Time to Treatment Initiation for Breast Cancer During the 2020 COVID-19 Pandemic

Abstract

PURPOSE: The COVID-19 pandemic has posed significant pressures on healthcare systems, raising concern that related care delays will result in excess cancer-related deaths. Because data regarding the impact on patients with breast cancer are urgently needed, we aimed to provide a preliminary estimate of the impact of COVID-19 on time to treatment initiation (TTI) for patients newly diagnosed with breast cancer cared for at a large academic center. METHODS: We conducted a retrospective study of patients with newly diagnosed early-stage breast cancer between January 1, 2020, and May 15, 2020, a time period during which care was affected by COVID-19, and an unaffected cohort diagnosed between January 1, 2018 and May 15, 2018. Outcomes included patient volume, TTI, and initial treatment modality. Adjusted TTI was compared using multivariable linear regression. RESULTS: Three hundred sixty-six patients were included. There was an 18.8% decrease in patient volume in 2020 (n = 164) versus 2018 (n = 202). There was no association between time of diagnosis (pre-COVID-19 or during COVID-19) and adjusted TTI ( P = .926). There were fewer in situ diagnoses in the 2020 cohort ( P = .040). There was increased use of preoperative systemic therapy in 2020 (43.9% overall, 20.7% chemotherapy, and 23.2% hormonal therapy) versus 2018 (16.4% overall, 12.4% chemotherapy, and 4.0% hormonal therapy) ( P < .001). CONCLUSION: TTI was maintained among patients diagnosed and treated for breast cancer during the COVID-19 pandemic at a single large academic center. There was a decrease in patient volume, specifically in patients with in situ disease and a shift in initial therapy toward the use of preoperative hormonal therapy.

Breast cancer diagnosis and treatment during the COVID-19 pandemic in a nationwide, insured population

“…In examining treatment after breast cancer diagnosis, we found remarkably high uptake of pre-operative systemic therapy in the early months of the pandemic, consistent with survey data from this time period indicating increased willingness among physicians to use neoadjuvant endocrine therapy [ 22 ]; this use was more likely to be short term than in other periods and likely intended to tide patients over until surgery. Across this large national population, the uptake was similar to that reported in a study of a single academic center [ 23 ], suggesting that the patterns observed, while variable across geographic regions, may have occurred across multiple practice types. While longer than 8 weeks from diagnosis to first treatment is generally considered treatment delay [ 24 , 25 ], in the early months of the pandemic, the proportion of patients with newly diagnosed breast cancer who did not receive any treatment in the first 2 months was, somewhat counterintuitively, reduced compared to the pre-pandemic or later-pandemic periods.…”

Effects of COVID‐19 on mastectomy and breast reconstruction rates: A national surgical sample

“…This large drop in the volume of surgical breast patients in 2020 indicates an overall decrease in breast cancer surgeries and screenings 15 . Hawrot et al 15 also reported increased use of preoperative systemic therapy (hormonal therapy and chemotherapy), 43.9% in 2020 versus 16.4% in 2018 ( p < 0.001), consistent with the ACS guidelines.…”

“…The 10.7% decline in the number of female surgical breast patients from 2019 to 2020 is notable as, historically, the volume of institutions participating in NSQIP has grown over time, 14 but our finding is consistent with the literature. Hawrot et al's 15 single‐institution retrospective review comparing the treatment of early‐stage breast cancer patients in 2020 with a pre‐pandemic (2018) cohort reported an 18.8% decline in breast cancer patient volume. This large drop in the volume of surgical breast patients in 2020 indicates an overall decrease in breast cancer surgeries and screenings 15 .…”

“…Hawrot et al's 15 single‐institution retrospective review comparing the treatment of early‐stage breast cancer patients in 2020 with a pre‐pandemic (2018) cohort reported an 18.8% decline in breast cancer patient volume. This large drop in the volume of surgical breast patients in 2020 indicates an overall decrease in breast cancer surgeries and screenings 15 . Hawrot et al 15 also reported increased use of preoperative systemic therapy (hormonal therapy and chemotherapy), 43.9% in 2020 versus 16.4% in 2018 ( p < 0.001), consistent with the ACS guidelines.…”

Impact of the COVID-19 pandemic on breast and cervical cancer stage at diagnosis in Brazil

“…Considering this, the main negative impacts of the COVID-19 pandemic for delaying cancer patients’ treatment seemed to be the decrease in screening and diagnostic procedures. Hawrot et al [ 8 ] also found in a retrospective cohort that time to treatment initiation after breast cancer diagnosis was maintained during the pandemic in the United States. The main hypothesis to explain the decrease of the interval to the first cancer centre visit observed in our centre is that fewer patients were referred during the pandemic, facilitating the access of those patients who were referred.…”