BC and progression during neoadjuvant CT should begin RT before 6-8 weeks [22].…”

“…A selective omission or delay of radiation therapy has been considered a valid strategy to limit the viral spread without compromising oncologic outcomes. All the guidelines agreed on considering the omission of RT for elderly BC patients in the post-operative setting, with particular characteristics such as age >65 or 70, tumor ≤2 or 3 cm in dimension with negative surgical margins, Luminal A (ER+, PgR+, Her2-), negative nodes, and all that cases where endocrine therapy would be indicated [22]. Regarding RT, the use of moderate hypofractionation and ultrahypofractionation had a certain appeal for selected BC patients during the COVID-19 pandemic.…”

Lasting Impacts of the COVID-19 Pandemic on Breast Cancer Diagnosis and Treatment in the United States

“…In patients with breast cancer without positive regional lymph node disease, moderate hypofractionation was already widely used but the pandemic accelerated the use of ultra-hypofractionation in patients with early-stage breast cancer. 23 As a result of the COVID-19 pandemic, utilization of telemedicine and hypofractionation modalities are likely to remain part of the radiotherapy treatment of breast cancer.…”

Research trends and hotspots of breast cancer management during the COVID-19 pandemic: A bibliometric analysis

“…The susceptibility to the adverse effects caused by COVID-19 has received huge amounts of global attention, due to the potentially increased vulnerability of COVID-19-induced mortality (2). During the pandemic, the management of cancer patients has changed significantly, which consists of delayed breast cancer screening, untimely treatment and follow-up, and breast cancer recovery after infection with COVID-19 (3)(4)(5)(6)(7)(8). The true effect of the COVID-19 pandemic on patient outcomes remains unknown, though most of the changes were reasonable responses to the current healthcare emergency (3).…”