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Joudi M, Moradi Binabaj M, Porouhan P, PeyroShabany B, Tabasi M, Fazilat-Panah D, Khajeh M, Mehrabian A, Dehghani M, Welsh JS, Keykhosravi B, Akbari Yazdi A, Ariamanesh M, Ghasemi A, Ferns G, Javadinia SA. A Cohort Study on the Immunogenicity and Safety of the Inactivated SARS-CoV-2 Vaccine (BBIBP-CorV) in Patients With Breast Cancer; Does Trastuzumab Interfere With the Outcome? Front Endocrinol (Lausanne) 2022; 13:798975. [PMID: 35299966 PMCID: PMC8923352 DOI: 10.3389/fendo.2022.798975] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/24/2022] [Indexed: 12/23/2022] Open
Abstract
AIM To determine the efficacy and safety of inactivated SARS-CoV-2 vaccine (BBIBP-CorV) in patients with breast cancer. METHODS In this multi- institutional cohort study, a total of 160 breast cancer patients (mean age of 50.01 ± 11.5 years old) were assessed for the SARS-CoV-2 Anti-Spike IgG and SARS-CoV2 Anti RBD IgG by ELISA after two doses of 0.5 mL inactivated, COVID-19 vaccine (BBIBP-CorV). All patients were followed up for three months for clinical COVID-19 infection based on either PCR results or imaging findings. Common Terminology Criteria for Adverse Events were used to assess the side effects. RESULTS The presence of SARS-CoV-2 anti-spike IgG, SARS-CoV2 anti-RBD IgG, or either of these antibodies was 85.7%, 87.4%, and 93.3%. The prevalence of COVID-19 infection after vaccination was 0.7%, 0% and 0% for the first, second and third months of the follow-up period. The most common local and systemic side-effects were injection site pain and fever which were presented in 22.3% and 24.3% of patients, respectively. DISCUSSION The inactivated SARS-CoV-2 vaccine (BBIBP-CorV) is a tolerable and effective method to prevent COVID-19.
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Affiliation(s)
- Maryam Joudi
- Department of Pediatrics, School of Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Maryam Moradi Binabaj
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Pejman Porouhan
- Department of Radiation Oncology, Vasei Hospital, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Babak PeyroShabany
- Department of Internal Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mohsen Tabasi
- Center for Inflammation and Lung Research, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | | | - Mahtab Khajeh
- Vasei Clinical Research Development Unit, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Arezoo Mehrabian
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Mansoureh Dehghani
- Department of Radiation Oncology, Neyshabur University of Medical Sciences, Neyshabur, Iran
- *Correspondence: Mansoureh Dehghani,
| | - James S. Welsh
- Department of Radiation Oncology, Edward Hines Jr VA Hospital and Stritch School of Medicine, Loyola University Chicago, Chicago, IL, United States
| | - Batol Keykhosravi
- Vasei Clinical Research Development Unit, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Azam Akbari Yazdi
- Vasei Clinical Research Development Unit, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mona Ariamanesh
- Department of Pathology, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Ahmad Ghasemi
- Department of Basic Sciences, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Gordon Ferns
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Seyed Alireza Javadinia
- Vasei Clinical Research Development Unit, Sabzevar University of Medical Sciences, Sabzevar, Iran
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Tonneson JE, Hoskin TL, Day CN, Durgan DM, Dilaveri CA, Boughey JC. Impact of the COVID-19 Pandemic on Breast Cancer Stage at Diagnosis, Presentation, and Patient Management. Ann Surg Oncol 2022; 29:2231-2239. [PMID: 34812981 PMCID: PMC8609838 DOI: 10.1245/s10434-021-11088-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/25/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The COVID-19 pandemic caused delays in breast cancer management forcing clinicians to potentially alter treatment recommendations. This study compared breast cancer stage at diagnosis and rates of neoadjuvant therapy among women presenting to our institution before and during COVID-19. METHODS Retrospective chart review of patients with a new breast cancer diagnosis from March 2020-August 2020 (during-COVID-19) were compared with March 2019-August 2019 (pre-COVID-19). We compared stage at diagnosis, clinical/demographic features, and neoadjuvant therapy use between the time periods. RESULTS A total of 573 patients included: 376 pre-COVID-19, 197 during-COVID-19. Method of cancer detection was by imaging in 66% versus 63% and by physical findings/symptoms in 34% versus 37% of patients comparing pre-COVID-19 to during-COVID-19, p = 0.47. Overall clinical prognostic stage did not differ significantly (p = 0.39) between the time periods, nor did cM1 disease (2% in each period); 23% pre-COVID-19 and 27% during-COVID-19 presented with cN+ disease (p = 0.38). Neoadjuvant therapy use was significantly higher during-COVID-19 (39%) versus pre-COVID-19 (29%, p = 0.02) driven by increased neoadjuvant endocrine therapy (NET) use (7% to 16%, p = 0.002), whereas neoadjuvant chemotherapy use did not change (22% vs. 23%, p = 0.72). In HR+/HER2- disease, NET use increased from 10% pre-COVID-19 to 23% during-COVID-19 (p = 0.001) with a significant increase in stage I patients (7 to 22%, p < 0.001) and nonsignificant increases in stage II (18 to 23%, p = 0.63) and stage III (9 to 29%, p = 0.29). CONCLUSIONS Breast cancer stage at diagnosis did not differ significantly during-COVID-19 compared with pre-COVID-19. More patients during-COVID-19 were treated with NET, which was significantly increased in stage I HR+/HER2- disease.
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Affiliation(s)
- Jennifer E. Tonneson
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN USA
| | - Tanya L. Hoskin
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN USA
| | - Courtney N. Day
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN USA
| | - Diane M. Durgan
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN USA
| | - Christina A. Dilaveri
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN USA
| | - Judy C. Boughey
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN USA
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Keikha L, Maserat E, Mohammadzadeh Z. Telerehabilitation and Monitoring Physical Activity in Patient with Breast Cancer: Systematic Review. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2022; 27:8-17. [PMID: 35280190 PMCID: PMC8865237 DOI: 10.4103/ijnmr.ijnmr_472_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/10/2021] [Accepted: 10/04/2021] [Indexed: 11/04/2022]
Abstract
Background Timely rehabilitation in patients with Breast Cancer (BC) has a great impact on improving their physical and mental conditions. Thus, the appropriate follow-up method is essential especially during the Covid-19 pandemic. The aim of this study was to review the different technology-assisted interventions for improving physical activity in BC patients. Materials And Methods In this systematic review, the original studies were extracted from the beginning of indexing in databases including PubMed, Scopus, Google Scholar, and Web of Science until 2019. Finally, 45 papers were included in this study based on the inclusion criteria for before the Covid-19 pandemic and 3 articles extracted for the Covid-19 period. Results The most widely used technologies for BC patients were in the United States (46.67%). Telephone, mobile application, and web with 28.89%, 15.56%, and 8.89% frequencies were the most common technologies, respectively. Although the majority of the participants were satisfied with the intervention method, in some cases, the patients were unsatisfied due to the complexity of the technology. These technologies were used for various purposes, such as physical activity and functions, control of pain severity, fitness, quality of life, diet behavior, fatigue, muscle strength, cardio-respiratory capacity, as well as arm and shoulder exercises. Conclusions In conclusion, virtual communication can improve the health of BC patients and also increases patients' desire and hope to continue treatment. It is worth noting that in the Covid-19 pandemic, with the strengthening of virtual communication infrastructure, more attention was paid to BC patients due to their sensitive conditions.
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Affiliation(s)
- Leila Keikha
- Assistant Professor of Health Information Management, Department of Library and Information Sciences, School of Allied Medical Sciences, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Elham Maserat
- Department of Medical Informatics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Zeinab Mohammadzadeh
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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104
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Disparities in Time to Treatment for Breast Cancer: Existing Knowledge and Future Directions in the COVID-19 Era. CURRENT BREAST CANCER REPORTS 2022; 14:213-221. [PMID: 36530340 PMCID: PMC9735127 DOI: 10.1007/s12609-022-00469-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 12/12/2022]
Abstract
Purpose of Review Despite significant advances in detection and treatment for breast cancer, the breast cancer mortality rate for Black women remains 40% higher than that for White women. Timely work-up and treatment improve outcomes, yet no gold standard exists for which to guide providers. Recent Findings A large body of literature demonstrates disparities in time to treatment for breast cancer, and most studies show that Black women receive treatment later than their White counterparts. The COVID-19 pandemic has been projected to worsen these disparities, but the extent of this impact remains unknown. Summary In this review, we describe the available evidence on disparities in time to treatment, potential drivers, and possible mitigation strategies. Future research must address how the COVID-19 pandemic has impacted the timely treatment of breast cancer patients, particularly populations vulnerable to disparate outcomes. Improved access to multidisciplinary breast programs, patient navigation services, and establishment of standards for timely treatment are necessary.
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105
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Marks DK, Budhathoki N, Kucharczyk J, Fa’ak F, D’Abreo N, Kwa M, Plasilova M, Dhage S, Soe PP, Becker D, Hindenburg A, Lee J, Winner M, Okpara C, Daly A, Shah D, Ramdhanny A, Meyers M, Oratz R, Speyer J, Novik Y, Schnabel F, Jones SA, Adams S. OUP accepted manuscript. Oncologist 2022; 27:89-96. [PMID: 35641208 PMCID: PMC8895753 DOI: 10.1093/oncolo/oyab042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose Provide real-world data regarding the risk for SARS-CoV-2 infection and mortality in breast cancer (BC) patients on active cancer treatment. Methods Clinical data were abstracted from the 3778 BC patients seen at a multisite cancer center in New York between February 1, 2020 and May 1, 2020, including patient demographics, tumor histology, cancer treatment, and SARS-CoV-2 testing results. Incidence of SARS-CoV-2 infection by treatment type (chemotherapy [CT] vs endocrine and/or HER2 directed therapy [E/H]) was compared by Inverse Probability of Treatment Weighting. In those diagnosed with SARS-CoV-2 infection, Mann–Whitney test was used to a assess risk factors for severe disease and mortality. Results Three thousand sixty-two patients met study inclusion criteria with 641 patients tested for SARS-COV-2 by RT-PCR or serology. Overall, 64 patients (2.1%) were diagnosed with SARS-CoV-2 infection by either serology, RT-PCR, or documented clinical diagnosis. Comparing matched patients who received chemotherapy (n = 379) with those who received non-cytotoxic therapies (n = 2343) the incidence of SARS-CoV-2 did not differ between treatment groups (weighted risk; 3.5% CT vs 2.7% E/H, P = .523). Twenty-seven patients (0.9%) expired over follow-up, with 10 deaths attributed to SARS-CoV-2 infection. Chemotherapy was not associated with increased risk for death following SARS-CoV-2 infection (weighted risk; 0.7% CT vs 0.1% E/H, P = .246). Advanced disease (stage IV), age, BMI, and Charlson’s Comorbidity Index score were associated with increased mortality following SARS-CoV-2 infection (P ≤ .05). Conclusion BC treatment, including chemotherapy, can be safely administered in the context of enhanced infectious precautions, and should not be withheld particularly when given for curative intent.
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Affiliation(s)
- Douglas K Marks
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Long Island School of Medicine, Mineola, NY, USA
- Corresponding author: Douglas K. Marks, Department of Medicine, NYU Long Island School of Medicine, 120 Mineola Blvd, Suite 500 Mineola, NY 11501, USA.
| | | | | | - Faisal Fa’ak
- NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Nina D’Abreo
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Maryann Kwa
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - Magdalena Plasilova
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Surgery, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - Shubhada Dhage
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Surgery, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - Phyu Phyu Soe
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Daniel Becker
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Alexander Hindenburg
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Johanna Lee
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Megan Winner
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Surgery, NYU Long Island School of Medicine, Mineola, NY,USA
| | | | - Alison Daly
- NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Darshi Shah
- NYU Langone Hospital-Long Island, Mineola, NY, USA
| | | | - Marleen Meyers
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - Ruth Oratz
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - James Speyer
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - Yelena Novik
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - Freya Schnabel
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Surgery, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - Simon A Jones
- Department of Population Health, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - Sylvia Adams
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, Manhattan, NY, USA
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Acquati C, Chen TA, Martinez Leal I, Connors SK, Haq AA, Rogova A, Ramirez S, Reitzel LR, McNeill LH. The Impact of the COVID-19 Pandemic on Cancer Care and Health-Related Quality of Life of Non-Hispanic Black/African American, Hispanic/Latina and Non-Hispanic White Women Diagnosed with Breast Cancer in the U.S.: A Mixed-Methods Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413084. [PMID: 34948695 PMCID: PMC8702073 DOI: 10.3390/ijerph182413084] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 02/07/2023]
Abstract
The COVID-19 pandemic has had critical consequences for cancer care delivery, including altered treatment protocols and delayed services that may affect patients’ quality of life and long-term survival. Breast cancer patients from minoritized racial and ethnic groups already experience worse outcomes, which may have been exacerbated by treatment delays and social determinants of health (SDoH). This protocol details a mixed-methods study aimed at comparing cancer care disruption among a diverse sample of women (non-Hispanic White, non-Hispanic Black/African American, and Hispanic/Latina) and assessing how proximal, intermediate, and distal SDoH differentially contribute to care continuity and health-related quality of life. An embedded mixed-methods design will be implemented. Eligible participants will complete an online survey, followed by a semi-structured interview (with a subset of participants) to further understand factors that influence continuity of care, treatment decision-making, and self-reported engagement. The study will identify potentially modifiable factors to inform future models of care delivery and improve care transitions. These data will provide the necessary evidence to inform whether a subsequent, multilevel intervention is warranted to improve quality of care delivery in the COVID-19 aftermath. Additionally, results can be used to identify ways to leverage existing social resources to help manage and support patients’ outcomes.
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Affiliation(s)
- Chiara Acquati
- Graduate College of Social Work, University of Houston, 3511 Cullen Blvd, Houston, TX 77204, USA
- Department of Health Disparities Research, The UT MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA;
- Correspondence: ; Tel.: +1-713-743-4343
| | - Tzuan A. Chen
- HEALTH Research Institute, University of Houston, 4849 Calhoun Road, Houston, TX 77204, USA; (T.A.C.); (I.M.L.); (L.R.R.)
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
| | - Isabel Martinez Leal
- HEALTH Research Institute, University of Houston, 4849 Calhoun Road, Houston, TX 77204, USA; (T.A.C.); (I.M.L.); (L.R.R.)
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
| | - Shahnjayla K. Connors
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
- Department of Social Sciences, University of Houston-Downtown, Houston, TX 77002, USA
| | - Arooba A. Haq
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
| | - Anastasia Rogova
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
| | - Stephanie Ramirez
- College of Natural Sciences and Mathematics, University of Houston, 3507 Cullen Blvd, Houston, TX 77204, USA;
| | - Lorraine R. Reitzel
- HEALTH Research Institute, University of Houston, 4849 Calhoun Road, Houston, TX 77204, USA; (T.A.C.); (I.M.L.); (L.R.R.)
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
| | - Lorna H. McNeill
- Department of Health Disparities Research, The UT MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA;
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Teoh SP, Bustamam RS, Mustapha FI, Yip CH, Saad M, Somasundaram S, Megat Ramli PN, Nik Farid ND, Bhoo-Pathy N. Proposal for development of a guideline in maintaining quality cancer care during and post-covid-19 in an upper middle-income country with universal health coverage. J Cancer Policy 2021; 30:100300. [PMID: 35559796 PMCID: PMC8378062 DOI: 10.1016/j.jcpo.2021.100300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/27/2021] [Accepted: 08/16/2021] [Indexed: 11/26/2022]
Abstract
Background During periods of high community transmission of COVID-19, the public hospitals in Malaysia, an upper middle-income country, have been forced to scale down elective surgeries, prioritize cancer treatments based on treatment benefits, and postpone non-emergency imaging procedures. These inevitably led to disruptions in cancer care delivery within the public health care system. This study aims to explore the facilitators and barriers faced by healthcare providers and cancer survivors in cancer care, and to co-design a guideline to maintain the delivery of cancer care amid the disaster situations. Method In-depth interviews (IDIs) will be conducted with Malaysian healthcare providers and cancer survivors and findings will be analysed thematically. The insights will be used in a subsequent phase to co-design a guideline to maintain the delivery of quality cancer care in Malaysia via a three-round modified Delphi survey with a broad range of cancer stakeholders. Expected results Findings derived from IDIs and existing literature will be included for rating across three rounds by the expert panel. Feedback provided will be refined until consensus on the best practises for cancer care continuity during crises is achieved. Conclusion The output of the present study is not only expected to ensure the continuity of delivery of high-quality cancer care in Malaysia during the ongoing pandemic but also to be adapted during unforeseen crises in the near future. Policy summary statement Collaborative work between policy makers, public health physicians, members of the multidisciplinary oncology team as well as cancer survivors is vital in developing an evidenced- based contingency plan for maintaining access to cancer care.
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108
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Tonneson JE, Boughey JC. ASO Author Reflections: How COVID-19 Impacted Breast Cancer Presentation and Management. Ann Surg Oncol 2021; 29:2240-2241. [PMID: 34850303 PMCID: PMC8631558 DOI: 10.1245/s10434-021-11098-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Jennifer E Tonneson
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Judy C Boughey
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
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109
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Lessons Learned: Management of Breast Cancer Patients throughout the COVID-19 Pandemic. CURRENT BREAST CANCER REPORTS 2021; 13:227-234. [PMID: 34804376 PMCID: PMC8596360 DOI: 10.1007/s12609-021-00429-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/20/2022]
Abstract
Purpose of Review The COVID-19 pandemic of 2020 presented a multitude of challenges for physicians nationwide. Standard of care treatment was tailored to protect patients from virus exposure, while delivering safe and adequate care. This article reviews the steps taken to treat and protect breast cancer patients during the pandemic and reentry approaches to resume care. Recent Findings Breast cancer experts rapidly convened to develop treatment guidelines during the pandemic. These recommendations encompass screening approach, prioritization of breast cancer patients, educational modifications, research and data considerations, and a re-entry treatment approach as the pandemic evolved. Without prior experience with a pandemic of this magnitude, these guidelines were based on expert knowledge and previously established data. Summary This emergency forced physicians to operate in a more efficient and effective manner to deliver value-based patient care, and future evaluation of these adjustments will determine if overall patient outcomes were compromised.
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110
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Smetherman D, Biggs K, Fayanju OM, Grosskreutz S, Khan Z, Malak S, Moseley T, Smith-Graziani D, Valero V, Lightfoote J. Racial and Ethnic Disparities in Breast Cancer: A Collaboration Between the American College of Radiology Commissions on Women and Diversity and Breast Imaging. JOURNAL OF BREAST IMAGING 2021; 3:712-720. [PMID: 38424936 DOI: 10.1093/jbi/wbab081] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Indexed: 03/02/2024]
Abstract
Since the 1980s, the mortality rate from breast cancer in the United States has dropped almost 40%. The quality of life and survival gains from early detection and improved treatment have not been shared equally by all ethnic groups, however. Many factors, including social determinants of health, unequal access to screening and oncologic care, and differences in incidence, tumor biology, and risk factors, have contributed to these unequal breast cancer outcomes. As breast radiologists approach their own patients, they must be aware that minority women are disproportionately affected by breast cancer at earlier ages and that non-Hispanic Black and Hispanic women are impacted by greater severity of disease than non-Hispanic White women. Guidelines that do not include women younger than 50 and/or have longer intervals between examinations could have a disproportionately negative impact on minority women. In addition, the COVID-19 pandemic could worsen existing disparities in breast cancer mortality. Increased awareness and targeted efforts to identify and mitigate all of the underlying causes of breast cancer disparities will be necessary to realize the maximum benefit of screening, diagnosis, and treatment and to optimize quality of life and mortality gains for all women. Breast radiologists, as leaders in breast cancer care, have the opportunity to address and reduce some of these disparities for their patients and communities.
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Affiliation(s)
- Dana Smetherman
- Ochsner Health, Department of Radiology, New Orleans, LA, USA
| | - Kelly Biggs
- James E. Van Zandt, VA Medical Center, Department of Radiology, Altoona, PA, USA
| | - Oluwadamilola M Fayanju
- Perelman School of Medicine, University of Pennsylvania, Department of Surgery, Philadelphia, PA, USA
| | | | - Zahra Khan
- Medina Global, Strategic Planning and Health Policy, Cambridge, MA, USA
| | - Sharp Malak
- St. Bernard's Healthcare, Department of Radiology, Jonesboro, AR, USA
| | - Tanya Moseley
- The University of Texas MD Anderson Cancer Center, Departments of Breast Surgical Oncology and Breast Imaging, Houston, TX, USA
| | | | - Vicente Valero
- The University of Texas MD Anderson Cancer Center, Breast Medical Oncology Department, Houston, TX, USA
| | - Johnson Lightfoote
- Pomona Valley Hospital Medical Center, Department of Radiology, Pomona, CA, USA
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Abstract
Breast surgical oncology is a rapidly evolving field with significant advances shaped by practice-changing research. Three areas of ongoing controversy are (1) high rates of contralateral prophylactic mastectomy (CPM) in the United States despite uncertain benefit, (2) indications for and use of neoadjuvant chemotherapy (NACT) and endocrine therapy (NET), and (3) staging and treatment of the axilla, particularly after neoadjuvant systemic therapy. We discuss the patient populations for whom CPM may or may not be beneficial, indications for NACT and NET, and the trend toward de-escalation of locoregional axillary treatment.
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Affiliation(s)
- Lily Gutnik
- Duke University School of Medicine, DUMC 3513, Durham, NC 27707, USA. https://twitter.com/LGutnik
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112
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Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study. Lancet Oncol 2021. [DOI: https:/doi.org/10.1016/s1470-2045(21)00493-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
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Zhao F, Henderson TO, Cipriano TM, Copley BL, Liu M, Burra R, Birch SH, Olopade OI, Huo D. The impact of coronavirus disease 2019 on the quality of life and treatment disruption of patients with breast cancer in a multiethnic cohort. Cancer 2021; 127:4072-4080. [PMID: 34292583 PMCID: PMC8426957 DOI: 10.1002/cncr.33798] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND As the coronavirus disease 2019 (COVID-19) pandemic continues to spread, it remains unclear how vulnerable populations with preexisting health conditions like cancer have been affected. METHODS Between July and September of 2020, the authors conducted a cross-sectional study that surveyed 2661 patients with breast cancer who were registered in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort and received 1300 responses (71.5% White patients and 22.4% Black patients). The survey measured the psychosocial well-being of participants before and during the COVID-19 pandemic and examined whether they experienced any type of financial challenges or treatment disruption. RESULTS The results indicated that feelings of isolation increased significantly during the pandemic. Meanwhile, the overall median isolation/stress score was 1.2 on a scale from 0 (never) to 4 (always), which was not significantly different between White patients and Black patients. One-third of patients experienced some type of financial challenge during this time. Medicaid recipients, of whom almost 80% were Black, were more likely to experience financial challenges. In addition, approximately one-fourth of patients experienced difficulty getting treatment. CONCLUSIONS This study indicates that the quality of life of patients with breast cancer and their scheduled treatments have been adversely affected during the COVID-19 pandemic. These findings suggest that more support should be provided by hospital centers and the medical research community to patients with cancer during this challenging pandemic. LAY SUMMARY The authors surveyed patients with breast cancer in Chicago using a questionnaire to examine how their lives have been affected during the coronavirus disease 2019 (COVID-19) pandemic. The results indicate that the lives of patients with breast cancer and their scheduled treatments have been adversely affected during the pandemic. In addition, patients who were covered by Medicaid, most of whom were Black, were more likely to experience financial challenges. The findings suggest that hospital centers and the medical research community should reach out and provide more information to support patients with cancer during this challenging pandemic.
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Affiliation(s)
- Fangyuan Zhao
- Department of Public Health SciencesUniversity of ChicagoChicagoIllinois
| | | | - Toni M. Cipriano
- Section of Hematology and OncologyDepartment of MedicineUniversity of ChicagoChicagoIllinois
| | | | | | - Rahul Burra
- The CollegeUniversity of ChicagoChicagoIllinois
| | - Sondra H. Birch
- Department of Public Health SciencesUniversity of ChicagoChicagoIllinois
| | - Olufunmilayo I. Olopade
- Section of Hematology and OncologyDepartment of MedicineUniversity of ChicagoChicagoIllinois
| | - Dezheng Huo
- Department of Public Health SciencesUniversity of ChicagoChicagoIllinois
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Yoshimoto N, Takayama S, Sakamoto M, Ishikawa K, Katada T, Kawate A, Takura K, Takayama S, Yamashita M, Yamamoto S, Yokoyama K, Kani H. COVID-19 Screening of Breast Cancer Patients During Treatment: A Single Center Experience in Japan. CANCER DIAGNOSIS & PROGNOSIS 2021; 1:423-425. [PMID: 35403168 PMCID: PMC8962867 DOI: 10.21873/cdp.10056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/22/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND/AIM Breast cancer treatment mainly involves interventional methods such as surgical resection and chemotherapy. How to best perform these treatments during the COVID-19 pandemic remains to be established. PATIENTS AND METHODS Patients with breast cancer who received SARS-CoV-2 PCR screening before cancer treatment from December 2020 to April 2021 were included. PCR screening was performed within 72 hours of the scheduled admission time and treatment. RESULTS A total of 19 tests in 15 patients were analysed. Fourteen cases displayed no symptoms, and five cases had some symptoms. COVID PCR tests were negative in all cases. CONCLUSION COVID-19 screening can ensure that breast cancer patients do not miss scheduled treatments as a result of the pandemic. Diagnosis of patients with symptoms that are shared by COVID-19 infection, chemotherapy, and breast cancer recurrence must be performed carefully.
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Affiliation(s)
- Nobuyasu Yoshimoto
- Department of Breast Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Satoru Takayama
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Masaki Sakamoto
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Ken Ishikawa
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Takeyasu Katada
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Akifumi Kawate
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Kohei Takura
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Shoryu Takayama
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | | | - Shinya Yamamoto
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Kioto Yokoyama
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Hisanori Kani
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
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Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study. Lancet Oncol 2021; 22:1507-1517. [PMID: 34624250 PMCID: PMC8492020 DOI: 10.1016/s1470-2045(21)00493-9] [Citation(s) in RCA: 128] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. METHODS This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20-60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. FINDINGS Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16-30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77-0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50-0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80-0·88; p<0·001), and full lockdowns (0·57, 0·54-0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. INTERPRETATION Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. FUNDING National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
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116
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Sella T, Weiss A, Mittendorf EA, King TA, Pilewskie M, Giuliano AE, Metzger-Filho O. Neoadjuvant Endocrine Therapy in Clinical Practice: A Review. JAMA Oncol 2021; 7:1700-1708. [PMID: 34499101 DOI: 10.1001/jamaoncol.2021.2132] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Importance In clinical practice, neoadjuvant endocrine therapy (NET) is rarely used despite being an effective treatment modality able to downstage tumors and facilitate breast-conserving surgery. Observations Using data from studies conducted since 2000, we provide readers with a critical in-depth review on clinical aspects related to the application of NET in the treatment of hormone receptor (HR)-positive/ERBB2 (formerly HER2)-negative breast cancer. This includes an overview of patient-selection criteria, regimen choice, treatment duration, evaluation of response by imaging, interpretation of pathology after treatment, and surgical considerations. Areas of controversy include the use of gene-expression tests for patient selection, treatment of premenopausal women, surgical management of the axilla after NET, and adjuvant systemic therapy decision-making, including the use of chemotherapy. Conclusions and Relevance NET is an optimal treatment modality for a considerable proportion of postmenopausal women diagnosed with HR-positive tumors. The treatment landscape for HR-positive breast cancer is evolving, with novel agents and the growing use of gene expression profiling to define treatment selection. As such, it is likely that NET use will increase and the practical considerations outlined here will become more important.
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Affiliation(s)
- Tal Sella
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Anna Weiss
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts.,Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elizabeth A Mittendorf
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts.,Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tari A King
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts.,Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Melissa Pilewskie
- Breast Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Armando E Giuliano
- Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Health System, Los Angeles, California
| | - Otto Metzger-Filho
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
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Illmann CF, Doherty C, Wheelock M, Vorstenbosch J, Lipa JE, Zhong T, Isaac KV. The Impact of the COVID-19 Pandemic on Breast Reconstruction: A Canadian Perspective. Plast Surg (Oakv) 2021; 29:287-293. [PMID: 34760846 PMCID: PMC8573645 DOI: 10.1177/22925503211030017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has led to unprecedented challenges and restrictions in surgical access across Canada, including for breast reconstructive services which are an integral component of comprehensive breast cancer care. We sought to determine how breast reconstructive services are being restricted, and what strategies may be employed to optimize the provision of breast reconstruction through a pan-Canadian evaluation from the providers' perspective. METHODS This was a cross-sectional survey of Canadian plastic and reconstructive surgeons who perform breast reconstruction. The 33-item web-based questionnaire was developed by a pan-Canadian working group of breast reconstruction experts and disseminated via email to members of the Canadian Society of Plastic Surgery. The questionnaire queried respondents on the impact of the COVID-19 pandemic and associated restrictions on surgeons' breast reconstruction practice patterns and opinions on strategies for resource utilization. RESULTS Responses were received from 49 surgeons, who reported practicing in 8 of 10 Canadian provinces. Restrictions on the provision of breast reconstructive procedures were most limited during the First Wave of the COVID-19 pandemic, where all respondents reported at least some reduction in capacity and more than a quarter reporting complete cessation. Average reported reduction in capacity ranged from 31% to 78% across all 3 waves. Autologous, delayed, and prophylactic reconstructions were most commonly restricted. CONCLUSION This study provides a pan-Canadian impact assessment on breast reconstructive services during the COVID-19 pandemic from the providers' perspective. To uphold the standards of patient-centred care, a unified approach to strategically reorganize health care delivery now and in the future is needed.
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Affiliation(s)
- Caroline F. Illmann
- Division of Plastic Surgery, University of British Columbia, Vancouver, Canada
| | - Christopher Doherty
- Division of Plastic Surgery, University of British Columbia, Vancouver, Canada
| | - Margaret Wheelock
- Division of Plastic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joshua Vorstenbosch
- Division of Plastic and Reconstructive Surgery, McGill University, Montreal, Quebec, Canada
| | - Joan E. Lipa
- Division of Plastic, Reconstructive and Aesthetic Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Toni Zhong
- Division of Plastic and Reconstructive Surgery, University Health Network, Toronto, Ontario, Canada
| | - Kathryn V. Isaac
- Division of Plastic Surgery, University of British Columbia, Vancouver, Canada
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Friedrich AKU, DiComo JA, Golshan M. The Impact of COVID-19 on Breast Surgery Fellowships. CURRENT BREAST CANCER REPORTS 2021; 13:235-240. [PMID: 34703524 PMCID: PMC8531885 DOI: 10.1007/s12609-021-00430-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/03/2022]
Abstract
Purpose of Review Across the world, medical training has been affected by the COVID-19 virus and this has changed the way physicians are educated. What is less clear is the effect of the pandemic on breast surgical oncology fellows who were in training during this time. This review discusses the experience of breast surgical oncology fellows during the pandemic and how fellowships adapted to preserve the educational experience and conserve the quality of training. Recent Findings The challenges and changes experienced by breast surgery fellows during the COVID-19 pandemic have proved to be sudden shifts in not only fellowship training, but future patient care and research opportunities, all while confronting the global impact of a deadly pandemic. While experiences between fellowships varied, the similarities and differences encountered highlight the regional and temporal differences in how fellowships responded to the pandemic. Summary Breast surgical oncology fellowship is one year long, with every day allocated to ensure the surgeon has a deep understanding of the multidisciplinary approach to this ever-evolving field. As the pandemic spread and affected different regions with varying severity, elective cases were canceled, resources were re-allocated, and uncertainty abounded. At the same time, novel approaches to fellowship training were rapidly implemented. It will take time and additional research to fully understand the long-term consequences for trainees affected during their breast surgery fellowship.
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Affiliation(s)
- Ann-Kristin U Friedrich
- Department of Surgery, Yale University School of Medicine, 310 Cedar Street, New Haven, CT 06510 USA
| | - Joseph A DiComo
- Department of Surgery, Women and Infant's, Providence, RI USA
| | - Mehra Golshan
- Department of Surgery, Yale University School of Medicine, 310 Cedar Street, New Haven, CT 06510 USA
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119
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120
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The safety of performing breast reconstruction during the COVID-19 pandemic. Breast Cancer 2021; 29:242-246. [PMID: 34652688 PMCID: PMC8517296 DOI: 10.1007/s12282-021-01304-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/07/2021] [Indexed: 11/18/2022]
Abstract
Purpose Elective operations including surgeries for breast cancer were significantly reduced during the height of the surge of COVID-19 cases in Massachusetts. The safety of performing breast reconstruction during the pandemic was unknown. This study aims to review the safety of performing mastectomy with immediate breast reconstruction during the first COVID-19 surge in Massachusetts. Methods A retrospective chart review of patients who underwent mastectomy with immediate breast reconstruction by Massachusetts General Hospital breast and plastic surgeons immediately preceding and during the COVID-19 pandemic was performed. Results Thirty patients (34 breasts) underwent mastectomies with immediate breast reconstruction during the COVID-19 restriction period in Massachusetts. Most reconstructions were unilateral. All reconstructions were performed with implants or expanders, and no autologous reconstructions were performed. Two patients (2 breasts) had operative complications. The complication rate during the pandemic was similar to the complication rate pre-pandemic. No patients or surgeons experienced symptoms or positive COVID-19 tests. Over 90% of patients were discharged the same day. Conclusion Prosthetic breast reconstruction was able to be performed safely during the height of the COVID-19 pandemic surge in Massachusetts. Strict screening protocols, proper use of personal protective equipment, and same-day discharge when possible are essential for patient and surgeon safety during the pandemic.
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121
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Linck PA, Garnier C, Depetiteville MP, MacGrogan G, Mathoulin-Pélissier S, Quénel-Tueux N, Charitansky H, Boisserie-Lacroix M, Chamming's F. Impact of the COVID-19 lockdown in France on the diagnosis and staging of breast cancers in a tertiary cancer centre. Eur Radiol 2021; 32:1644-1651. [PMID: 34647179 PMCID: PMC8514205 DOI: 10.1007/s00330-021-08264-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/09/2021] [Accepted: 07/23/2021] [Indexed: 01/21/2023]
Abstract
Objectives Due to COVID-19, a lockdown took place between March 17 and May 1, 2020, in France. This study evaluates the impact of the lockdown on the diagnosis and staging of breast cancers in a tertiary cancer centre. Methods Our database was searched for all consecutive invasive breast cancers diagnosed in our institution during the lockdown (36 working days), during equivalent periods of 36 working days before and after lockdown and a reference period in 2019. The number and staging of breast cancers diagnosed during and after lockdown were compared to the pre-lockdown and reference periods. Tumour maximum diameters were compared using the Mann–Whitney test. Proportions of tumour size categories (T), ipsilateral axillary lymph node invasion (N) and presence of distant metastasis (M) were compared using Fisher’s exact test. Results Compared to the reference period (n = 40 in average), the number of breast cancers diagnosed during lockdown (n = 32) decreased by 20% but increased by 48% after the lockdown (n = 59). After the lockdown, comparatively to the reference period, breast cancers were more often symptomatic (86% vs 57%; p = 0.001) and demonstrated bigger tumour sizes (p = 0.0008), the rates of small tumours (T1) were reduced by 38%, locally advanced cancers (T3, T4) increased by 80% and lymph node invasion increased by 64%. Conclusion The COVID-19 lockdown was associated with a 20% decrease in the number of diagnosed breast cancers. Because of delayed diagnosis, breast cancers detected after the lockdown had poorer prognosis with bigger tumour sizes and higher rates of node invasion. Key Points • The number of breast cancer diagnosed in a large tertiary cancer centre in France decreased by 20% during the first COVID-19 lockdown. • Because of delayed diagnosis, breast cancers demonstrated bigger tumour size and more frequent axillary lymph node invasion after the lockdown. • In case of a new lockdown, breast screening programme and follow-up examinations should not be suspended and patients with clinical symptoms should be encouraged to seek attention promptly.
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Affiliation(s)
- Pierre-Antoine Linck
- Department of Radiology, Institut Bergonié, Comprehensive Cancer Centre, 33076, Bordeaux, France
| | - Cassandre Garnier
- Department of Radiology, Institut Bergonié, Comprehensive Cancer Centre, 33076, Bordeaux, France
| | | | - Gaëtan MacGrogan
- Department of Pathology, Institut Bergonié, Comprehensive Cancer Centre, 33076, Bordeaux, France
| | - Simone Mathoulin-Pélissier
- Unité D'Épidémiologie Et de Recherche Cliniques, Institut Bergonié, Comprehensive Cancer Centre, 33076, Bordeaux, France.,Inserm UMR 1219, Epicene Team, Bordeaux, France.,Inserm CIC-EC 1401, Bordeaux, France
| | - Nathalie Quénel-Tueux
- Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Centre, 33076, Bordeaux, France
| | - Hélène Charitansky
- Department of Surgery, Institut Bergonié, Comprehensive Cancer Centre, 33076, Bordeaux, France
| | | | - Foucauld Chamming's
- Department of Radiology, Institut Bergonié, Comprehensive Cancer Centre, 33076, Bordeaux, France.
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Burstein H, Curigliano G, Thürlimann B, Weber W, Poortmans P, Regan M, Senn H, Winer E, Gnant M. Customizing local and systemic therapies for women with early breast cancer: the St. Gallen International Consensus Guidelines for treatment of early breast cancer 2021. Ann Oncol 2021; 32:1216-1235. [PMID: 34242744 PMCID: PMC9906308 DOI: 10.1016/j.annonc.2021.06.023] [Citation(s) in RCA: 367] [Impact Index Per Article: 122.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/22/2021] [Accepted: 06/27/2021] [Indexed: 12/12/2022] Open
Abstract
The 17th St Gallen International Breast Cancer Consensus Conference in 2021 was held virtually, owing to the global COVID-19 pandemic. More than 3300 participants took part in this important bi-annual critical review of the 'state of the art' in the multidisciplinary care of early-stage breast cancer. Seventy-four expert panelists (see Appendix 1) from all continents discussed and commented on the previously elaborated consensus questions, as well as many key questions on early breast cancer diagnosis and treatment asked by the audience. The theme of this year's conference was 'Customizing local and systemic therapies.' A well-organized program of pre-recorded symposia, live panel discussions and real-time panel voting results drew a worldwide audience of thousands, reflecting the far-reaching impact of breast cancer on every continent. The interactive technology platform allowed, for the first time, audience members to ask direct questions to panelists, and to weigh in with their own vote on several key panel questions. A hallmark of this meeting was to focus on customized recommendations for treatment of early-stage breast cancer. There is increasing recognition that the care of a breast cancer patient depends on highly individualized clinical features, including the stage at presentation, the biological subset of breast cancer, the genetic factors that may underlie breast cancer risk, the genomic signatures that inform treatment recommendations, the extent of response before surgery in patients who receive neoadjuvant therapy, and patient preferences. This customized approach to treatment requires integration of clinical care between patients and radiology, pathology, genetics, and surgical, medical and radiation oncology providers. It also requires a dynamic response from clinicians as they encounter accumulating clinical information at the time of diagnosis and then serially with each step in the treatment plan and follow-up, reflecting patient experiences and treatment response.
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Affiliation(s)
- H.J. Burstein
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA,Correspondence to: Dr Harold J. Burstein, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - G. Curigliano
- European Institute of Oncology, University of Milan, Milan, Italy,Giuseppe Prof. Giuseppe Curigliano, European Institute for Oncology, Via Giuseppe Ripamonti 435, Milano 20141, Italy
| | | | | | | | - M.M. Regan
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - H.J. Senn
- St. Gallen Oncology Conferences (Foundation SONK), St. Gallen, Switzerland
| | - E.P. Winer
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M. Gnant
- Medical University of Vienna, Vienna, Austria
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Hills N, Leslie M, Davis R, Crowell M, Kameyama H, Rui H, Chervoneva I, Dooley W, Tanaka T. Prolonged Time from Diagnosis to Breast-Conserving Surgery is Associated with Upstaging in Hormone Receptor-Positive Invasive Ductal Breast Carcinoma. Ann Surg Oncol 2021; 28:5895-5905. [PMID: 33748899 PMCID: PMC7982278 DOI: 10.1245/s10434-021-09747-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/06/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Time to surgery (TTS) has been suggested to have an association with mortality in early-stage breast cancer. OBJECTIVE This study aims to determine the association between TTS and preoperative disease progression in tumor size or nodal status among women diagnosed with clinical T1N0M0 ductal breast cancer. METHODS Women diagnosed with clinical T1N0M0 ductal breast cancer who had breast-conserving surgery as their first definitive treatment between 2010 and 2016 (n = 90,405) were analyzed using the National Cancer Database. Separate multivariable logistic regression models for hormone receptor (HR)-positive and HR-negative patients, adjusted for clinical and demographic variables, were used to assess the relationship between TTS and upstaging of tumor size (T-upstaging) or nodal status (N-upstaging). RESULTS T-upstaging occurred in 6.76% of HR-positive patients and 11.00% of HR-negative patients, while N-upstaging occurred in 12.69% and 10.75% of HR-positive and HR-negative patients, respectively. Among HR-positive patients, odds of T-upstaging were higher for 61-90 days TTS (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.05-1.34) and ≥91 days TTS (OR 1.47, 95% CI 1.17-1.84) compared with ≤30 days TTS, and odds of N- upstaging were higher for ≥91 days TTS (OR 1.35, 95% CI 1.13-1.62). No association between TTS and either T- or N-upstaging was found among HR-negative patients. Other clinical and demographic variables, including grade, tumor location, and race/ethnicity, were associated with both T- and N-upstaging. CONCLUSION TTS ≥61 and ≥91 days was a significant predictor of T- and N-upstaging, respectively, in HR-positive patients; however, TTS was not associated with upstaging in HR-negative breast cancer. Delays in surgery may contribute to measurable disease progression in T1N0M0 ductal breast cancer.
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Affiliation(s)
- Natalie Hills
- University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, OK, USA
| | - Macall Leslie
- University of Oklahoma Health Sciences Center, College of Medicine, Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Rachel Davis
- University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, OK, USA
| | - Marielle Crowell
- University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, OK, USA
| | - Hiroyasu Kameyama
- University of Oklahoma Health Sciences Center, College of Medicine, Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Hallgeir Rui
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Inna Chervoneva
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - William Dooley
- Department of Surgery, University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, OK, USA
| | - Takemi Tanaka
- University of Oklahoma Health Sciences Center, College of Medicine, Stephenson Cancer Center, Oklahoma City, OK, USA.
- Department of Pathology, University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, OK, USA.
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Iles KA, Thornton M, Park J, Roberson M, Spanheimer PM, Ollila DW, Gallagher K. Bridging Endocrine Therapy for HR+/HER2- Resectable Breast Cancer: Is it Safe? Am Surg 2021; 88:471-479. [PMID: 34587799 DOI: 10.1177/00031348211047205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic has required new treatment paradigms to limit exposures and optimize hospital resources, including the use of neoadjuvant endocrine therapy (NAET) as bridging therapy for HR+/HER2-invasive tumors and DCIS. While this approach has been used in locally advanced disease, it is unclear how it may affect outcomes in resectable HR+/HER2- tumors. METHODS Women ≥18 years diagnosed with in situ (Tis) or non-metastatic HR+/HER2- breast cancer from March-May 2019 and 2020 were included. Fisher's exact test and two-sample t test were used to compare baseline characteristics and surgical outcomes between strata. Sub-analysis was performed between patients who received primary surgery vs a bridging NAET approach. RESULTS Despite similar clinical characteristics, patients in 2019 were more likely to have a surgery-first approach (75% vs 42%, P-value = .0007), receive surgery sooner (22 vs 29 days, P-value < .001), and within 60 days from diagnosis date (100% vs 85%, P-value = .0301). Neoadjuvant endocrine therapy was a more prevalent approach in 2020 (48% vs 7%, P-value < .0001). Rates of clinical to pathologic up-staging remained consistent across primary surgery vs bridging NAET subgroups (P-value = .9253). DISCUSSION Pandemic-driven treatment protocols provide a unique opportunity to assess the utility of bridging endocrine therapy for resectable HR+/HER2- tumors. Differences in clinical and pathologic staging were similar across groups and did not appear to be affected by receipt of NAET. Our limited cohort demonstrates this strategic therapeutic avenue can optimize health care utilization and may be a reasonable approach when delaying surgery is preferred.
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Affiliation(s)
- Kathleen A Iles
- Department of Surgery, 6797University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Madeline Thornton
- Department of Surgery, 6797University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jihye Park
- Department of Epidemiology, 6797University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mya Roberson
- Department of Epidemiology, 6797University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Philip M Spanheimer
- Department of Surgical Oncology, 6797University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David W Ollila
- Department of Surgical Oncology, 6797University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristalyn Gallagher
- Department of Surgical Oncology, 6797University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Li S, O'Brien S, Murphy C, Nabil C. Identifying Patients at Risk of Delayed Breast Imaging Due to the COVID-19 Pandemic. Cureus 2021; 13:e17235. [PMID: 34540462 PMCID: PMC8443468 DOI: 10.7759/cureus.17235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Epidemiological models predict worse cancer outcomes due to COVID-19 pandemic-related delays in cancer surveillance and treatment. This study evaluated patient demographic factors associated with delayed breast imaging or procedure appointments due to COVID-19. METHODS Patients attending a breast imaging or procedure appointment at the Pennsylvania Hospital Breast Center from December 28, 2020 to January 31, 2021 were asked to complete a voluntary and anonymous survey on the impact of COVID-19. Chi-squared and two-sample t-tests were used to analyze correlations between having a delayed appointment and various demographic variables. RESULTS Five hundred seventy patients completed the survey. Participants were more likely to have delayed a breast imaging or procedure appointment if they were younger (53.9 versus 57.4 years old, p=0.014), had more total household residents (2.7 versus 2.2, p=0.019) or children (0.8 versus 0.4, p=0.016), personally had COVID-19 (p=0.04), or personally had to quarantine (p<0.01). Race, ethnicity, education, income level, and marital status were not found to statistically significantly correlate with having a delayed appointment. CONCLUSION This study found that younger age, a greater number of residents and children in the household, and having a personal history of COVID-19 infection or quarantining were factors significantly correlated with delaying a breast imaging or procedure appointment. As radiology practices prepare to mitigate the impact of COVID-19 on screening practices and cancer outcomes, these findings may help imaging centers refine patient outreach efforts and policy accommodations to protect the most vulnerable populations.
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Affiliation(s)
- Shiyi Li
- Interventional Radiology, Einstein Medical Center Philadelphia, Philadelphia, USA
| | - Sophia O'Brien
- Radiology, Hospital of University of Pennsylvania, Philadelphia, USA
| | | | - Calisi Nabil
- Radiology, Emory University School of Medicine, Atlanta, USA
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126
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Vu E, Schröder C, Dülk J, Stelmes JJ, Vu J, Schilling J, Förster FG, Förster R. Nationwide Survey of German Outpatient Gynecologic Oncology Practices during the Coronavirus Disease 2019 Pandemic: Reactions to the First Wave and Future Perspectives. Breast Care (Basel) 2021; 382:1-7. [PMID: 34580581 PMCID: PMC8450854 DOI: 10.1159/000518858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/23/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction In the spring of 2020, coronavirus disease 2019 posed a substantial challenge for countries and their healthcare systems. In Germany, over 70% of all cancer patients are treated in an outpatient setting, so gynecologic oncology practices are the guarantors of optimal patient care. We developed a survey to evaluate the management of gynecologic oncology patients. Methods The survey consisted of 38 questions and was sent to the members of the Berufsverband Niedergelassener Gynäkologischer Onkologen in Deutschland e.V. (BNGO), a professional association of gynecologic oncologists in the outpatient sector in Germany. Results The survey was completed by 54 out of 133 (41%) gynecologic oncologists from 14 out of 15 (93%) federal states where the BNGO is represented. Facing the pandemic, popular measures were mask requirements (100%), restriction of access to practices (94%), increased number of disinfectant dispensers (85%), installment of panes of acrylic glass (76%), or spatial alterations (67%). For most patients the pandemic had no influence on prioritization of therapies (82%) or prescribed systemic treatments (87%). Despite an increase in perceived psychological burden among the staff (72%), 85% (45/54) of the practices were not offered any additional psychological support. Discussion and Conclusion As most cancer patients in Germany are treated in an outpatient setting, a suitable reaction of oncology centers to the new circumstances was crucial to secure optimal treatment and patient care. Nevertheless, the low prioritization of mental health or distress of healthcare workers poses a serious threat to the maintenance of optimal medical care in further waves of the pandemic.
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Affiliation(s)
- Erwin Vu
- Department of Radiation Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Christina Schröder
- Institute for Radiation Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Jonas Dülk
- Friedrich Alexander University Erlangen, Erlangen, Germany
| | - Jean-Jacques Stelmes
- Department of Radiation Oncology, Oncological Institute of Southern Switzerland, Cantonal Hospitals, Bellinzona, Switzerland
| | - Jennifer Vu
- Friedrich Alexander University Erlangen, Erlangen, Germany
| | - Jörg Schilling
- Gemeinschaftspraxis Dres. med. Schilling, Till and Kohn, Berlin, Germany
| | - Frank Gerhard Förster
- MVZ Flemmingstraße, Poliklinik GmbH, Chemnitz, Germany.,Faculty of Business and Economics, University of Applied Sciences Zwickau, Zwickau, Germany
| | - Robert Förster
- Institute for Radiation Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
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127
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Affiliation(s)
- Rahul Banerjee
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Manju George
- COLONTOWN/Paltown Development Foundation, Crownsville, MD
| | - Arjun Gupta
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
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128
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Ata Güler S, Özkan Güler Ö, Şimşek T, Zafer Cantürk N. Changes and disruptions in diagnosis, treatment and follow-up of breast cancer during two periods of the COVID-19 pandemic in Turkey. Turk J Surg 2021; 37:222-231. [DOI: 10.47717/turkjsurg.2021.5069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 08/12/2021] [Indexed: 11/23/2022]
Abstract
Objective: COVID-19 disease, which rapidly became a pandemic, led to significant changes in the provision of health services. This included radical changes to the supply and delivery of routine services to release resources for emergency care. During this process, a range of restrictions were imposed including the recommended rules to be followed before, during and after surgery. Health services provided for breast cancer diagnosis, treatment and follow-up have also undergone enforced changes meaning the diagnosis, treatment, and follow-up of patients with priority has come to the fore. In this study, the effect of the COVID-19 pandemic in Turkey, between March 11, 2020 and May 31, 2020 was assessed in comparison to pre-pandemic practice in terms of divided into two periods, and breast cancer diagnosis, treatment, and follow-up.
Material and Methods: Surgeons dealing with breast cancer treatment and registered to SENATURK (Turkish Senology Academy) were contacted online. The period was divided into two, between March 11th and April 30th and May 1st to May 31st, 2020. Surgeons were requested to complete two electronic evaluation forms, one for each period, investigating change in practice. Only complete responses for both periods were included in the analysis.
Results: There were 93 respondents. Except for less multidisciplinary breast councils, there was no delay in radiological and pathological diagnoses. The number of breast cancer surgeries increased in Period 2, and more COVID-19 positive breast cancer patients were operated in Period 2. Benign breast patients were delayed less frequently in Period 2. In the statistical analysis performed between the two groups, it was found that only a significant difference was in the number of outpatients with benign breasts.
Conclusion: With sufficient awareness of the risks of COVID-19 and with individual protection, breast cancer treatment was not affected during the assessed period of active pandemic in Turkey.
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Palumbo I, Borghesi S, Gregucci F, Falivene S, Fontana A, Aristei C, Ciabattoni A. Omission of adjuvant radiotherapy for older adults with early-stage breast cancer particularly in the COVID era: A literature review (on the behalf of Italian Association of Radiotherapy and Clinical Oncology). J Geriatr Oncol 2021; 12:1130-1135. [PMID: 34020908 PMCID: PMC8131185 DOI: 10.1016/j.jgo.2021.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/21/2021] [Accepted: 05/07/2021] [Indexed: 12/25/2022]
Abstract
This review is aimed at evaluating whether radiation therapy (RT) can be omitted in older adult early-stage low-risk breast cancer (BC) patients. The published data are particularly relevant at present, during the COVID-19 pandemic emergency, to define a treatment strategy and to prioritize essential therapy. Cochrane Database of Systematic Reviews and PubMED were systematically researched from outset through April 2020 using Mesh terms. Only randomized controlled trials (RCT), with one arm without adjuvant whole-breast irradiation (WBI), were included in the analysis. Recent literature regarding the COVID pandemic and BC RT was assessed. The reported RCTs identified a group of BC patients (pT1-2N0M0 R0, grade 1-2, estrogen receptor (ER) positive, human epidermal growth factor receptor 2 (HER2) negative tumours) in which the absolute risk of local recurrence (LR) was considered low enough to omit RT. The most common risk factors were tumor diameter, nodal and receptor status. Adjuvant RT had a significant impact on LR but not on distant metastasis (DM) or death. During the COVID 19 pandemic, results from RTCs were re-considered to define treatment recommendations for BC patients. International scientific societies and radiation oncology experts suggested RT omission, whenever possible, in older adult early-stage BC patients. Adjuvant RT might be omitted in a highly selected group of older adult early-stage BC patients with favourable prognostic factors. Hypofractionated regimens should be the standard. RT omission, partial breast irradiation (PBI), and ultra- hypofractionated regimens could be considered in selected cases due to the pandemic.
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Affiliation(s)
- Isabella Palumbo
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Simona Borghesi
- Radiation Oncology Department, Arezzo-Valdarno, Azienda USL Toscana Sud Est, Arezzo, Italy
| | - Fabiana Gregucci
- Radiation Oncology Division, Miulli-Felli Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Sara Falivene
- Radiation Oncology Division, Ospedale del Mare, Asl Napoli 1 centro, Napoli, Italy
| | - Antonella Fontana
- Radiation Oncology Division, Santa Maria Goretti Hospital, Latina, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy,Corresponding author at: Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia, Perugia General Hospital, Sant'Andrea delle Fratte, 06156 Perugia, Italy
| | - Antonella Ciabattoni
- Radiation Oncology Division, San Filippo Neri, Hospital, ASL Roma 1, Roma, Italy
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130
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Wilke LG, Nguyen TT, Yang Q, Hanlon BM, Wagner KA, Strickland P, Brown E, Dietz JR, Boughey JC. Analysis of the Impact of the COVID-19 Pandemic on the Multidisciplinary Management of Breast Cancer: Review from the American Society of Breast Surgeons COVID-19 and Mastery Registries. Ann Surg Oncol 2021; 28:5535-5543. [PMID: 34431019 PMCID: PMC8384097 DOI: 10.1245/s10434-021-10639-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/08/2021] [Indexed: 12/29/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has resulted in rapid and regionally different approaches to breast cancer care.
Methods In order to evaluate these changes, a COVID-19-specific registry was developed within the American Society of Breast Surgeons (ASBrS) Mastery that tracked whether decisions were usual or modified for COVID-19. Data on patient care entered into the COVID-19-specific registry and the ASBrS Mastery registry from 1 March 2020 to 15 March 2021 were reviewed.
Results Overall, 177 surgeons entered demographic and treatment data on 2791 patients. Mean patient age was 62.7 years and 9.0% (252) were of African American race. Initial consultation occurred via telehealth in 6.2% (173) of patients and 1.4% (40) developed COVID-19. Mean invasive tumor size was 2.1 cm and 17.8% (411) were node-positive. In estrogen receptor-positive/human epidermal growth factor receptor 2-negative (ER+/HER2−) disease, neoadjuvant endocrine therapy (NET) was used as the usual approach in 6.9% (119) of patients and due to COVID-19 in an additional 31% (542) of patients. Patients were more likely to receive NET due to COVID-19 with increasing age and if they lived in the Northeast or Southeast (odds ratio [OR] 1.1, 2.3, and 1.7, respectively; p < 0.05). Genomic testing was performed on 51.5% (781) of estrogen-positive patients, of whom 20.7% (162) had testing on the core due to COVID-19. Patients were less likely to have core biopsy genomic testing due to COVID-19 if they were older (OR 0.89; p = 0.01) and more likely if they were node-positive (OR 4.0; p < 0.05). A change in surgical approach due to COVID-19 was reported for 5.4% (151) of patients. Conclusion The ASBrS COVID-19 registry provided a platform for monitoring treatment changes due to the pandemic, highlighting the increased use of NET.
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Affiliation(s)
- Lee G Wilke
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | | | - Qiuyu Yang
- UW Department of Surgery, Madison, WI, USA
| | | | | | | | - Eric Brown
- Comprehensive Breast Care, Troy, MI, USA
| | - Jill R Dietz
- Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Judy C Boughey
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA
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131
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Zhou H, Chen H, Cheng C, Wu X, Ma Y, Han J, Li D, Lim GH, Rozen WM, Ishii N, Roy PG, Wang Q. A quality evaluation of the clinical practice guidelines on breast cancer using the RIGHT checklist. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1174. [PMID: 34430615 PMCID: PMC8350626 DOI: 10.21037/atm-21-2884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/02/2021] [Indexed: 11/06/2022]
Abstract
Background Breast cancer is the most frequent type of cancer in women. The methodological quality of clinical practice guidelines (CPGs) on breast cancer has been shown to be heterogeneous. The aim of our study was to evaluate the quality of breast cancer CPGs published in years 2018-2020, using the Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist. Methods We searched Medline (via PubMed), Chinese National Knowledge Infrastructure (CNKI), Wanfang and Chinese Biomedical Literature (CBM) as well as websites of guideline organizations for CPGs on breast cancer published between 2018 and 2020. We used the RIGHT checklist to evaluate the reporting quality of the included guidelines by assessing whether the CPGs adhered to each item of the checklist and calculated the proportions of appropriately reported RIGHT checklist items. We also presented the adherence reporting rates for each guideline and the mean rates for each of the seven domains of the RIGHT checklist. Results A total of 45 guidelines were included. Eighteen (40.0%) guidelines had an overall reporting rate below 50% and only three (6.7%) reported more than 80% of the items. The domains “Basic information” and “Background” had the highest reporting rates (75.9% and 62.5%, respectively). The mean reporting rates of the domains “Evidence”, “Recommendation”, “Review and quality assurance”, “Funding and declaration and management of interests” and “Other information” were 42.7%, 53.0%, 33.3%, 45.0%, and 44.4%, respectively. Conclusions The reporting quality varied among guidelines for breast cancer, showing the need for improvement in reporting the contents. Guideline developers should pay more attention to reporting the evidence, review and quality assurance, and funding and declaration and management of interests in future.
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Affiliation(s)
- Hanqiong Zhou
- Department of Internal Medicine, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Haiyang Chen
- Department of Internal Medicine, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Cheng Cheng
- Department of Hematology, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Xuan Wu
- Department of Internal Medicine, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Yanfang Ma
- School of Chinese Medicine of Hong Kong Baptist University, Hong Kong, China
| | - Jing Han
- Department of Internal Medicine, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Ding Li
- Department of Pharmacy, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Geok Hoon Lim
- Breast Department, KK Women's and Children's Hospital, Singapore, Singapore
| | - Warren M Rozen
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
| | - Naohiro Ishii
- Department of Plastic and Reconstructive Surgery, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | - Pankaj G Roy
- Department of Breast Surgery, Oxford University Hospitals NHSFT, Oxford, UK
| | - Qiming Wang
- Department of Internal Medicine, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
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132
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Cavalcante FP. Breast cancer care: Looking for the new normal. Semin Oncol 2021; 48:236-237. [PMID: 34429199 DOI: 10.1053/j.seminoncol.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/22/2021] [Indexed: 11/11/2022]
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Dietz JR. Presidential Address: 2020 is Hindsight. Ann Surg Oncol 2021; 28:5468-5472. [PMID: 34420130 PMCID: PMC8380094 DOI: 10.1245/s10434-021-10521-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/15/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Jill R Dietz
- Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
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134
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Boughey JC, Nguyen TT, Dietz JR, Wilke LG. ASO Authors Reflection: Lessons Learned from the COVID-19 Pandemic-Should We Change Surgical Management of Patients with Breast Cancer? Ann Surg Oncol 2021; 29:549-550. [PMID: 34379253 PMCID: PMC8356538 DOI: 10.1245/s10434-021-10630-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 07/30/2021] [Indexed: 12/03/2022]
Affiliation(s)
| | - Toan T Nguyen
- Surgical Oncology, Lakeland Regional Health, Lakeland, FL, USA
| | - Jill R Dietz
- Chief Transformation Officer, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Lee G Wilke
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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135
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AlSaleh K, Al Zahwahry H, Bounedjar A, Oukkal M, Saadeddine A, Mahfouf H, Bouzid K, Bensalem A, Filali T, Abdel-Razeq H, Larbaoui B, Kandil A, Abulkhair O, Al Foheidi M, Errihani H, Ghosn M, Abdel-Aziz N, Arafah M, Boussen H, Dabouz F, Rasool H, Bahadoor M, Ayari J, Kullab S, Nabholtz JM. Response to Induction Neoadjuvant Hormonal Therapy Using Upfront 21-Gene Breast Recurrence Score Assay-Results From the SAFIA Phase III Trial. JCO Glob Oncol 2021; 7:811-819. [PMID: 34086481 PMCID: PMC8457874 DOI: 10.1200/go.20.00575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Luminal, human epidermal growth factor receptor 2–negative breast cancer represents the most common subtype of breast malignancies. Neoadjuvant strategies of operable breast cancer are mostly based on chemotherapy, whereas it is not completely understood which patients might benefit from neoadjuvant hormone therapy (NAHT).
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Affiliation(s)
- Khalid AlSaleh
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Mohammed Oukkal
- Medical Oncology Department, Beni-Messous University Hospital, Algiers, Algeria
| | - Ahmed Saadeddine
- Oncology Center, King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia
| | | | - Kamel Bouzid
- Oncology Center of Pierre et Marie Curie, Algiers, Algeria
| | - Assia Bensalem
- Oncology Department, Dr Benbadis University Hospital, Constantine, Algeria
| | - Taha Filali
- Oncology Department, Constantine University Hospital, Constantine, Algeria
| | | | | | | | | | - Meteb Al Foheidi
- Oncology Center of Princess Noorah, King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
| | - Hassan Errihani
- Medical Oncology, National Institute of Oncology, Mohammed V University, Rabat, Morocco
| | - Marwan Ghosn
- Hematology-Oncology Department, Hotel Dieu de France, University Saint Joseph, Beirut, Lebanon
| | - Nashwa Abdel-Aziz
- Oncology Center, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia
| | - Maria Arafah
- Department of Pathology, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia
| | - Hamouda Boussen
- Faculty of Medicine Tunis, University Tunis El Manar, Abderrahmen Mami Hospital, Ariana, Tunisia
| | - Farida Dabouz
- International Cancer Research Group (ICRG), Sharjah, United Arab Emirates
| | - Haleem Rasool
- King Faisal Specialist Hospital and Research Center (KFSHRC), Jeddah, Saudi Arabia
| | - Mohun Bahadoor
- International Cancer Research Group (ICRG), Sharjah, United Arab Emirates
| | - Jihen Ayari
- Faculty of Medicine Tunis, Oncology Department, University Tunis El Manar, Military Hospital of Tunis, Tunis, Tunisia
| | - Sharif Kullab
- Oncology Center, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia
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Hammond JB, Thomas O, Jogerst K, Kosiorek HE, Rebecca AM, Cronin PA, Casey WJ, Kruger EA, Pockaj BA, Teven CM. Same-day Discharge Is Safe and Effective After Implant-Based Breast Reconstruction. Ann Plast Surg 2021; 87:144-149. [PMID: 33470624 DOI: 10.1097/sap.0000000000002667] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Same-day discharge after mastectomy is a recently described treatment approach. Limited data exist investigating whether same-day discharge can be successfully implemented in patients undergoing mastectomy with immediate implant-based breast reconstruction (IBR). METHODS Patients having mastectomy with IBR from 2013 to 2019 were reviewed. Enhanced recovery with same-day discharge was implemented in 2017. Patient characteristics, oncologic treatments, surgical techniques, and 90-day postoperative complications and reoperations were analyzed comparing enhanced recovery patients with historical controls. RESULTS A total of 363 patients underwent nipple-sparing (214, 59%) or skin-sparing (149, 41%) mastectomy with 1-stage (270, 74%) or tissue expander (93, 26%) IBR. Enhanced recovery was used for 151 patients, with 79 of these patients (52%) discharged same-day. Overall, enhanced recovery patients experienced a significantly lower rate of 90-day complications (21% vs 41%, P < 0.001), including hematoma (3% vs 11%, P = 0.002), mastectomy flap necrosis (7% vs 15%, P = 0.02), seroma (1% vs 9%, P < 0.001), and wound breakdown (3% vs 9%, P = 0.05). Postoperative complication rates did not significantly differ among enhanced recovery patients discharged same day. Postoperative admissions significantly decreased after enhanced recovery implementation (100% to 48%, P < 0.001), and admitted enhanced recovery patients experienced a lower length of stay (1.2 vs 1.8, P < 0.001). Enhanced recovery patients experienced a lower incidence of ≥1 unplanned reoperation (22% vs 33%, P = 0.01); overall average unplanned and total reoperations did not significantly differ between groups. CONCLUSIONS In conjunction with enhanced recovery practices, same-day discharge after mastectomy with IBR is a safe and feasible treatment approach.
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Affiliation(s)
| | | | | | - Heidi E Kosiorek
- Department of Health Sciences Research, Section of Biostatistics, Mayo Clinic, Scottsdale
| | | | - Patricia A Cronin
- Division of Surgical Oncology and Endocrine Surgery, Mayo Clinic, Phoenix, AZ
| | | | - Erwin A Kruger
- Division of Surgical Oncology and Endocrine Surgery, Mayo Clinic, Phoenix, AZ
| | - Barbara A Pockaj
- Division of Surgical Oncology and Endocrine Surgery, Mayo Clinic, Phoenix, AZ
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Chou CP, Lin HS. Delayed Breast Cancer Detection in an Asian Country (Taiwan) with Low COVID-19 Incidence. Cancer Manag Res 2021; 13:5899-5906. [PMID: 34349563 PMCID: PMC8326285 DOI: 10.2147/cmar.s314282] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 07/15/2021] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To assess whether the COVID-19 pandemic delayed breast cancer diagnosis in Taiwan, an Asian country with a low COVID-19 incidence. METHODS The monthly volume of breast biopsies and breast cancers during the COVID-19 pandemic (during January 21 and July 31, 2020) was compared to the same period in 2019 (pre-COVID-19). RESULTS Taiwan recorded a lower COVID-19 incidence rate (20.2 cases per million population) than other Asian countries. The screen-detected lesions accounted for 55% and 36% of 2019 and 2020 total biopsied lesions, respectively. Total breast biopsy, mammography-guided, and ultrasound-guided biopsies decreased by 17%, 23%, and 14%, respectively, from pre-COVID-19 to COVID-19. Monthly differences were significant in total biopsy (p=0.03), mammography-guided biopsy (p=0.04), and a benign pathology result after breast biopsy (p<0.01). Nearly 46% decline was noted in the biopsy results of non-invasive breast cancer in 2020. The number of total breast cancers and early breast cancers (stages 0 and 1) decreased by 10% and 38%, respectively, during pandemic. Individuals with early breast cancer accounted for 71% and 49% of the total diagnosed breast cancer in the pre-COVID-19 and COVID-19 periods, respectively (p<0.001). CONCLUSION The pandemic significantly delayed early breast cancer detection in Taiwan despite low COVID-19 incidence. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT04750018.
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Affiliation(s)
- Chen-Pin Chou
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Medical Laboratory Sciences and Biotechnology, Fooling University, Kaohsiung, 807, Taiwan
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Huey-Shyan Lin
- Department of Health-Business Administration, School of Nursing, Fooyin University, Kaohsiung, Taiwan
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138
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Xie J, Qi W, Cao L, Tan Y, Huang J, Gu X, Chen B, Shen P, Zhao Y, Zhang Y, Zhao Q, Huang H, Wang Y, Fang H, Jin Z, Li H, Zhao X, Qian X, Xu F, Ou D, Wang S, Xu C, Li M, Jiang Z, Wang Y, Huang X, Chen J. Predictors for Fear of Cancer Recurrence in Breast Cancer Patients Referred to Radiation Therapy During the COVID-19 Pandemic: A Multi-Center Cross-Section Survey. Front Oncol 2021; 11:650766. [PMID: 34381703 PMCID: PMC8351463 DOI: 10.3389/fonc.2021.650766] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/02/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The outbreak of COVID-19 pandemic has greatly impacted on radiotherapy (RT) strategy for breast cancer patients, which might lead to increased distressing psychological symptoms. We performed a multi-center cross-section survey to investigate prevalence of fear of cancer recurrence (FCR) and predictors for FCR in patients referred to RT during pandemic. METHODS 542 patients were consecutively enrolled from three regions in China including Yangtze Delta River Region, Guangdong and Shanxi province. Patients' characteristics were collected using an information sheet, Fear of progression questionnaire-short form, Hospital Anxiety/Depression Scale and EORTC QLQ-C30. The hierarchical multiple regression models were performed. RESULTS 488 patients with complete data were eligible. The RT strategy was affected in 265 (54.3%) patients, including 143 with delayed RT initiation, 66 believing to have delayed RT initiation but actually not, 24 with RT interruptions, 19 shifting to local hospitals for RT and the remaining 13 influenced on both RT schedule and hospital level. The model explained 59.7% of observed variances in FCR (p<0.001) and showed that influence of RT strategy had significantly impacted on FCR (△R2 = 0.01, △F=2.966, p=0.019). Hospitals in Shanxi province (β=-0.117, p=0.001), emotional function (β=-0.19, p<0.001), social function (β=-0.111, p=0.006), anxiety (β=0.434, p<0.001) and RT interruption (β=0.071, p=0.035) were independent predictors. CONCLUSIONS RT strategy for breast cancer patients was greatly influenced during pandemic. RT interruption is an independent predictor for high FCR. Our findings emphasize the necessity to ensure continuum of RT, and efforts should be taken to alleviate FCR through psychological interventions.
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Affiliation(s)
- Jinrong Xie
- Department of Radiation Oncology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weixiang Qi
- Department of Radiation Oncology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lu Cao
- Department of Radiation Oncology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yuting Tan
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jin Huang
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xiaodong Gu
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Taiyuan, China
| | - Bingguang Chen
- Department of Oncology, Yunfu People’s Hospital, Yunfu, China
| | - Peipei Shen
- Department of Radiation Oncology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Yutian Zhao
- Department of Radiation Oncology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Ying Zhang
- Oncology Center, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China
| | - Qingwen Zhao
- Department of Oncology, Datong Second People’s Hospital, Datong, China
| | - Hecheng Huang
- Department of Radiation Oncology, Shantou Central Hospital, Shantou, China
| | - Yubin Wang
- Department of Radiation Oncology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haicheng Fang
- Radiation Oncology Center, Puning Overseas Chinese Hospital, Jieyang, China
| | - Zhenjun Jin
- Department of Radiation Oncology, Changshu No.1 People’s Hospital Affiliated to Soochow University, Changshu, China
| | - Hui Li
- Oncology Center, Yuncheng First Hospital, Yuncheng, China
| | - Xuehong Zhao
- Department of Oncology, Lin-fen Central Hospital, Linfen, China
| | - Xiaofang Qian
- Department of Radiation Oncology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Feifei Xu
- Department of Radiation Oncology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Dan Ou
- Department of Radiation Oncology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shubei Wang
- Department of Radiation Oncology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Cheng Xu
- Department of Radiation Oncology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Min Li
- Department of Radiation Oncology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zefei Jiang
- Department of Breast Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China
- Chinese Society of Clinical Oncology (CSCO), Beijing, China
| | - Yu Wang
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, Taiyuan, China
| | - Xiaobo Huang
- Department of Breast Tumor Radiotherapy, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiayi Chen
- Department of Radiation Oncology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Kronenfeld JP, Collier AL, Choi S, Perez-Sanchez D, Shah AM, Lee C, Goel N. Surgical oncology operative experience at a high-volume safety-net hospital during the COVID-19 pandemic. J Surg Oncol 2021; 124:983-988. [PMID: 34291824 PMCID: PMC8426825 DOI: 10.1002/jso.26616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/08/2021] [Accepted: 07/10/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND The coronavirus (COVID-19) pandemic led to disruptions in operative and hospital capabilities as the country triaged resources and canceled elective procedures. This study details the operative experience of a safety-net hospital for cancer-related operations during a 3-month period at the height of the pandemic. METHODS Patients operated on for or diagnosed with malignancies of the abdomen, breast, skin, or soft-tissue (September 3, 2020-September 6, 2020) were identified from operative/clinic schedules. Sociodemographics, tumor and treatment characteristics, and COVID-19 information was identified through retrospective chart review of a prospectively maintained database. Descriptive statistics were calculated. RESULTS Fifty patients evaluated within this window underwent oncologic surgery. Median age was 61 (interquartile range: 53-68), 56% were female, 86% were White, and 66% were Hispanic. The majority (28%) were for colon cancer. Only two patients tested positive for COVID-19 preoperatively or within 30 days of their operation. There were no mortalities during the 1-year study period. CONCLUSION During the COVID-19 pandemic, many hospitals and operative centers limited interventions to preserve resources, but oncologic procedures continued at many large-volume academic cancer centers. This study underscores the importance of continuing to offer surgery during the pandemic for surgical oncology cases at safety-net hospitals to minimize delays in time-sensitive oncologic treatment.
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Affiliation(s)
- Joshua P Kronenfeld
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Amber L Collier
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Seraphina Choi
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Dayana Perez-Sanchez
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ankit M Shah
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Christina Lee
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Neha Goel
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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140
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Pawloski KR, Matar R, Sevilimedu V, Tadros AB, Kirstein LJ, Cody HS, Van Zee KJ, Morrow M, Moo TA. Postdischarge Nonsteroidal Anti-Inflammatory Drugs Are not Associated with Risk of Hematoma after Lumpectomy and Sentinel Lymph Node Biopsy with Multimodal Analgesia. Ann Surg Oncol 2021; 28:5507-5512. [PMID: 34247337 PMCID: PMC8272604 DOI: 10.1245/s10434-021-10446-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/17/2021] [Indexed: 12/12/2022]
Abstract
Background Nonsteroidal anti-inflammatory drugs (NSAIDs) are increasingly used in ambulatory breast surgery. The risk of hematoma associated with intraoperative ketorolac is low, but whether concomitant routine discharge with NSAIDs increases the risk of hematoma is unclear. Methods We retrospectively identified patients who underwent lumpectomy and sentinel lymph node biopsy (SLNB), and compared the 30-day risk of hematoma between patients discharged with opioids (opioid period: January 2018–August 2018) and patients discharged with NSAIDs with or without opioids (NSAID period: January 2019–April 2020). The association between study period and hematoma risk was assessed using multivariable models. Covariates included intraoperative ketorolac, home aspirin, and race/ethnicity. During the NSAID period, a survey was used to assess analgesic consumption on postoperative days 1–5. Results In total, 2724 patients were identified: 858 (31%) in the opioid period and 1866 (69%) in the NSAID period. In the NSAID period, 867 (46%) received NSAIDs and opioids, and 999 (54%) received NSAIDs only. Receipt of intraoperative ketorolac was higher in the NSAID period (78 vs. 64%, P < 0.001). The risks of any hematoma (4.1 vs. 3.6%, P = 0.6) and reoperation for bleeding (0.5 vs. 0.6%, P = 0.8) were similar between groups. Study period was not associated with hematoma risk (odds ratio 0.87, 95% confidence interval 0.56–1.35, P = 0.5). Among survey respondents (41%), nonopioid analgesic consumption did not increase after opioids were removed from the discharge regimen (median, 6 pills/group, P = 0.06). Conclusions NSAIDs are associated with a low risk of hematoma after lumpectomy and SLNB, and should be prescribed instead of opioids, unless contraindicated.
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Affiliation(s)
- Kate R Pawloski
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Regina Matar
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Audree B Tadros
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Laurie J Kirstein
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Hiram S Cody
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Kimberly J Van Zee
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Tracy-Ann Moo
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
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Abstract
PURPOSE OF REVIEW The disruption to people's lives, including financial impacts, morbidity and loss of life caused by the Coronavirus disease (COVID-19) pandemic requires a dramatic transformation of cancer care delivery, including supportive care. This paper focuses on issues of supportive care in the context of the pandemic, and the extent to which these issues will impact supportive cancer care post-COVID-19. RECENT FINDINGS Cancer care, including supportive care delivery, has had to be dramatically altered during the COVID-19 pandemic, including reallocation of human resources, repurposing of existing physical space, amplified use of telehealth and other remote patient monitoring technologies, changes to treatment and follow-up care patient schedules, among others. These changes have resulted in psychosocial sequelae for cancer patients (including anxiety, stress, loss of control), financial toxicity, and risk of disengagement from treatment and follow-up care. SUMMARY COVID-19 has seriously disrupted cancer treatment and supportive care for patients and survivors. This paper highlights implications for clinical practice during and post-COVID-19, including the durability of practice adaptations and opportunities for research into mechanisms to support supportive care post the pandemic, including the advancement of eHealth technologies and alternative models of care that integrate community resources, primary care and allied health disciplines.
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Affiliation(s)
- Fredrick D Ashbury
- Department of Oncology, University of Calgary, Alberta
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- VieCure, Denver, CO
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142
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Siavashpour Z, Goharpey N, Mobasheri M. Radiotherapy based management during Covid-19 pandemic - A systematic review of presented consensus and guidelines. Crit Rev Oncol Hematol 2021; 164:103402. [PMID: 34214608 PMCID: PMC8242203 DOI: 10.1016/j.critrevonc.2021.103402] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/17/2021] [Accepted: 06/18/2021] [Indexed: 01/18/2023] Open
Abstract
Treatment management of cancer patients in the radiation oncology departments during the current COVID-19 pandemic is challenging. A systematic review of published consensus/guidelines on the role of radiotherapy prioritization, suggested treatment protocols, and set up management was undertaken based on the PRISMA protocol and through PubMed/PMC, Scopus, Google Scholar, Web of Science databases until 01/20/2021. One hundred and sixty-eight publications or regional consensus were included. Summary of recommendations contained: (1) using hypo-fractionated (Hypo-F) regimens for therapeutic/palliative indications, (2) delaying radiotherapy for several weeks or until pandemic over, (3) omitting radiotherapy by replacement of alternative therapies or active surveillance, (4) applying safer patients' setup and preparation protocols, (5) developing telemedicine/telehealth service. To conclude, it is essential to carefully weigh the risk of exposure to COVID-19 infection and the benefit of treating cancer patients during the pandemic. Trying to have a global guideline facing this or any other probable crisis is crucial for health care service.
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Affiliation(s)
- Zahra Siavashpour
- Radiotherapy Oncology Department, Shohada-e Tajrish Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Neda Goharpey
- Radiotherapy Oncology Department, Shohada-e Tajrish Educational Hospital, Tehran, Iran.
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McCray E, Naron R, White S, Messersmith S, Stewart C. Metastatic Breast Cancer Masked as Constipation. Cureus 2021; 13:e16031. [PMID: 34336518 PMCID: PMC8319244 DOI: 10.7759/cureus.16031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/23/2022] Open
Abstract
Even though screening mammography has been attributed to decreased mortality in recent decades, breast cancer is one of the leading causes of death among women in the United States. Disruption of screening protocols and variation in the presentation may alter the course of detection and management. We report a case of hormone receptor-positive breast cancer that presented as vague gastrointestinal symptoms in a patient with a delayed workup for a self-discovered breast lump during the coronavirus disease global pandemic. A 48-year-old woman with a history of gastroesophageal reflux and hypertension presented to the emergency department with primary complaints of constipation and abdominal distention with associated flatus and nausea. Vitals were within normal limits, and physical examination was notable for abdominal distention and diffuse tenderness to palpation. Labs demonstrated hypercalcemia and an unremarkable complete blood count. A chest X-ray showed a right hilar mass, and a CT chest revealed multiple lytic bone lesions diffusely scattered throughout the entire skeleton; no hilar mass was noted on the CT chest. A CT scan of the abdomen and pelvis incidentally revealed a right breast mass. A bone marrow biopsy identified invasive ductal carcinoma. Mammography and biopsy of the breast mass identified estrogen receptor/progesterone receptor-positive invasive ductal carcinoma, consistent with the bone marrow biopsy, confirming the diagnosis of metastatic breast cancer. Unpredicted disruptions in screening processes may result in delayed cancer diagnoses. This case illustrates the importance of routine self-breast examinations, screening mammography, and maintaining a broad differential diagnosis.
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Affiliation(s)
- Edwin McCray
- Internal Medicine, Campbell University School of Osteopathic Medicine, Lillington, USA
| | - Robyn Naron
- Internal Medicine, Campbell University School of Osteopathic Medicine, Lillington, USA
| | - Sarah White
- Internal Medicine, Campbell University School of Osteopathic Medicine, Lillington, USA
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144
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Sokas C, Kelly M, Sheu C, Song J, Welch HG, Bergmark R, Minami C, Trinh QD. Cancer in the Shadow of COVID: Early-Stage Breast and Prostate Cancer Patient Perspectives on Surgical Delays Due to COVID-19. Ann Surg Oncol 2021; 28:8688-8696. [PMID: 34170430 PMCID: PMC8231084 DOI: 10.1245/s10434-021-10319-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/11/2021] [Indexed: 12/03/2022]
Abstract
Background During the height of the coronavirus disease 2019 (COVID-19) pandemic, elective surgeries, including oncologic surgeries, were delayed. Little prospective data existed to guide practice, and professional surgical societies issued recommendations grounded mainly in common sense and expert consensus, such as medical therapy for early-stage breast and prostate cancer patients. To understand the patient experience of delay in cancer surgery during the pandemic, we interviewed breast and prostate cancer patients whose surgeries were delayed due to the pandemic. Patients and Methods Patients with early-stage breast or prostate cancer who suffered surgical postponement at Brigham and Women’s Hospital (BWH) were invited to participate. Semi-structured telephone interviews were conducted with 21 breast and prostate cancer patients. Interviews were transcribed, and qualitative analysis using ground-theory approach was performed. Results Most patients reported significant distress due to cancer and COVID. Key themes that emerged included the lack of surprise and acceptance of the surgical delays but endorsed persistent cancer- and delay-related worries. Satisfaction with patient–physician communication and the availability of a delay strategy were key factors in patients’ acceptance of the situation; perceived lack of communication prompted a few patients to seek care elsewhere. Discussion The clinical effect of delay in cancer surgery will take years to fully understand, but there are immediate steps that can be taken to improve the patient experience of delays in care, including elicitation of individual patient perspectives and ongoing communication. More work is needed to understand the wider experiences of patients, especially minority, socioeconomically disadvantaged, and uninsured patients, who encounter delays in oncologic care. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1245/s10434-021-10319-0.
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Affiliation(s)
- Claire Sokas
- Department of Surgery, Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, MA, USA.
| | - Masami Kelly
- Department of Surgery, Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, MA, USA
| | - Christina Sheu
- Department of Surgery, Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, MA, USA
| | | | - H Gilbert Welch
- Department of Surgery, Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, MA, USA
| | - Regan Bergmark
- Department of Surgery, Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, MA, USA.,Division of Otolaryngology, Brigham and Women's Hospital, Boston, MA, USA
| | - Christina Minami
- Department of Surgery, Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, MA, USA.,Division of Breast Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Quoc-Dien Trinh
- Department of Surgery, Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, MA, USA.,Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
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Koca B, Yildirim M. Delay in breast cancer diagnosis and its clinical consequences during the coronavirus disease pandemic. J Surg Oncol 2021; 124:261-267. [PMID: 34137039 PMCID: PMC8426951 DOI: 10.1002/jso.26581] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/06/2021] [Accepted: 06/08/2021] [Indexed: 12/13/2022]
Abstract
Objective At the end of 1 year of the coronavirus disease (COVID‐19) pandemic, we aimed to reveal the changes in breast cancer cases in the context of cause and effect based on the data of surgically treated patients in our institution. Patients and Methods Patients with breast cancer were divided into two groups. Group 1 consisted of patients who were operated in the year before the COVID‐19 pandemic, and Group 2 consisted of patients who were operated within the first year of the pandemic. Tumor size, axillary lymph node positivity, distant organ metastasis status, neoadjuvant chemotherapy, and type of surgery performed were compared between the two groups. Results The tumor size, axillary lymph node positivity, and neoadjuvant chemotherapy were higher in Group 2 than in Group 1 (p = .005, p = .012, p = .042, respectively). In addition, the number of breast‐conserving surgery + sentinel lymph node biopsy were lower, while the number of mastectomy and modified radical mastectomy were higher in Group 2 than in Group 1 (p = .034). Conclusion Patients presented with larger breast tumors and increased axillary involvement during the pandemic. Moreover, distant organ metastases may increase in the future.
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Affiliation(s)
- Bulent Koca
- Department of General Surgery, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Murat Yildirim
- Department of General Surgery, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
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Soriano EC, Perndorfer C, Otto AK, Fenech AL, Siegel SD, Dickson-Witmer D, Clements L, Laurenceau JP. Psychosocial Impact of Cancer Care Disruptions in Women With Breast Cancer During the COVID-19 Pandemic. Front Psychol 2021; 12:662339. [PMID: 34194367 PMCID: PMC8236578 DOI: 10.3389/fpsyg.2021.662339] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/28/2021] [Indexed: 01/11/2023] Open
Abstract
Background: The COVID-19 pandemic caused significant disruptions in cancer care, and preliminary research suggests that these disruptions are associated with increased levels of psychosocial distress among cancer survivors. The purpose of this study was to offer a descriptive report of the psychosocial functioning, perceived risk and fear of cancer progression, and COVID-19 pandemic impact and experiences in a unique, high-risk patient cohort: breast cancer survivors whose cancer treatment was delayed and/or changed due to the COVID-19 pandemic. Methods: This cross-sectional study included 50 women with dual carcinoma in situ, lobular carcinoma in situ, or invasive breast cancer whose cancer surgery was postponed due to the pandemic. As they awaited delayed surgery or shortly after they received delayed surgery, participants completed questionnaires on psychosocial functioning (depression, anxiety, sleep, and quality of life), their perceived risk and fear of cancer progression, patient-provider communication about disruptions in their care, personal impact of the pandemic, worry/threat about COVID-19, and COVID-19 symptoms/diagnoses. Descriptive statistics and bivariate correlations were computed among continuous study variables. Independent samples t-tests explored group differences in psychosocial functioning between survivors who were still awaiting delayed surgery and those who had recently received it. Results: Overall, the sample denied that the pandemic seriously negatively impacted their finances or resource access and reported low-to-moderate levels of psychosocial distress and fear about COVID-19. Twenty-six percent had clinically significant levels of fear of cancer progression, with levels comparable to other recent work. About a third were still awaiting delayed cancer surgery and this group reported lower satisfaction with communication from oncology providers but overall did not seem to report more psychosocial difficulties than those who already had surgery. Conclusion: Shortly before or after primary breast cancer surgery that was delayed due to the COVID-19 pandemic, this sample of survivors appears to be generally managing well psychosocially. However, many psychosocial difficulties (e.g., fear of cancer recurrence/progression) typically have an onset after the completion of treatment, therefore, research should continue to follow this cohort of cancer survivors as the pandemic's direct impact on their care likely increases their risk for these difficulties later in survivorship.
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Affiliation(s)
- Emily C. Soriano
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
| | - Christine Perndorfer
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
| | - Amy K. Otto
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Alyssa L. Fenech
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
| | - Scott D. Siegel
- Christiana Care Health System, Helen F. Graham Cancer Center and Research Institute, Newark, DE, United States
| | - Diana Dickson-Witmer
- Christiana Care Health System, Helen F. Graham Cancer Center and Research Institute, Newark, DE, United States
| | - Lydia Clements
- Christiana Care Health System, Helen F. Graham Cancer Center and Research Institute, Newark, DE, United States
| | - Jean-Philippe Laurenceau
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
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147
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Goldbach MM, Burkbauer L, Bharani T, Williams AD, Keele L, Rothman J, Jankowitz R, Tchou JC. Effectiveness of a Short Duration of Neoadjuvant Endocrine Therapy in Patients with HR+ Breast Cancer-An NCDB Analysis (2004-2016). Ann Surg Oncol 2021; 28:8651-8662. [PMID: 34125350 PMCID: PMC8202052 DOI: 10.1245/s10434-021-10287-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/28/2021] [Indexed: 12/14/2022]
Abstract
Background National medical/surgical organizations have recommended the use of neoadjuvant endocrine therapy (NET) to bridge surgery delay of weeks to months for patients with hormone receptor positive (HR+) breast cancer during the ongoing coronavirus disease 2019 (COVID-19) pandemic. The effects of NET of varying durations on pathologic response are unclear. Using the National Cancer Database (NCDB), we evaluated objective response to short (< 9 weeks), moderate (9–27 weeks), and long (> 27 weeks) duration of NET. Patients and Methods The study cohort included female patients diagnosed with nonmetastatic invasive HR+ breast cancer, stratifying by those who received NET versus no NET between 2004 and 2016. Pathologic response was grouped into four categories (complete, downstaged, stable, upstaged) by comparing clinical and pathologic staging data. Objective response to NET included complete, downstaged, and stable pathologic response. Clinical characteristics were compared using χ2 and analysis of variance (ANOVA) tests. Multivariable logistic regression was used to determine factors associated with NET use and objective response according to NET duration. Results A minority (1.2%) received NET in our cohort. Factors associated with NET use included older age, non-Black patients, more advanced clinical stage, higher comorbidity score, government insurance, and lobular histology. Objective response rate (ORR) was 56.7%, 52.1%, and 49.0% after short, moderate, and long NET duration, respectively. Conclusion Short NET duration did not result in an inferior ORR. Future study to evaluate the interaction between surgery delay and NET use on clinical outcome will provide insights into the safety of NET to bridge potential surgery delay in patients with HR+ breast cancer. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-021-10287-5.
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Affiliation(s)
- Macy M Goldbach
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Laura Burkbauer
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tina Bharani
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Luke Keele
- Division of Epidemiology and Biostatistics, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jami Rothman
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Rena Rowan Breast Center, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel Jankowitz
- Rena Rowan Breast Center, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia C Tchou
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Rena Rowan Breast Center, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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148
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Tolaney SM, Tayob N, Dang C, Yardley DA, Isakoff SJ, Valero V, Faggen M, Mulvey T, Bose R, Hu J, Weckstein D, Wolff AC, Reeder-Hayes K, Rugo HS, Ramaswamy B, Zuckerman D, Hart L, Gadi VK, Constantine M, Cheng K, Briccetti F, Schneider B, Garrett AM, Marcom K, Albain K, DeFusco P, Tung N, Ardman B, Nanda R, Jankowitz RC, Rimawi M, Abramson V, Pohlmann PR, Van Poznak C, Forero-Torres A, Liu M, Ruddy K, Zheng Y, Rosenberg SM, Gelber RD, Trippa L, Barry W, DeMeo M, Burstein H, Partridge A, Winer EP, Krop I. Adjuvant Trastuzumab Emtansine Versus Paclitaxel in Combination With Trastuzumab for Stage I HER2-Positive Breast Cancer (ATEMPT): A Randomized Clinical Trial. J Clin Oncol 2021; 39:2375-2385. [PMID: 34077270 DOI: 10.1200/jco.20.03398] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The ATEMPT trial was designed to determine if treatment with trastuzumab emtansine (T-DM1) caused less toxicity than paclitaxel plus trastuzumab (TH) and yielded clinically acceptable invasive disease-free survival (iDFS) among patients with stage I human epidermal growth factor receptor 2-positive (HER2+) breast cancer (BC). METHODS Patients with stage I centrally confirmed HER2+ BC were randomly assigned 3:1 to T-DM1 or TH and received T-DM1 3.6 mg/kg IV every 3 weeks for 17 cycles or T 80 mg/m2 IV with H once every week × 12 weeks (4 mg/kg load →2 mg/kg), followed by H × 39 weeks (6 mg/kg once every 3 weeks). The co-primary objectives were to compare the incidence of clinically relevant toxicities (CRTs) in patients treated with T-DM1 versus TH and to evaluate iDFS in patients receiving T-DM1. RESULTS The analysis population includes all 497 patients who initiated protocol therapy (383 T-DM1 and 114 TH). CRTs were experienced by 46% of patients on T-DM1 and 47% of patients on TH (P = .83). The 3-year iDFS for T-DM1 was 97.8% (95% CI, 96.3 to 99.3), which rejected the null hypothesis (P < .0001). Serially collected patient-reported outcomes indicated that patients treated with T-DM1 had less neuropathy and alopecia and better work productivity compared with patients on TH. CONCLUSION Among patients with stage I HER2+ BC, one year of adjuvant T-DM1 was associated with excellent 3-year iDFS, but was not associated with fewer CRT compared with TH.
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Affiliation(s)
- Sara M Tolaney
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
| | | | - Chau Dang
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Denise A Yardley
- Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN
| | | | - Vicente Valero
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Ron Bose
- Washington University, St Louis, MO
| | - Jiani Hu
- Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | | | | | - Dan Zuckerman
- St Luke's Mountain States Tumor Institute, Boise, ID
| | - Lowell Hart
- Wake Forest Baptist Health, Winston-Salem, NC
| | - Vijayakrishna K Gadi
- University of Washington, Seattle, WA. Currently at University of Illinois at Chicago, Chicago, IL
| | | | - Kit Cheng
- North Shore-LIJ Cancer Institute, Lake Success, NY
| | | | | | | | | | | | | | - Nadine Tung
- Harvard Medical School, Boston, MA.,Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | | | - Mothaffar Rimawi
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX
| | | | - Paula R Pohlmann
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | | | | | | | | | - Yue Zheng
- Dana-Farber Cancer Institute, Boston, MA
| | | | - Richard D Gelber
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
| | - Lorenzo Trippa
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
| | | | | | - Harold Burstein
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
| | - Ann Partridge
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
| | - Eric P Winer
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
| | - Ian Krop
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
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149
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Choobin MH, Mirabolfathi V, Chapman B, Moradi AR, Grunfeld EA, Derakshan N. The Impact of COVID-19 Outbreak on Emotional and Cognitive Vulnerability in Iranian Women With Breast Cancer. Front Psychol 2021; 12:663310. [PMID: 34177718 PMCID: PMC8220448 DOI: 10.3389/fpsyg.2021.663310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/19/2021] [Indexed: 12/23/2022] Open
Abstract
The psychological cost on emotional well-being due to the collateral damage brought about by COVID-19 in accessing oncological services for breast cancer diagnosis and treatment has been documented by recent studies in the United Kingdom. The current study set out to examine the effect of delays to scheduled oncology services on emotional and cognitive vulnerability in women with a breast cancer diagnosis in Iran, one of the very first countries to be heavily impacted by COVID-19. One hundred thirty-nine women with a diagnosis of primary breast cancer answered a series of online questionnaires to assess the current state of rumination, worry, and cognitive vulnerability as well as the emotional impact of COVID-19 on their mental health. Results indicated that delays in accessing oncology services significantly increased COVID related emotional vulnerability. Regression analyses revealed that after controlling for the effects of sociodemographic and clinical variables, women’s COVID related emotional vulnerability explained higher levels of ruminative response and chronic worry as well as poorer cognitive function. This study is the first in Iran to demonstrate that the effects of COVID-19 on emotional health amongst women affected by breast cancer can exaggerate anxiety and depressive related symptoms increasing risks for clinical levels of these disorders. Our findings call for an urgent need to address these risks using targeted interventions exercising resilience.
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Affiliation(s)
| | - Vida Mirabolfathi
- Department of Cognitive Psychology, Institute for Cognitive Science Studies (ICSS), Tehran, Iran
| | - Bethany Chapman
- Centre for Building Resilience in Breast Cancer; Department of Psychological Sciences, Birkbeck, University of London, London, United Kingdom
| | - Ali Reza Moradi
- Department of Clinical Psychology, Kharazmi University, Tehran, Iran.,Department of Cognitive Psychology, Institute for Cognitive Science Studies (ICSS), Tehran, Iran
| | - Elizabeth A Grunfeld
- Centre for Building Resilience in Breast Cancer; Department of Psychological Sciences, Birkbeck, University of London, London, United Kingdom
| | - Nazanin Derakshan
- Centre for Building Resilience in Breast Cancer; Department of Psychological Sciences, Birkbeck, University of London, London, United Kingdom
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150
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Thompson HK, Spicer PJ. Recurrent breast cancer diagnosis delayed by COVID-19 pandemic. Radiol Case Rep 2021; 16:2450-2453. [PMID: 34093928 PMCID: PMC8162720 DOI: 10.1016/j.radcr.2021.05.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/19/2021] [Accepted: 05/22/2021] [Indexed: 11/26/2022] Open
Abstract
We describe the case of a 64-year-old female with a no relevant medical history. Screening mammography in March 2020 demonstrated calcifications in the right breast, and a diagnostic mammogram was recommended. In the months that followed, the patient experienced tissue changes in the right breast but avoided returning to the facility as the COVID-19 pandemic worsened. The patient returned for a diagnostic mammogram in September of 2020, which indicated suspicious lymph nodes and an increase in calcifications. Further analysis through ultrasound-guided core biopsy ultimately led to a right mastectomy and lymph node biopsy, which were performed in October 2020. Pathology results confirmed the diagnosis of invasive ductal carcinoma with lobular features.
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Affiliation(s)
- Hanna K Thompson
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Paul J Spicer
- Department of Radiology, University of Kentucky School of Medicine, Lexington, KY, USA
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