Impact of the COVID-19 Pandemic on Breast Cancer Management in Portugal: A Cross-Sectional Survey-Based Study of Medical Oncologists

Abstract

Introduction Cancer care providers have faced many challenges in delivering safe care for patients during the COVID-19 pandemic. This cross-sectional survey-based study investigated the impact of the pandemic on clinical practices of Portuguese medical oncologists caring for patients with breast cancer. Methods An anonymous online survey comprising 42 questions gathered information regarding COVID-19 testing, treatment in (neo)adjuvant and metastatic settings, and other aspects of breast cancer management. Practices before and during the pandemic were compared, and potential differences in outcomes according to respondents’ regions, case volumes, and practice type were explored. Results Of 129 respondents, 108 worked in the public health system, giving a representative national picture of the impact of the COVID-19 pandemic on breast cancer management. Seventy-one percent of respondents reported a reduction in visits for new cases of breast cancer, and there was a shift towards increased use of telemedicine. Clinical decision-making was largely unaffected in the most aggressive indications (i.e., triple-negative, HER2-positive, visceral crisis). The use of neoadjuvant therapy increased when access to surgery was difficult, whereas dose-dense regimens decreased, and cyclin-dependent kinase 4/6 inhibitor treatment decreased for less aggressive disease and increased for more aggressive disease. The use of oral formulations and metronomic chemotherapy regimens increased, and clinical trial participation decreased. Some differences by respondents’ region and case volume were noted. Conclusion Medical oncologists in Portugal implemented many changes during the COVID-19 pandemic, most of which were logical and reasonable responses to the current healthcare emergency; however, the true impact on patient outcomes remains unknown. Supplementary Information The online version contains supplementary material available at 10.1007/s40487-022-00191-7.

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

“… New Zealand’s COVID-19 elimination pursuit helped minimize COVID-19 impact on breast cancer management. Alpuim Costa et al, Portugal 75 Cross-sectional survey-based study Dec 2020–Feb 2021 129 (NR) Impact of COVID-19 on clinical practices of oncologists for breast cancer patients. 71.3% of subjects reported reduced visits for new breast cancer cases, an increase in the tendency for telemedicine use, in cases of most aggressive indications such as HER2-positive, triple-negative, visceral crisis, clinical decision-making procedures remained unaffected, use of neoadjuvant therapy increased, but dose-dense regimens decreased, for less aggressive cases application of cycline-dependent kinase 4/6 inhibitor decreased, treatment with oral formulations and metronomic chemotherapy improved.…”

“…Where possible, prescribing oral formulations was also proposed to limit attendance at hospitals with associated concerns with catching COVID-19 alongside increasing home delivery of medicines where possible. 75 The prescribing of metronomic chemotherapy, ie, frequent low doses of chemotherapy versus maximum dosing, may also be beneficial during a pandemic to limit the impact of chemotherapy on the immune system and patient recovery times ( Table 2 ). 75 , 76 …”

“… 75 The prescribing of metronomic chemotherapy, ie, frequent low doses of chemotherapy versus maximum dosing, may also be beneficial during a pandemic to limit the impact of chemotherapy on the immune system and patient recovery times ( Table 2 ). 75 , 76 …”

Impact of the COVID-19 pandemic on clinical trials: a cross-sectional questionnaire study in China

“…Our respondents indicated that high-tech apps are able to increase subjects’ adaptability and protocol compliance in clinical research. Moreover, remote drug distribution and continuous medical oversight of adverse events in trials are available through telemedicine, which reduces hospital visits, decreases the risk of nosocomial infections and dropout rate ( 37 ), and eases the stress on medical resources. Although there are some limitations in telemedicine, such as the inability to collect bio-specimens, the difficulty in performing physical examination, and the poor quality of the internet provider network in low-income areas, it is still recommended as a routine element in future clinical trials.…”