Changes in breast cancer management during the Corona Virus Disease 19 pandemic: An international survey of the European Breast Cancer Research Association of Surgical Trialists (EUBREAST)

Abstract

Background: Corona Virus Disease 19 (COVID-19) had a worldwide negative impact on healthcare systems, which were not used to coping with such pandemic. Adaptation strategies prioritizing COVID-19 patients included triage of patients and reduction or re-allocation of other services. The aim of our survey was to provide a real time international snapshot of modifications of breast cancer management during the COVID-19 pandemic. Methods: A survey was developed by a multidisciplinary group on behalf of European Breast Cancer Research Association of Surgical Trialists and distributed via breast cancer societies. One reply per breast unit was requested. Results: In ten days, 377 breast centres from 41 countries completed the questionnaire. RT-PCR testing for SARS-CoV-2 prior to treatment was reported by 44.8% of the institutions. The estimated time interval between diagnosis and treatment initiation increased for about 20% of institutions. Indications for primary systemic therapy were modified in 56% (211/377), with upfront surgery increasing from 39.8% to 50.7% (p < 0.002) and from 33.7% to 42.2% (p < 0.016) in T1cN0 triple-negative and ER-negative/HER2positive cases, respectively. Sixty-seven percent considered that chemotherapy increases risks for developing COVID-19 complications. Fifty-one percent of the responders reported modifications in chemotherapy protocols. Gene-expression profile used to evaluate the need for adjuvant chemotherapy increased in 18.8%. In luminal-A tumours, a large majority (68%) recommended endocrine treatment to postpone surgery. Postoperative radiation therapy was postponed in 20% of the cases. Conclusions: Breast cancer management was considerably modified during the COVID-19 pandemic. Our data provide a base to investigate whether these changes impact oncologic outcomes.

Management of early breast cancer during the COVID-19 pandemic in Brazil

“…There are other surveys that deal with the management of breast cancer [54,55]. An interesting European study evaluated the changes in EBC management during the pandemic [55]. Unlike the results of the present study, upfront surgery in that study increased in cases of T1 N0 TN and in HER2.…”

“…There are other surveys that deal with the management of breast cancer [54,55]. An interesting European study evaluated the changes in EBC management during the pandemic [55].…”

Hughes et al. (2020) 'I feel cancer patients have been neglected'.

“…However, high COVID-19-related anxiety is associated with reporting more somatic symptoms [33], and so women with high cancer-related anxiety due to missed screening may report more symptoms, leading to unnecessary healthcare contacts and exposure to COVID-19. Similarly, the recommendation to defer surgery in favour of hormone therapy (HT) [13][14] could have negative effects beyond cancer-related anxiety as a small proportion of this sample reported worsening HT side-effects and difficulty accessing medication which can adversely affect adherence [34][35]. The current sample had been prescribed HT for more than two years on average and the impact may be stronger in those newly prescribed [36].…”

“…Although data on the risk and outcomes of COVID-19 in breast cancer is currently lacking, advancing age, comorbidities and chemotherapyinduced immunosuppression present particular challenges [13]. Widespread measures have been implemented to reduce infection including postponement of surgery and routine followup, and switching to oral therapies where possible [14][15] which may have resulted in shortterm mental health and longer-term oncological implications [12,16] requiring further investigation.…”

Considerations for the Management of Women with Breast Cancer during the COVID-19 Pandemic

“…A European multinational survey revealed significant changes in management of patients with breast cancer, including increased time to treatment initiation (20%), postponement of radiation therapy (20%), and changes to treatment protocols in over 50% patients. 4 Several international oncological societies have proposed guidelines for the care of patients with breast cancer during the pandemic with a view to optimize resource allocation and maximize risk versus benefit for the individual and society. The applicability of these recommendations should be based on the current availability of resources, expertise and severity of the COVID-19 pandemic in each region.…”