COVID-19: Changes to breast cancer management in UK mapped
medwireNews: Although a large proportion of breast cancer patients experienced changes in their management during the first peak of the COVID-19 pandemic, the majority of altered decisions were in line with prepandemic guidelines, report UK researchers.
These findings imply that “breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic,” say Cliona Kirwan (Manchester University NHS Foundation Trust) and collaborators, but they add that “the potential impact of delays to [breast cancer] presentation or diagnosis remains unknown.”
The B-MaP-C cohort included 3766 patients with early breast cancer who received a treatment recommendation from a multidisciplinary team (MDT) at one of 64 units during the first period of COVID-19 restrictions in the UK, between March 16 and May 8, 2020.
Of these, 59% received so-called COVID-altered management – defined as treatments that were not standard practice for the unit, even if they were standard for other units – at some point during their treatment journey.
For instance, among the 2216 individuals receiving treatment in the preoperative setting, neoadjuvant chemotherapy was omitted for 160 and incomplete for 92, while 951 patients with hormone receptor-positive disease received bridging endocrine therapy (ET) to allow postponement of surgery.
“Although the primary reason for ‘bridging’ ET is likely due to anticipated reduced theatre capacity, in some, the decision may have been driven by comorbidity and increased risk of COVID-19 mortality,” write the study authors in the British Journal of Cancer.
A total of 1863 patients received an MDT decision for postoperative therapy, and adjuvant chemotherapy was omitted for 81 patients who would have been offered it before the pandemic. The team highlights, however, that the median benefit of adjuvant chemotherapy for these patients was estimated at just 3% based on the NHS Predict tool.
Of note, 72% of the breast cancer units included in the study offered the five-fraction adjuvant radiotherapy protocol, which was shown to be noninferior in terms of local control to the standard 15-fraction protocol in the FAST-Forward study published in April 2020. As a result, 781 patients received hypofractionated radiotherapy rather than the 15-fraction regimen as would have been the case prepandemic.
Kirwan and colleagues point out that just 19% of the participants who received COVID-altered treatment were managed in a way “that was clearly outside the pre-COVID breast cancer NICE guidelines […], implying that breast cancer oncological outcomes in this study are unlikely to be negatively impacted (although the psychological impact of reconstruction omission is yet to be determined).”
And the team concludes: “Appraisal of these changes will guide the evaluation of the impact of the pandemic on immediate patient outcomes and the degree to which breast cancer management has been affected in routine clinical practice.
“This will assist with planning of service delivery once routine breast cancer management resumes and in the event of a further pandemic.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group
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