Delay in Breast Cancer Treatments During the First COVID-19 Lockdown. A Multicentric Analysis of 432 Patients

Vanni, Gianluca; Tazzioli, Giovanni; Pellicciaro, Marco; Materazzo, Marco; Orsaria, Paolo; Cattadori, Francesca; Combi, Francesca; Papi, Simona; Pistolese, Chiara Adriana; Cotesta, Maria; Santori, Francesca; Caspi, Jonathan; Chiaravalloti, Agostino; Muscoli, Saverio; Lombardo, Vittorio; Grasso, Antonella; Caggiati, Lorenza; Raselli, Roberta; Palli, D.; Altomare, Vittorio; D’Angelillo, Rolando Maria; Palombi, Leonardo; Buonomo, Oreste Claudio

doi:10.21873/anticanres.14741

Cited by 73 publications

(107 citation statements)

References 33 publications

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“… 22 26 38 39 However, some studies pointed out that the reductions in diagnostic procedures are also related to a decrease in cancer encounters, leading to a reduction in diagnostic suspicion 22 and therefore a treatment delay. 40 …”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic and related control measures on cancer diagnosis in Catalonia: a time-series analysis of primary care electronic health records covering about five million people

et al. 2021

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ObjectiveCancer care has been disrupted by the response of health systems to the COVID-19 pandemic, especially during lockdowns. The objective of our study is to evaluate the impact of the pandemic on the incidence of cancer diagnoses in primary care.DesignTime-series study of malignant neoplasms and diagnostic procedures, using data from the primary care electronic health records from January 2014 to September 2020.SettingPrimary care, Catalonia, Spain.ParticipantsPeople older than 14 years and assigned in one of the primary care practices of the Catalan Institute of Health with a new diagnosis of malignant neoplasm.Main outcome measuresWe obtained the monthly expected incidence of malignant neoplasms using a temporary regression, where the response variable was the incidence of cancer from 2014 to 2018 and the adjustment variables were the trend and seasonality of the time series. Excess or lack of malignant neoplasms was defined as the number of observed minus expected cases, globally and stratified by sex, age, type of cancer and socioeconomic status.ResultsBetween March and September 2020 we observed 8766 (95% CI 4135 to 13 397) fewer malignant neoplasm diagnoses, representing a reduction of 34% (95% CI 19.5% to 44.1%) compared with the expected. This underdiagnosis was greater in individuals aged older than 64 years, men and in some types of cancers (skin, colorectal, prostate). Although the reduction was predominantly focused during the lockdown, expected figures have not yet been reached (40.5% reduction during the lockdown and 24.3% reduction after that).ConclusionsReduction in cancer incidence has been observed during and after the lockdown. Urgent policy interventions are necessary to mitigate the indirect effects of the COVID-19 pandemic and related control measures on other diseases and some strategies must be designed in order to reduce the underdiagnosis of cancer.

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Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic and related control measures on cancer diagnosis in Catalonia: a time-series analysis of primary care electronic health records covering about five million people

et al. 2021

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“…Also, a decline of 44.9% in weeks 11 to 20 of 2020 compared to 2018 to 2019 was found in Italy [11] and the number of new cancer diagnoses fell by 30% in April 2020 compared to April 2019 in Germany [12]. Furthermore, a significant increase in the incidence of more advanced stages of melanoma [13], breast [14,15] and lung cancer cases [16] at diagnosis has been observed.…”

Section: Introductionmentioning

confidence: 93%

Significant Decrease in Annual Cancer Diagnoses in Spain during the COVID-19 Pandemic: A Real-Data Study

Ruiz-Medina

Gil

Jiménez

et al. 2021

Cancers

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The COVID-19 pandemic has caused a profound change in health organizations at both the primary and hospital care levels. This cross-sectional study aims to investigate the impact of the COVID-19 pandemic in the annual rate of new cancer diagnosis in two university-affiliated hospitals. This study includes all the patients with a pathological diagnosis of cancer attended in two hospitals in Málaga (Spain) during the first year of pandemic. This study population was compared with the patients diagnosed during the previous year 2019. To analyze whether the possible differences in the annual rate of diagnoses were due to the pandemic or to other causes, the patients diagnosed during 2018 and 2017 were also compared. There were 2340 new cancer diagnosis compared to 2825 patients in 2019 which represented a decrease of −17.2% (p = 0.0001). Differences in the number of cancer patients diagnosed between 2018 and 2019 (2840 new cases; 0.5% increase) or 2017 and 2019 (2909 new cases; 3% increase) were not statistically significant. The highest number of patients lost from diagnosis in 2020 was in breast cancer (−26.1%), colorectal neoplasms (−16.9%), and head and neck tumors (−19.8%). The study of incidence rates throughout the first year of the COVID-19 pandemic shows that the diagnosis of new cancer patients has been significantly impaired. Health systems must take the necessary measures to restore pre-pandemic diagnostic procedures and to recover lost patients who have not been diagnosed.

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“…Both the advancement of oncological and surgical treatments, as well as a greater rate of early diagnosis facilitated this outcome improvement (9,12,13). Diagnosis of breast cancer in earlier stages is a benefit largely attributed to screening programs (7)(8)(9)(10). Early breast cancer diagnosis is a crucial factor responsible for reducing recurrence, increasing survival and improving quality of life (10).…”

Section: Discussionmentioning

confidence: 99%

“…Diagnosis of breast cancer in earlier stages is a benefit largely attributed to screening programs (7)(8)(9)(10). Early breast cancer diagnosis is a crucial factor responsible for reducing recurrence, increasing survival and improving quality of life (10). Adherence to the screening program has allowed a significant improvement in recent decades.…”

Section: Discussionmentioning

confidence: 99%

“…All our patients referred COVID-19 anxiety as the primary reason for delayed consultation. Furthermore, higher rates of procedure and oncological treatment refusal among patients with breast cancer have been reported during the pandemic (10). Many patients with palpable lesions or with extremely advanced breast cancer could not be diagnosed (19,20).…”

Section: Discussionmentioning

confidence: 99%

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Extremely Advanced Breast Cancer Presentation: Possible Effect of Coronavirus Pandemic Anxiety

Vanni

Santori

Pellicciaro

et al. 2021

In Vivo

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Background/Aim: Corona virus infection dramatically spread worldwide during 2020 and extraordinary restrictions have been implemented in order to reduce viral transmission. These measures compelled a complete restructuring of the health system, including temporary cancer screening suspension and a significant slow-down in cancer diagnoses and treatments. Case Report: We report five cases of extremely advanced breast cancer referred to our Department amid the COVID-19 pandemic. These patients exhibited a poor prognosis or worse quality of life due to their oncological disease. Conclusion: In our opinion, both the slow-down of diagnosis and treatment of oncological disease and anxiety over COVID-19 influenced this presentation. Moreover, other patients were unable to receive palliative care. Hopefully, these cases will not develop into extremely advanced-stage disease, and we will be able to provide at least the necessary palliative care.Breast oncological disease is the most commonly diagnosed female malignancy. It is the second leading cause of cancer death among women (1). Early diagnosis is important for improving patient prognosis and guaranteeing a conservative treatment. (2, 3).Infection with a novel corona virus, SARS-CoV-2, dramatically spread worldwide during the 2020 (3). Due to its rapid viral transmission and high associated mortality, on March 10, 2020, the Italian government, similarly to other governments throughout the world, has implemented exceptional constraints (4-6) in order to hinder viral transmission. These necessary measures forced a complete restructuring of the health system and resource reallocation in favor of patients with 8).Amidst the pandemic, especially during the first lockdown, only urgent medical treatments were guaranteed, at the expense of diagnostic procedures and oncological therapies, which suffered significant slowdown, with crucial delays in diagnoses and treatments (9). Moreover, Covid-19related anxiety also caused further diagnostic and therapeutic delays (10), consequently increasing the number of advanced breast cancer cases (9).Here we report five cases of patients with extremely advanced breast cancer, diagnosed during the pandemic as a possible effect of COVID-19-associated anxiety.This work is reported following the surgical case report guidelines and written consent from all the patients was obtained. Case ReportCase 1. A 52-year-old Caucasian woman, a former smoker of 4.75 pack years, was admitted to the Emergency Department for a lipothymic episode. Family history was negative for oncological or cardiovascular conditions and no comorbidities were reported.Physical examination of the breast revealed an ulcerated hemorrhagic lesion on the right gland, with hard-ligneous consistency involving all the breast and extending to the 2331 This article is freely accessible online.

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Delay in Breast Cancer Treatments During the First COVID-19 Lockdown. A Multicentric Analysis of 432 Patients

Cited by 73 publications

References 33 publications

Impact of the COVID-19 pandemic and related control measures on cancer diagnosis in Catalonia: a time-series analysis of primary care electronic health records covering about five million people

Impact of the COVID-19 pandemic and related control measures on cancer diagnosis in Catalonia: a time-series analysis of primary care electronic health records covering about five million people

Significant Decrease in Annual Cancer Diagnoses in Spain during the COVID-19 Pandemic: A Real-Data Study

Extremely Advanced Breast Cancer Presentation: Possible Effect of Coronavirus Pandemic Anxiety

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