Delays in operative management of early-stage, estrogen receptor–positive breast cancer during the COVID-19 pandemic: A multi-institutional matched historical cohort study

Lena, Élise Di; Hopkins, Brent; Wong, Stéphanie; Meterissian, Sarkis

doi:10.1016/j.surg.2021.10.033

Cited by 12 publications

(7 citation statements)

References 18 publications

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“… The guidelines based on the consensus of experienced health professionals can be helpful during the surgical delay of breast cancer patients during COVID-19. High-Income Countries Di Lena et al, Canada 72 Multi-institutional matched historical cohort study 1 Dec 2019–1 May 2020 76 (65 years) Effects of NET on early-stage ER+ breast cancer patients during COVID-19 pandemic Early-stage ER+ breast cancer patients taking NET did not experience upstaging of breast cancer during the pandemic in 2020 despite having 2.5 times longer delay due to the pandemic. NET can be applied to early-stage ER+ breast cancer patients in cases of surgical delays.…”

Section: Resultsmentioning

confidence: 99%

“…Encouragingly, breast cancer patients with early-stage ER+ who were taking NET did not experience pathological upstaging of their cancer despite having a longer delay for their surgery. 72 Similarly, 74% of oncologists surveyed in Egypt, Saudi Arabia, and the UAE preferred NET for hormone receptor-positive (HR+) and HER2 negative patients during COVID-19 with delays to surgery and concerns regarding the immune system following traditional chemotherapy. However, 58% of those surveyed still preferred 6 to 8 cycles of neoadjuvant chemotherapy to treat breast cancer patients where delays in surgery.…”

Section: Resultsmentioning

confidence: 99%

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

Prodhan

Islam

Khandker

et al. 2023

BCTT

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Prodhan

Islam

Khandker

et al. 2023

BCTT

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“…This is a retrospective study, for which data collection was limited until 2019. That is because (1) we could not foresee the impact of the COVID‐19 pandemic on oncologic surgical breast cancer cases 13 and (2) our institution implemented a simultaneous pilot study on opioid‐free analgesia for day surgical cases, which would have certainly influenced the results of this research 14 . In addition, this study only evaluates the prescribing practices of four breast surgeons; this is a small sample and care should be taken when extrapolating these findings to larger groups of surgeons.…”

Section: Discussionmentioning

confidence: 99%

Opioid prescribing practices in breast oncologic surgery—A retrospective cohort study

Di Lena,

Barone,

Hopkins

et al. 2024

World j. surg.

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BackgroundIn breast oncologic surgery, 75% of patients receive a postoperative opioid prescription at discharge, and 10%–20% will develop persistent opioid use. To inform future institutional guidelines, the objective of this study was to determine baseline opioid prescribing patterns in a single high‐volume, referral‐based breast center. We hypothesized that opioid prescribing practices varied between procedures and operating surgeons.MethodsA retrospective analysis of all women undergoing breast cancer surgery between January and December 2019. Opioid prescriptions at discharge were converted to morphine milligram equivalents (MME). The primary outcome of interest was MME prescribed at discharge. Multiple linear regression was used to identify factors independently associated with MME prescribed.Results392 patients met inclusion criteria; 68.3% underwent partial mastectomy. Median age was 61 (interquartile range [IQR] 51–70). Median MME prescribed at discharge was 112.5 (IQR 75–150); 83.9% of patients were prescribed co‐analgesia. The prescriber was a trainee in 37.7% of cases. 15 patients (3.8%) required opioid renewal. On multivariate analysis, axillary procedure was associated with increased MME (ß = 17, 95% CI 5.5–28 and ß = 32, 95% CI 17–47, for sentinel node and axillary dissection, respectively). However, the factor with the greatest impact on MME was operating surgeon (ß = 72, 95% CI 58–87). Residents prescribed less MME compared to attending surgeons (ß = 11, 95% CI −22; −0.06).ConclusionIn a tertiary care center, the operating surgeon had the greatest influence on opioid prescribing practices, and trainees tended to prescribe less MME. These findings support the need for a standardized approach to optimize prescribing and reduce opioid‐related harms after oncologic breast surgery.

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“…To offload hospitals and better treat patients during the pandemic without compromising their health, many societies made extraordinary recommendations. One of these was to postpone surgery in favor of neoadjuvant endocrine therapy in early-stage ER-positive and HER-negative patients until regular workload could be resumed [ 27 , 28 ]. This change in the treatment approach is consistent with the result that we observed with an increase in endocrine therapy, with a subsequent decrease in the primary surgery rates.…”

Section: Discussionmentioning

confidence: 99%

The impact of the COVID-19 pandemic in the clinical assistance to breast cancer patients

Ribeiro,

Peleteiro,

Fougo

2023

Cancer Causes Control

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Purpose We aimed to disclose the impact of the pandemic on breast cancer patients in a specialized breast cancer center (BCC). Methods A total of 501 breast cancer patients with a first appointment in the BCC from April 1st, 2019 to March 31st, 2021 were divided into four consecutive periods of 6 months. Data from the homologous semesters was compared. Patients with an appointment in the BCC during the study period were eligible for the secondary aim of our study (BCC workload). Results After the pandemic declaration (period 3), we found a decrease in the referral by screening programs (p = 0.002) and a reduction in the waiting time between the primary care referral and the first BCC appointment (p < 0.001). There were higher rates of palpable axillary nodes (p = 0.001), an increase in N stage 2 and 3 (p = 0.050), and a trend for primary endocrine therapy as the first treatment (p = 0.021) associated with higher rates of complete axillary node dissection (p = 0.030). In period 4, there were more outward diagnoses (p = 0.003) and a higher rate of surgery as the first treatment (p = 0.013). Conclusion COVID-19 pandemic implied a more advanced nodal stage, which may be related to the delay in breast cancer screening. Graphical abstract

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Delays in operative management of early-stage, estrogen receptor–positive breast cancer during the COVID-19 pandemic: A multi-institutional matched historical cohort study

Cited by 12 publications

References 18 publications

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

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

Opioid prescribing practices in breast oncologic surgery—A retrospective cohort study

The impact of the COVID-19 pandemic in the clinical assistance to breast cancer patients

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