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

Abstract

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.

Palliative Care in Breast Cancer During the COVID-19 Pandemic: A Scoping Review

“…Chemotherapy treatment modifications during the COVID-19 outbreak at a community cancer center in New York City. 43…”

“…24 After the content analysis, five broad categories were identified that reflect the predominant perspectives concerning PC and breast cancer within the context of the pandemic. These included general recommendations for standard palliative treatment and symptom management, [25][26][27][28][29][30][31] the use of palliative RT, 6,[22][23][24][32][33][34][35][36][37][38][39][40][41] palliative chemotherapy, 35,38,[42][43][44][45] management of metastatic breast cancer, 22,27,[46][47][48][49][50] and teleoncology for the provision of PC 30,[51][52][53][54][55][56] The summary of the main recommendations is shown in (Table 2).…”

“…45 Despite this, palliative chemotherapy was an important treatment during the health crisis, especially in patients with advanced breast cancer, as reported by a series report of five cases. 43 Metastatic Breast Cancer, Palliative Care, and Covid-19…”

Risk factors for heightened COVID‐19‐Related anxiety among breast cancer patients

“…The COVID‐19 pandemic has had a profoundly negative impact on the care of breast cancer patients, whose outcomes largely depend upon early detection and timely treatment. 1 Breast cancer patients experienced major disruptions to their care as COVID‐19 surges overwhelmed hospitals and outpatient facilities. 2 , 3 , 4 , 5 In addition, patients themselves frequently postponed or canceled scheduled visits due to fear of contracting COVID‐19 in health care settings.…”

“… 2 , 3 , 4 , 5 In addition, patients themselves frequently postponed or canceled scheduled visits due to fear of contracting COVID‐19 in health care settings. 1 These compounded care delays resulted in unmanaged symptoms and pathologic upstaging, 6 burdening patients with more intensive treatments, poorer outcomes, and increased care costs. 7 , 8 …”