Breast Cancer Management in the Era of Covid-19; Key Issues, Contemporary Strategies, and Future Implications

Abstract

During the COVID-19 pandemic, several priority diseases were not getting sufficient attention. Whilst breast cancer is a fatal disease affecting millions worldwide, identification and management of these patients did not initially attract critical attention to minimize the impact of lockdown, post-lockdown, and other measures. Breast cancer patients’ conditions may not remain stable without proper care, worsening their prognosis. Proper care includes the timely instigation of surgery, systemic therapy, and psychological support. This includes low-and middle-income countries where there are already concerns with available personnel and medicines to adequately identify and treat these patients. Consequently, there was a need to summarize the current scenario regarding managing breast cancer care during COVID-19 across all countries, including any guidelines developed. We systematically searched three scientific databases and found 76 eligible articles covering the medical strategies of high-income countries versus LMICs. Typically, diagnostic facilities in hospitals were affected at the beginning of the pandemic following the lockdown and other measures. This resulted in more advanced-stage cancers being detected at initial presentation across countries, negatively impacting patient outcomes. Other than increased telemedicine, instigating neo-adjuvant endocrine therapy more often, reducing non-essential visits, and increasing the application of neo-adjuvant chemotherapy to meet the challenges, encouragingly, there was no other significant difference among patients in high-income versus LMICs. Numerous guidelines regarding patient management evolved during the pandemic to address the challenges posed by lockdowns and other measures, which were subsequently adopted by various high-income countries and LMICs to improve patient care. The psychological impact of COVID-19 and associated lockdown measures, especially during the peak of COVID-19 waves, and the subsequent effect on the patient’s mental health must also be considered in this high-priority group. We will continue to monitor the situation to provide direction in future pandemics.

Impact of Lockdown Measures on Health Outcomes of Adults with Type 2 Diabetes Mellitus in Bangladesh

“…In addition, the high prevalence of uncontrolled T2DM and hypertension, as well as delays in the diagnosis of cardiovascular diseases among patients with diabetes before and during the pandemic, with its associated lockdown measures [ 29 , 30 , 31 , 32 ], further exacerbates concerns in this high-priority population [ 48 , 50 , 58 , 59 ]. We are aware that the pandemic has also adversely impacted on the diagnosis and management of other NCDs in LMICs [ 60 , 61 ]. This needs to be taken into consideration in future pandemics as a counter-consideration to aggressive lockdown measures [ 60 , 61 ].…”

“…We are aware that the pandemic has also adversely impacted on the diagnosis and management of other NCDs in LMICs [ 60 , 61 ]. This needs to be taken into consideration in future pandemics as a counter-consideration to aggressive lockdown measures [ 60 , 61 ].…”

A Global Review of the Impacts of the Coronavirus (COVID-19) Pandemic on Radiology Practice, Finances, and Operations

“…However, these studies demonstrate that the delayed diagnoses that have occurred during the pandemic may result in increased findings of advanced cancer stages in the upcoming years. Overall, there was a decrease in neo-adjuvant therapies during the pandemic with an increase in oral adjuvant therapies [59]. During the post-lockdown phase as imaging studies increased and larger-sized and advanced tumors were detected, more aggressive care and neo-adjuvant therapies were utilized.…”

Collateral effects of the COVID-19 pandemic on endocrine treatments for breast and prostate cancer in the UK: implications for bone health

“…Indeed, recent reports highlight that screening tests for breast cancer and visits to breast surgeons were delayed in the initial months following lockdown and up to at least June 2022 in the United Kingdom (UK) [2, 3]. Furthermore, breast and prostate cancer were under-diagnosed between March 2020 and June 2022 [2, 4].…”

“…Because healthcare staff were redeployed to care for COVID-19 patients, and many hospital beds were allocated to such patients, treatments for cancers were altered [4]. New guidelines were introduced in Europe for the management of cancer patients during the pandemic, including the recommendation to postpone surgery/radiotherapy and instead provide neo-adjuvant endocrine therapy for some breast cancer patients during the waiting period (though not specifically in the UK) [5].…”