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Lohfeld L, Sharma M, Bennett D, Gavin A, Hawkins ST, Irwin G, Mitchell H, O'Neill S, McShane CM. Impact of the COVID-19 pandemic on breast cancer patient pathways and outcomes in the United Kingdom and the Republic of Ireland - a scoping review. Br J Cancer 2024; 131:619-626. [PMID: 38704477 PMCID: PMC11333579 DOI: 10.1038/s41416-024-02703-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024] Open
Abstract
The COVID-19 pandemic brought unplanned service disruption for breast cancer diagnostic, treatment and support services. This scoping review describes these changes and their impact in the UK and the Republic of Ireland based on studies published between January 2020 and August 2023. Thirty-four of 569 papers were included. Data were extracted and results thematically organized. Findings include fewer new cases; stage shift (fewer early- and more late-stage disease); and changes to healthcare organization, breast screening and treatment. Examples are accepting fewer referrals, applying stricter referral criteria and relying more on virtual consultations and multi-disciplinary meetings. Screening service programs paused during the pandemic before enacting risk-based phased restarts with longer appointment times to accommodate reduced staffing numbers and enhanced infection-control regimes. Treatments shifted from predominantly conventional to hypofractionated radiotherapy, fewer surgical procedures and increased use of bridging endocrine therapy. The long-term impact of such changes are unknown so definitive guidelines for future emergencies are not yet available. Cancer registries, with their large sample sizes and population coverage, are well placed to monitor changes to stage and survival despite difficulties obtaining definitive staging during diagnosis because surgery and pathological assessments are delayed. Multisite longitudinal studies can also provide guidance for future disaster preparedness.
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Affiliation(s)
- Lynne Lohfeld
- Queen's University Belfast, Centre for Public Health, School of Medicine, Dentistry & Biomedical Sciences, Royal Victoria Hospital, 247 Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK.
| | - Meenakshi Sharma
- Queen's University Belfast, Centre for Public Health, School of Medicine, Dentistry & Biomedical Sciences, Royal Victoria Hospital, 247 Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK
| | - Damien Bennett
- Northern Ireland Cancer Registry, Centre for Public Health, School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Mulhouse Building, Grosvenor Road, Belfast, BT12 6DP, Northern Ireland, UK
| | - Anna Gavin
- Queen's University Belfast, Centre for Public Health, School of Medicine, Dentistry & Biomedical Sciences, Royal Victoria Hospital, 247 Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK
- Northern Ireland Cancer Registry, Centre for Public Health, School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Mulhouse Building, Grosvenor Road, Belfast, BT12 6DP, Northern Ireland, UK
| | - Sinéad T Hawkins
- Queen's University Belfast, Centre for Public Health, School of Medicine, Dentistry & Biomedical Sciences, Royal Victoria Hospital, 247 Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK
- Northern Ireland Cancer Registry, Centre for Public Health, School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Mulhouse Building, Grosvenor Road, Belfast, BT12 6DP, Northern Ireland, UK
| | - Gareth Irwin
- Belfast Health and Social Care Trust, 51 Lisburn Road, Belfast, BT9 7AB, Northern Ireland, UK
| | - Helen Mitchell
- Northern Ireland Cancer Registry, Centre for Public Health, School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Mulhouse Building, Grosvenor Road, Belfast, BT12 6DP, Northern Ireland, UK
| | - Siobhan O'Neill
- Belfast Health and Social Care Trust, 51 Lisburn Road, Belfast, BT9 7AB, Northern Ireland, UK
| | - Charlene M McShane
- Queen's University Belfast, Centre for Public Health, School of Medicine, Dentistry & Biomedical Sciences, Royal Victoria Hospital, 247 Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK
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Higgins Á, O'Reilly S, O'Sullivan MJ. The impact of the COVID-19 pandemic on symptomatic breast cancer presentations in an Irish breast cancer unit: a retrospective cohort study. Ir J Med Sci 2024; 193:1763-1772. [PMID: 38639840 PMCID: PMC11294258 DOI: 10.1007/s11845-024-03688-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/12/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND The coronavirus-19 (COVID-19) pandemic caused delays in the diagnosis and management of breast cancer which may have affected disease presentation. The aim of this study was to compare rates of metastatic disease, tumour characteristics and management in breast cancer patients diagnosed before and after the onset of COVID-19. METHODS A retrospective chart review was conducted on patients in a university teaching hospital who were diagnosed with invasive symptomatic breast cancer in 2019 (prepandemic control group) and in 2020, 2021, and 2022 (pandemic study groups). Rates of new metastatic presentations, tumour histopathological characteristics, operation type, and therapies administered were statistically compared. RESULTS A total of 1416 patients were identified. There was a significant increase in new metastatic breast cancer presentations in 2022 compared to 2019 (14.0% vs 3.8%, p ≤ 0.001), with non-significant increases in 2020 and 2021. Rates of adjuvant radiotherapy increased in 2020 and decreased in 2022 compared to 2019, with no significant change in neoadjuvant or adjuvant chemotherapy rates. Rates of axillary surgery increased during 2020 and 2021. There was an increase in high-grade tumours and lymphovascular invasion (LVI), and less frequent oestrogen receptor (ER) positivity in pandemic groups. No significant change was noted in BCS to mastectomy ratios, overall nodal positivity rates, or median tumour size. CONCLUSION Symptomatic breast cancers diagnosed since the onset of COVID-19 demonstrated an increase in new metastatic presentations and more aggressive histopathological characteristics when compared to a pre-pandemic control group. Rates of adjuvant radiotherapy and axillary surgery increased during the pandemic.
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Affiliation(s)
- Áine Higgins
- Department of Breast Surgery, Cork University Hospital and University College Cork, Cork, Ireland.
| | - Seamus O'Reilly
- Department of Medical Oncology, College of Medicine and Health, Cork University Hospital and Cancer Research@UCC, University College Cork, Cork, Ireland
| | - Martin J O'Sullivan
- Department of Breast Surgery, College of Medicine and Health, Cork University Hospital and Cancer Research@UCC, University College Cork, Cork, Ireland
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Heath L, Ordóñez-Mena JM, Aveyard P, Wherton J, Nicholson BD, Stevens R. How has the COVID-19 pandemic affected the delivery of preventive healthcare? An interrupted time series analysis of adults in English primary care from 2018 to 2022. Prev Med 2024; 181:107923. [PMID: 38432306 DOI: 10.1016/j.ypmed.2024.107923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/14/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Offering advice and support for smoking, obesity, excess alcohol, and physical inactivity is an evidence-based component of primary care. The objective was to quantify the impact of the pandemic on the rate of advice or referral for these four risk factors. METHODS A retrospective cohort study using primary care data from 1847 practices in England and 21,191,389 patients contributing to the Oxford Clinical Informatics Digital Hub. An interrupted time series analysis was undertaken with a single change point (March 2020). Monthly trends were modelled from 1st January 2018 - 30th June 2022 using segmented linear regression. RESULTS There was an initial step reduction in advice and referrals for smoking, obesity, excess alcohol, and physical inactivity in March 2020. By June 2022, advice on smoking (slope change -0.02 events per hundred patient years/month (EPH/month); 95% confidence interval (CI) -0.17, 0.21), obesity (0.06 EPH/month; 95% CI 0.01, 0.12), alcohol (0.02 EPH/month; 95% CI -0.01, 0.05) and physical inactivity (0.05 EPH/month; 95% CI 0.01, 0.09) had not returned to pre-pandemic levels. Similarly, smoking cessation referral remained lower (0.01 EPH/month; 95% CI -0.01, 0.09), excess alcohol referral returned to similar levels (0.0005 EPH/month; 95% CI 0.0002, 0.0008), while referral for obesity (0.14 EPH/month; 95% CI 0.10, 0.19) and physical inactivity (0.01 EPH/month; 95% CI 0.01, 0.02) increased relative to pre-pandemic rates. CONCLUSION Advice and support for smoking, and advice for weight, excess alcohol and physical inactivity have not returned to pre-pandemic levels. Clinicians and policy makers should prioritise preventive care in COVID-19 recovery plans.
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Affiliation(s)
- Laura Heath
- GP and Clinical Doctoral Fellow Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - José M Ordóñez-Mena
- Medical Statistician Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Aveyard
- GP and Professor of Behavioural Medicine Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Joseph Wherton
- Senior Researcher Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Brian D Nicholson
- GP and Associate Professor Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard Stevens
- Associate Professor of Medical Statistics Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Machii R, Takahashi H, Miyazawa J, Nakayama T. Cancer screening in Japan 2 years after the COVID-19 pandemic: Changes in participation, 2017-2021. Prev Med Rep 2024; 39:102649. [PMID: 38375089 PMCID: PMC10875236 DOI: 10.1016/j.pmedr.2024.102649] [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: 07/19/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/21/2024] Open
Abstract
Objectives The impact of the coronavirus disease (COVID-19) pandemic on cancer screening has become a global concern; compared with pre-pandemic levels, the number of individuals who underwent population-based cancer screening in Japan decreased by 10-30% in fiscal year (FY)2020. Therefore, it is important to monitor subsequent changes in the number of participants. Methods This descriptive study analysed data from a national database to determine changes from 2017 to 2021 in the number of people screened for gastric cancer (upper gastrointestinal [UGI] series or endoscopy), colorectal cancer (faecal immunochemical test), lung cancer (chest X-ray), breast cancer (mammography), and cervical cancer (Pap smear). Results Compared with the pre-pandemic period (FY 2017-2019), the number of participants in screening programmes in FY2021 decreased maximally for the gastric cancer UGI series (2.8 million to 2.2 million; -23.3 %), followed by those for lung cancer (7.9 million to 7.3 million; -8.2 %), colorectal cancer (8.4 million to 7.8 million; -7.3 %), breast cancer (3.1 million to 3.0 million; -4.5 %), and cervical cancer (4.3 million to 4.1 million; -3.2 %). Conversely, the number of people screened for endoscopic gastric cancer screening increased (1.0 million to 1.2 million; +13.1 %). Conclusions The number of participants, which decreased sharply immediately after the onset of the COVID-19 pandemic, recovered only slightly in FY2021 and did not return to pre-pandemic levels yet, except for endoscopic gastric cancer screening. Therefore, the impact of this decline in participation in cancer-detection programmes and changes in mortality should be monitored carefully.
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Affiliation(s)
- Ryoko Machii
- Division of Screening Assessment and Management, Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Hirokazu Takahashi
- Division of Screening Assessment and Management, Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Jin Miyazawa
- Division of Screening Assessment and Management, Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Tomio Nakayama
- Division of Screening Assessment and Management, Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
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Pearson SA, Taylor S, Krishan A, Marsden A, Howell S, Yorke J. A pragmatic qualitative study to explore women's and clinicians' experience of access to systemic anti-cancer therapies for the treatment of secondary breast cancer. Eur J Oncol Nurs 2024; 70:102515. [PMID: 38471325 DOI: 10.1016/j.ejon.2024.102515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 01/14/2024] [Accepted: 01/24/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE An estimated 57,000 women are currently living with secondary (metastatic) breast cancer across the UK. Equitable access to treatment has been associated with improved clinical outcomes, however geographical disparities have been reported which remain poorly understood. The purpose of our study was to explore women and clinicians' experience of geographic access to systemic anti-cancer therapies for the treatment of secondary breast cancer. METHOD The study setting was the integrated cancer system across the northwest region of Greater Manchester UK. A pragmatic qualitative study design was used. Women aged >18 years with a confirmed SBC diagnosis and clinicians responsible for the care and treatment of women with a secondary breast cancer diagnosis were interviewed using semi structured interviews to elicit their experience and perspectives on geographic access to treatment. Data were analysed using thematic analysis to identify emergent themes. RESULTS Eighteen interviews with women and 12 interviews with clinicians were completed. Four meta-themes were identified for geographic access, the influence of the health care system, person centred factors and the impact of Covid-19 on treatment access and receipt. CONCLUSION Our study was the first of its kind to explore women and clinicians experience of geographic access to systemic anti-cancer therapies for the treatment of secondary breast cancer. Findings provided a greater understanding of distance decay and the influence of the health care system on treatment access. This included the importance and availability of clinical trials as a potential treatment option. This provided important insights and contributed to ongoing debate.
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Affiliation(s)
- Sally Anne Pearson
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK; Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
| | - Sally Taylor
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK; Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Ashma Krishan
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Antonia Marsden
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Sacha Howell
- Division of Cancer Sciences, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | - Janelle Yorke
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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Inoue D, Orisaka M, Hirose H, Miyashita H, Yamada S, Tsuyoshi H, Shinagawa A, Kurokawa T, Yoshida Y. Attitudes toward cancer screening in regional Japan during the COVID-19 pandemic: An anonymous survey. Cancer Sci 2023; 114:4081-4088. [PMID: 37605505 PMCID: PMC10551611 DOI: 10.1111/cas.15931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/10/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic has raised concerns about the impact of delayed health check-ups and cancer screenings on cancer diagnosis and treatment. This study aimed to investigate the awareness of cancer patients on future screening measures during the pandemic in rural Japan. An anonymized open-data survey was undertaken in Fukui Prefecture, a rural region of Japan, in 2021. Participants were asked about their cancer screening history, screening frequency during the pandemic, and reasons for not undergoing screening. Among the 1262 respondents, the proportion of patients who underwent cancer screening in 2020 during the pandemic was similar to the proportion who underwent regular (annual or biannual) screening in 2019 before the pandemic. Of those who underwent regular screening, 82% still underwent screening in 2020, while only 21% of those who had irregular screenings. The number of respondents who believed they were healthy and did not require screening increased over time, possibly due to restrictions on going out and refraining from activities during the pandemic. This study in rural Japan found that regular cancer screening prior to the pandemic was associated with a more positive attitude toward screening during the pandemic. Raising awareness about the importance of cancer screening and encouraging participation is crucial for promoting positive attitudes in the future. The findings highlight the need for continued efforts to ensure access to screening services during the pandemic and future public health emergencies.
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Affiliation(s)
- Daisuke Inoue
- Department of Obstetrics and GynecologyUniversity of FukuiFukuiJapan
| | - Makoto Orisaka
- Department of Obstetrics and GynecologyUniversity of FukuiFukuiJapan
| | - Hiroaki Hirose
- Department of Health and WelfareFukui PrefectureFukuiJapan
| | | | - Shizuka Yamada
- Department of Obstetrics and GynecologyUniversity of FukuiFukuiJapan
| | - Hideaki Tsuyoshi
- Department of Obstetrics and GynecologyUniversity of FukuiFukuiJapan
| | - Akiko Shinagawa
- Department of Obstetrics and GynecologyUniversity of FukuiFukuiJapan
| | - Tetsuji Kurokawa
- Department of Obstetrics and GynecologyUniversity of FukuiFukuiJapan
| | - Yoshio Yoshida
- Department of Obstetrics and GynecologyUniversity of FukuiFukuiJapan
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Simon A, Badachi Y, Ropers J, Laurent I, Dong L, Da Maia E, Bourcier A, Canlorbe G, Uzan C. Value of high-resolution full-field optical coherence tomography and dynamic cell imaging for one-stop rapid diagnosis breast clinic. Cancer Med 2023; 12:19500-19511. [PMID: 37772663 PMCID: PMC10587972 DOI: 10.1002/cam4.6560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Full-field optical coherence tomography combined with dynamic cell imaging (D-FFOCT) is a new, simple-to-use, nondestructive, quick technique that can provide sufficient spatial resolution to mimic histopathological analysis. The objective of this study was to evaluate diagnostic performance of D-FFOCT for one-stop rapid diagnosis breast clinic. METHODS Dynamic full-field optical coherence tomography was applied to fresh, untreated breast and nodes biopsies. Four different readers (senior and junior radiologist, surgeon, and pathologist) analyzed the samples without knowing final histological diagnosis or American College of Radiology classification. The results were compared to conventional processing and staining (hematoxylin-eosin). RESULTS A total of 217 biopsies were performed on 152 patients. There were 144 breast biopsies and 61 lymph nodes with 101 infiltrative cancers (49.27%), 99 benign lesions (48.29%), 3 ductal in situ carcinoma (1.46%), and 2 atypias (0.98%). The diagnostic performance results were as follow: sensitivity: 77% [0.7;0.82], specificity: 64% [0.58;0.71], PPV: 74% [0.68;0.78], and NPV: 75% [0.72;0.78]. A large image atlas was created as well as a diagnosis algorithm from the readers' experience. CONCLUSION With 74% PPV and 75% NPV, D-FFOCT is not yet ready to be used in clinical practice to identify breast cancer. This is mainly explained by the lack of experience and knowledge of this new technic by the four lectors. By training with the diagnosis algorithm and the image atlas, radiologists could have better outcomes allowing quick detection of breast cancer and lymph node involvement. Deep learning could also be used, and further investigation will follow.
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Affiliation(s)
- Alexis Simon
- Department of Radiology, Pitié‐Salpêtrière HospitalAssistance Publique‐Hôpitaux de Paris (AP‐HP)ParisFrance
| | - Yasmina Badachi
- Department of Radiology, Pitié‐Salpêtrière HospitalAssistance Publique‐Hôpitaux de Paris (AP‐HP)ParisFrance
| | - Jacques Ropers
- Clinical Research Unit, Pitié‐Salpêtrière HospitalAssistance Publique‐Hôpitaux de Paris (AP‐HP)ParisFrance
| | - Isaura Laurent
- Clinical Research Unit, Pitié‐Salpêtrière HospitalAssistance Publique‐Hôpitaux de Paris (AP‐HP)ParisFrance
| | - Lida Dong
- Department of Pathology, Pitié‐Salpêtrière HospitalAssistance Publique‐Hôpitaux de Paris (AP‐HP)ParisFrance
| | - Elisabeth Da Maia
- Department of Pathology, Pitié‐Salpêtrière HospitalAssistance Publique‐Hôpitaux de Paris (AP‐HP)ParisFrance
| | - Agnès Bourcier
- Department of Gynaecological and Breast Surgery and OncologyAssistance Publique des Hôpitaux de Paris (AP‐HP)ParisFrance
| | - Geoffroy Canlorbe
- Department of Gynaecological and Breast Surgery and OncologyAssistance Publique des Hôpitaux de Paris (AP‐HP)ParisFrance
- Centre de Recherche Saint‐Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and TherapeuticsSorbonne UniversityParisFrance
- Institut Universitaire de Cancérologie (IUC)Sorbonne UniversityParisFrance
| | - Catherine Uzan
- Department of Gynaecological and Breast Surgery and OncologyAssistance Publique des Hôpitaux de Paris (AP‐HP)ParisFrance
- Centre de Recherche Saint‐Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and TherapeuticsSorbonne UniversityParisFrance
- Institut Universitaire de Cancérologie (IUC)Sorbonne UniversityParisFrance
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Zubair A, Jamshaid S, Scholfield DW, Hariri AA, Ahmed J, Ghufoor K, Ali S. Impact of COVID-19 pandemic on head-neck cancer referral and treatment pathway in North East London. Ann R Coll Surg Engl 2023; 105:S28-S34. [PMID: 35446702 PMCID: PMC10390247 DOI: 10.1308/rcsann.2021.0360] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 08/02/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has led to wide-ranging disruption of head-neck cancer (HNC) service provision in the UK. Early reports suggest delays in referral, diagnosis and initiation of treatment for new cancer cases compared with before the pandemic. METHODS The HNC service was studied retrospectively for the time-periods between 1 January 2020 to 31 October 2020 (hereafter 'post-COVID') and 1 January 2019 to 31 October 2019 (hereafter 'pre-COVID'). We analysed: (1) the number of cases treated at our centre, (2) stage of disease at presentation and (3) treatment delivery times. RESULTS In the post-COVID period, the total number of HNC cases treated decreased (48 vs 56 pre-COVID). There was increase in advanced stage at presentation (58% vs 42% pre-COVID) and a significant increase in the need for airway stabilisation (13 vs 5 pre-COVID; p=0.03). Average time from referral to treatment was significantly prolonged (72.5 days vs 49.23 days pre-COVID; p=0.03). Two-week wait referrals were seen in HNC clinics at median time of 11.9 days, compared with 7.1 days during the pre-COVID period (p=0.07). However, there was no delay in the initiation of first treatment after the decision to treat (29.2 days vs 24.7 days pre-COVID; p=0.58). CONCLUSION The results of this study call for early referral at the primary care level and rapid radiopathological confirmation at the tertiary level to prevent delays in diagnosis of new HNC cases.
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Affiliation(s)
| | | | | | | | | | | | - S Ali
- Barts Health NHS Trust, UK
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Mitchell H, Mclean J, Gavin AT, Visser O, Millar E, Luff T, Bennett D. Impact of COVID-19 control on lung, breast, and colorectal pathological cancer diagnoses. A comparison between the Netherlands, Aotearoa New Zealand, and Northern Ireland. BMC Cancer 2023; 23:700. [PMID: 37495980 PMCID: PMC10373228 DOI: 10.1186/s12885-023-11216-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/24/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic was managed in Aotearoa New Zealand (NZ) by a COVID-19 elimination policy, involving border closure and an initial national lockdown. This was different to most other countries including Northern Ireland (NI) and the Netherlands (NED). We quantify the effect of these policies on the diagnosis of three major cancers, comparing NZ with these two European countries. METHOD Data from NED, NZ and NI population-based cancer registries were used to assess trends in all pathologically diagnosed (PD) lung, breast, and colorectal cancers from March to December 2020 (pandemic period) and compared to the similar pre-pandemic period (2017-2019). Trend data were also collated on COVID-19 cases and deaths per 100,000 in each population. RESULTS Comparing the pre-pandemic period to the pandemic period there were statistically significant reductions in numbers of lung (↓23%) and colorectal (↓15%) PD cancers in NI and numbers of breast (↓18%) and colorectal cancer (↓18.5%) diagnosed in the NED. In NZ there was no significant change in the number of lung (↑10%) or breast cancers (↑0.2%) but a statistically significant increase in numbers of colorectal cancer diagnosed (↑5%). CONCLUSION The impact of COVID-19 on cancer services was mitigated in NZ as services continued as usual reflecting minimal healthcare disruption and protected cancer services linked with the elimination approach adopted. The reduction in PD cases diagnosed in NED and NI were linked with higher COVID-19 rates and reflect societal restrictions which resulted in delayed patient presentation to primary and secondary care, disruption to screening and healthcare services as a result of COVID-19 infections on staff and the need to shift intensive care to COVID-19 patients. Reductions in PD cancers in NI and the NED and in particularly lung cancers in NI, highlight the need for targeted public health campaigns to identify and treat 'missing' patients. Protecting cancer services should be a priority in any future pandemic or systemic healthcare system disruption.
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Affiliation(s)
- Helen Mitchell
- Centre for Public Health, Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, Northern Ireland.
| | - Jennifer Mclean
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Anna T Gavin
- Centre for Public Health, Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, Northern Ireland
| | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Elinor Millar
- Te Aho o Te Kahu - Cancer Control Agency, Wellington, New Zealand
| | - Tessa Luff
- Te Aho o Te Kahu - Cancer Control Agency, Wellington, New Zealand
| | - Damien Bennett
- Centre for Public Health, Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, Northern Ireland
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Myers C, Bennett K, Cahir C. Breast cancer care amidst a pandemic: a scoping review to understand the impact of coronavirus disease 2019 on health services and health outcomes. Int J Qual Health Care 2023; 35:mzad048. [PMID: 37497806 PMCID: PMC10373113 DOI: 10.1093/intqhc/mzad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/19/2023] [Accepted: 06/28/2023] [Indexed: 07/28/2023] Open
Abstract
Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, health services for breast cancer (BC) have been disrupted. Our scoping review examines the impact of the COVID-19 pandemic on BC services, health outcomes, and well-being for women. Additionally, this review identifies social inequalities specific to BC during the pandemic. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines, the literature search was conducted using scientific databases starting from March 2020 through November 2021. Studies were identified and selected by two researchers based on inclusion criteria, and the relevant data were extracted and charted to summarize the findings. Ninety-three articles were included in this review. Main themes included are as follows: (i) the impact of COVID-19 on BC services; (ii) the impact of COVID-19 on health outcomes and well-being in women with BC; and (iii) any variation in the impact of COVID-19 on BC by social determinants of health. There were apparent disruptions to BC services across the cancer continuum, especially screening services. Clinical repercussions were a result of such disruptions, and women with BC experienced worsened quality of life and psychosocial well-being. Finally, there were social inequalities dependent on social determinants of health such as age, race, insurance status, and region. Due to the disruption of BC services during the COVID-19 pandemic, women were impacted on their health and overall well-being. The variation in impact demonstrates how health inequities have been exacerbated during the pandemic. This comprehensive review will inform timely health-care changes to minimize long-term impacts of the pandemic and improve evidence-based multidisciplinary needs.
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Affiliation(s)
- Charlotte Myers
- School of Population Health, RCSI University of Medicine and Health Science, Dublin D02 DH60, Ireland
| | - Kathleen Bennett
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Science, Dublin D02 DH60, Ireland
| | - Caitriona Cahir
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Science, Dublin D02 DH60, Ireland
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Aggarwal A, Han L, Sullivan R, Haire K, Sangar V, van der Meulen J. Managing the cancer backlog: a national population-based study of patient mobility, waiting times and 'spare capacity' for cancer surgery. THE LANCET REGIONAL HEALTH. EUROPE 2023; 30:100642. [PMID: 37465324 PMCID: PMC10350851 DOI: 10.1016/j.lanepe.2023.100642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 07/20/2023]
Abstract
Background Waiting times for cancer treatments continue to increase in many countries. In this study we estimated potential 'spare surgical capacity' in the English NHS and identified regions more likely to have spare capacity based on patterns of patient mobility (the extent to which patients receive surgery at hospitals other than their nearest). Methods We identified patients who had an elective breast or colorectal cancer surgical resection between January 2016 and December 2018. We estimated each hospital's 'maximum surgical capacity' as the maximum 6-month moving average of its surgical volume. 'Spare surgical capacity' was estimated as the difference between maximum surgical capacity and observed surgical volume. We assessed the association between spare surgical capacity and whether a hospital performed more or fewer procedures than expected due to patient mobility as well as the association between spare surgical capacity and whether or not waiting times targets for treatment were likely to be met. Findings 100,585 and 49,445 patients underwent breast and colorectal cancer surgery respectively. 67 of 166 hospitals (40.4%) providing breast cancer surgery and 82 of 163 hospitals (50.3%) providing colorectal cancer surgery used less than 80% of their maximum surgical capacity. Hospitals with a 'net loss' of patients to hospitals further away had more potential spare capacity than hospitals with a 'net gain' of patients (p < 0.001 for breast and p = 0.01 for colorectal cancer). At the national level, we projected an annual potential spare capacity of 8389 breast cancer and 4262 colorectal cancer surgical procedures, approximately 25% of the volumes actually performed. Interpretation Spare surgical capacity potentially exists in the present configuration of hospitals providing cancer surgery and requires regional allocation for efficient utilisation. Funding National Institute for Health Research.
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Affiliation(s)
- Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Institute of Cancer Policy, King's College London, London, UK
| | - Lu Han
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Vijay Sangar
- The Christie NHS Trust and Manchester University NHS Foundation Trust, Manchester, UK
- Manchester University, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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12
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Oymans EJ, de Kroon CD, Bart J, Nijman HW, van der Aa MA. Incidence of gynaecological cancer during the COVID-19 pandemic: A population-based study in the Netherlands. Cancer Epidemiol 2023; 85:102405. [PMID: 37356263 PMCID: PMC10281225 DOI: 10.1016/j.canep.2023.102405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/16/2023] [Accepted: 06/18/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To study the impact of the COVID-19 pandemic and consequent lockdown on the number of diagnoses of gynaecological malignancies in the Netherlands. METHODS We performed a retrospective cohort study using data from the Netherlands Cancer Registry (NCR) on women of 18 years and older diagnosed with invasive endometrial, ovarian, cervical or vulvar cancer in the period 2017-2021. Analyses were stratified for age, socioeconomical status (SES) and region. RESULTS The incidence rate of gynaecological cancer was 67/100.000 (n = 4832) before (2017-2019) and 68/100.000 (n = 4833) during (2020) the COVID-19 pandemic. Comparing the number of diagnoses of the two periods for the four types of cancer separately showed no significant difference. During the first wave of COVID-19 (March-June 2020), a clear decrease in number of gynaecological cancer diagnoses was visible (20-34 %). Subsequently, large increases in number of diagnoses were visible (11-29 %). No significant differences in incidence were found between different age groups, SES and regions. In 2021 an increase of 5.9 % in number of diagnoses was seen. CONCLUSION In the Netherlands, a clear drop in number of diagnoses was visible for all four types of gynaecological cancers during the first wave, with a subsequent increase in number of diagnoses in the second part of 2020 and in 2021. No differences between SES groups were found. This illustrates good organisation of and access to health care in the Netherlands.
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Affiliation(s)
- Eline J Oymans
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands; Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
| | - Cor D de Kroon
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Joost Bart
- University of Groningen, University Medical Center Groningen, Department of Pathology, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Maaike A van der Aa
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands
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13
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Elghobashy M, Wahab L, Gunavardhan A, O'Sullivan E, Provenzano E, Deb R, Pritchard S, Di Palma S, Ellis IO, Boyd C, Pinder SE, Shaaban AM. Impact of COVID-19 on the practice of breast pathologists: a survey of breast pathologists in the UK and Ireland. J Clin Pathol 2023; 76:234-238. [PMID: 34620607 PMCID: PMC8507406 DOI: 10.1136/jclinpath-2021-207725] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/23/2021] [Indexed: 12/16/2022]
Abstract
AIMS There is little information on the impact of COVID-19 on breast pathologists. This survey assessed the effect of the COVID-19 pandemic on UK and Ireland-based breast pathologists to optimise working environments and ensure preparedness for potential future pandemics. METHODS A 35-question survey during the first wave of COVID-19 infections in the UK including questions on workload, working practices, professional development, training, health and safety and well-being was distributed to consultant breast pathologists and responses collected anonymously. RESULTS There were 135 responses from breast pathologists based in the UK and Ireland. Most participants (75.6%) stated that their workload had decreased and their productivity dropped. 86/135 (63.7%) were given the option of working from home and 36% of those who did reported improved efficiency. Multidisciplinary team meetings largely moved to virtual platforms (77.8%) with fewer members present (41.5%). Online education, including webinars and courses, was utilised by 92.6%. 16.3% of pathologists reported shortages of masks, visors or gowns as the the most common health and safety concern. COVID-19 had a significant negative impact on the physical and mental health of 33.3% of respondents. A small number of pathologists (10.4%) were redeployed and/or retrained. CONCLUSION The UK and Ireland breast pathologists adapted to the rapid change and maintained service delivery despite the significant impact of the pandemic on their working practices and mental health. It is important to apply flexible working patterns and environments that improve productivity and well-being. The changes suggested should be considered for long-term shaping of breast pathology services.
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Affiliation(s)
- Mirna Elghobashy
- University of Birmingham, College of Medical and Dental Sciences, Birmingham, UK
| | - Lutful Wahab
- Histopathology, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Anu Gunavardhan
- Histopathology, Betsi Cadwaladr University Health Board, Bangor, UK
| | | | | | - Rahul Deb
- Cellular Pathology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | | | - Silvana Di Palma
- Histology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Ian O Ellis
- Molecular Medical Sciences, University of Nottingham, Nottingham, UK
| | - Clinton Boyd
- Histopathology, Belfast Health and Social Care Trust, Belfast, UK
| | - Sarah E Pinder
- Academic Oncology/Breast Pathology, King's College London, London, UK
| | - Abeer M Shaaban
- Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Cellular Pathology, Queen Elizabeth Hospital, Birmingham, UK
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14
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Gathani T, Dodwell D, Horgan K. The impact of the first 2 years of the COVID-19 pandemic on breast cancer diagnoses: a population-based study in England. Br J Cancer 2023; 128:481-483. [PMID: 36371502 PMCID: PMC9660015 DOI: 10.1038/s41416-022-02054-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/19/2022] [Accepted: 10/28/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Toral Gathani
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
- Department of Breast Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - David Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kieran Horgan
- Department of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, UK
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15
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Machii R, Takahashi H. Japanese cancer screening programs during the COVID-19 pandemic: Changes in participation between 2017-2020. Cancer Epidemiol 2023; 82:102313. [PMID: 36508964 PMCID: PMC9726684 DOI: 10.1016/j.canep.2022.102313] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/21/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The impact of the coronavirus disease 2019 (COVID-19) pandemic on cancer screening participation is a global concern. A national database of screening performance is available in Japan for population-based cancer screening, estimated to cover approximately half of all cancer screenings. METHODS Utilizing the fiscal year (FY) 2017-2020 national database, the number of participants in screenings for gastric cancer (upper gastrointestinal [UGI] series or endoscopy), colorectal cancer (fecal occult blood test), lung cancer (chest X-ray), breast cancer (mammography), and cervical cancer (Pap smear) were identified. The percent change in the number of participants was calculated. RESULTS Compared with the pre-pandemic period (FY 2017-2019), in percentage terms FY 2020 recorded the largest decline in gastric cancer UGI series (2.82 million to 1.91 million, percent change was -32.2 %), followed by screening for breast cancer (3.10 million to 2.57 million, percent change was -17.2 %), lung cancer (7.92 million to 6.59 million, percent change was -16.7 %), colorectal cancer (8.42 million to 7.30 million, percent change was -13.4 %), cervical cancer (4.26 million to 3.77 million, percent change was -11.6 %), and gastric cancer via endoscopy (1.02 million to 0.93 million, percent change was -9.0 %). CONCLUSION The number of participants in population-based screenings in Japan decreased by approximately 10-30 % during the pandemic. The impact of these declines on cancer detection or mortality should be carefully monitored.
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Affiliation(s)
- Ryoko Machii
- Division of Quality Assurance Programs, Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
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16
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Anedda G, Cappellacci F, Canu GL, Farris S, Calò PG, Dessena M, Medas F. Axillary Treatment Management in Breast Cancer during COVID-19 Pandemic (Association between ACOSOG Z0011 Criteria and OSNA Test). J Pers Med 2023; 13:jpm13020241. [PMID: 36836475 PMCID: PMC9960710 DOI: 10.3390/jpm13020241] [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] [Received: 12/20/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
The outbreak of the SARS-COVID-2 pandemic (COVID-19) had a significant effect on the organisation of healthcare systems. Surgical units saw a significant reduction in the volume of surgical procedures performed, with lengthening waiting lists as a consequence. We assessed the surgical activity in relation to breast cancer that took place at the University Hospital of Cagliari, Italy, from February 2018 to March 2022. Two phases were identified based on the epidemiological circumstances: Phase 1-February 2018 to February 2020; Phase 2-March 2020 to March 2022. The surgery performed in the two phases was then compared. All the patients in our sample underwent a breast surgical procedure involving a lymph node biopsy using OSNA associated with the ACOSOG Z0011 criteria. In the study period overall at our facility, there were 4214 procedures, 417 of which involved breast surgery. In Phase 2, 91 procedures were performed using the OSNA method and ACOSOG Z0011 criteria, enabling the intraoperative staging of axillary nodes. Axillary treatment in breast cancer using this approach resulted in a significant reduction in the number of reoperations for the radicalisation of metastatic sentinel lymph nodes.
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Affiliation(s)
- Giacomo Anedda
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
- Correspondence: ; Tel.: +39-3335351390
| | | | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
| | - Stefania Farris
- Polispecialistyc Surgery Unit, Policlinico Universitario “Duilio Casula”, 09042 Cagliari, Italy
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
| | - Massimo Dessena
- Polispecialistyc Surgery Unit, Policlinico Universitario “Duilio Casula”, 09042 Cagliari, Italy
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
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17
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Li T, Nickel B, Ngo P, McFadden K, Brennan M, Marinovich ML, Houssami N. A systematic review of the impact of the COVID-19 pandemic on breast cancer screening and diagnosis. Breast 2023; 67:78-88. [PMID: 36646004 PMCID: PMC9813855 DOI: 10.1016/j.breast.2023.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/27/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Breast cancer care has been affected by the COVID-19 pandemic. This systematic review aims to describe the observed pandemic-related changes in clinical and health services outcomes for breast screening and diagnosis. METHODS Seven databases (January 2020-March 2021) were searched to identify studies of breast cancer screening or diagnosis that reported observed outcomes before and related to the pandemic. Findings were presented using a descriptive and narrative approach. RESULTS Seventy-four studies were included in this systematic review; all compared periods before and after (or fluctuations during) the pandemic. None were assessed as being at low risk of bias. A reduction in screening volumes during the pandemic was found with over half of studies reporting reductions of ≥49%. A majority (66%) of studies reported reductions of ≥25% in the number of breast cancer diagnoses, and there was a higher proportion of symptomatic than screen-detected cancers. The distribution of cancer stage at diagnosis during the pandemic showed lower proportions of early-stage (stage 0-1/I-II, or Tis and T1) and higher proportions of relatively more advanced cases than that in the pre-pandemic period, however population rates were generally not reported. CONCLUSIONS Evidence of substantial reductions in screening volume and number of diagnosed breast cancers, and higher proportions of advanced stage cancer at diagnosis were found during the pandemic. However, these findings reflect short term outcomes, and higher-quality research examining the long-term impact of the pandemic is needed.
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Affiliation(s)
- Tong Li
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia; School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Brooke Nickel
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Preston Ngo
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia
| | - Kathleen McFadden
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia
| | - Meagan Brennan
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia
| | - M Luke Marinovich
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nehmat Houssami
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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18
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Giorgi Rossi P, Carrozzi G, Falini P, Sampaolo L, Gorini G, Zorzi M, Armaroli P, Senore C, Sassoli de Bianchi P, Masocco M, Zappa M, Battisti F, Mantellini P. The impact of the COVID-19 pandemic on Italian population-based cancer screening activities and test coverage: Results from national cross-sectional repeated surveys in 2020. eLife 2023; 12:81804. [PMID: 36734526 PMCID: PMC9934859 DOI: 10.7554/elife.81804] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
Background In Italy, regions have the mandate to implement population-based screening programs for breast, cervical, and colorectal cancer. From March to May 2020, a severe lockdown was imposed due to the COVID-19 pandemic by the Italian Ministry of Health, with the suspension of screening programs. This paper describes the impact of the pandemic on Italian screening activities and test coverage in 2020 overall and by socioeconomic characteristics. Methods The regional number of subjects invited and of screening tests performed in 2020 were compared with those in 2019. Invitation and examination coverage were also calculated. PASSI surveillance system, through telephone interviews, collects information about screening test uptake by test provider (public screening and private opportunistic). Test coverage and test uptake in the last year were computed by educational attainment, perceived economic difficulties, and citizenship. Results A reduction of subjects invited and tests performed, with differences between periods and geographical macro areas, was observed in 2020 vs. 2019. The reduction in examination coverage was larger than that in invitation coverage for all screening programs. From the second half of 2020, the trend for test coverage showed a decrease in all the macro areas for all the screening programs. Compared with the pre-pandemic period, there was a greater difference according to the level of education in the odds of having had a test last year vs. never having been screened or not being up to date with screening tests. Conclusions The lockdown and the ongoing COVID-19 emergency caused an important delay in screening activities. This increased the preexisting individual and geographical inequalities in access. The opportunistic screening did not mitigate the impact of the pandemic. Funding This study was partially supported by Italian Ministry of Health - Ricerca Corrente Annual Program 2023 and by the Emilian Region DGR 839/22.
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Affiliation(s)
- Paolo Giorgi Rossi
- Azienda Unità Sanitaria Locale - IRCCS di Reggio EmiliaReggio EmiliaItaly
| | | | - Patrizia Falini
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO)FlorenceItaly
| | | | - Giuseppe Gorini
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO)FlorenceItaly
| | - Manuel Zorzi
- Registro Tumori del Veneto, Azienda ZeroPaduaItaly
| | - Paola Armaroli
- Centro di Prevenzione Oncologica, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di TorinoTurinItaly
| | - Carlo Senore
- Centro di Prevenzione Oncologica, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di TorinoTurinItaly
| | - Priscilla Sassoli de Bianchi
- Servizio Prevenzione Collettiva e Sanità Pubblica, Direzione Generale Cura della Persona, Salute e Welfare, Regione Emilia-RomagnaBolognaItaly
| | | | - Marco Zappa
- Osservatorio Nazionale ScreeningFlorenceItaly
| | - Francesca Battisti
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO)FlorenceItaly
| | - Paola Mantellini
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO)FlorenceItaly,Osservatorio Nazionale ScreeningFlorenceItaly
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19
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Al-Hussaini M, Al-Ani A, Hammouri M, Al-Huneidy L, Mansour A. Investigating the impact of COVID-19 on patients with cancer from areas of conflict within the MENA region treated at King Hussein Cancer Center. Front Oncol 2023; 13:1088000. [PMID: 36910625 PMCID: PMC9995942 DOI: 10.3389/fonc.2023.1088000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/30/2023] [Indexed: 02/25/2023] Open
Abstract
Background There is a paucity of evidence regarding the impact of COVID-19 on cancer care among refugees or patients from areas of conflict. Cancer care for these populations remains fragmented due to resource scarcity and limited infrastructure. Aims To explore the effect of COVID-19 on cancer care among patients from areas of conflict treated at King Hussein Cancer Center (KHCC). Methodology We performed a retrospective chart review of all patients from areas of conflict, treated at KHCC from 2018 to 2021. Patients' demographics and clinical characteristics are presented in the form of descriptive statistics. Interrupted Time Series (ITS) analysis was utilized to investigate the impact of COVID-19 on the number of admissions throughout the study's period. Results A total of 3317 patients from areas of conflict were included in the study. Among these, 1546 were males (46.6%) while 1771 (53.4%) were female. Libyans (34.6%), Palestinians (24.8%), Iraqis (24.5%), Syrians (15.3%), and Sudanese patients (0.9%) constituted our study sample. ITS analysis demonstrated that the start of the COVID-19 lockdown significantly decreased admissions by 44.0% (p = 0.020), while the end of the COVID-19 restriction significantly improved admissions by 43.0% (p = 0.023). Among those with available SEER stages, more than a quarter of patients had distant metastasis (n = 935, 28.2%) irrespective of age and biological sex. Advanced presentations during 2020 had approximately a 16% and 6% increase compared to 2018 and 2019, respectively. Breast cancer (21.4%), hematolymphoid cancers (18.1%), and cancers of the digestive system (16.5%) were the most common cancers among our cohort. Conclusion Restrictions associated with COVID-19 had a significant effect on the number of admissions of patients from areas of conflict. In the long term, this effect may impact the survival outcomes of affected patients.
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Affiliation(s)
- Maysa Al-Hussaini
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Abdallah Al-Ani
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | | | | | - Asem Mansour
- Department of Radiology, King Hussein Cancer Center, Amman, Jordan
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20
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Simão D, Sardinha M, Reis AF, Spencer AS, Luz R, Oliveira S. What Has Changed During the COVID-19 Pandemic? - The Effect on an Academic Breast Department in Portugal. Eur J Breast Health 2022; 18:74-78. [DOI: 10.4274/ejbh.galenos.2021.2021-11-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/11/2021] [Indexed: 12/01/2022]
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21
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Charos D, Andriopoulou M, Vivilaki V. Breast cancer and COVID-19: The need for enhanced psychological support for women with breast cancer during the pandemic. Eur J Midwifery 2022; 6:69. [PMID: 36591333 PMCID: PMC9773269 DOI: 10.18332/ejm/156899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 11/24/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Dimitrios Charos
- Department of Midwifery, University of West Attica, Athens, Greece,General Anticancer- Oncology Hospital ‘Agios Savvas’, Athens, Greece
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22
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Arnold M, Morgan E, Rumgay H, Mafra A, Singh D, Laversanne M, Vignat J, Gralow JR, Cardoso F, Siesling S, Soerjomataram I. Current and future burden of breast cancer: Global statistics for 2020 and 2040. Breast 2022; 66:15-23. [PMID: 36084384 PMCID: PMC9465273 DOI: 10.1016/j.breast.2022.08.010] [Citation(s) in RCA: 678] [Impact Index Per Article: 339.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Breast cancer is the most commonly diagnosed cancer worldwide, and its burden has been rising over the past decades. In this article, we examine and describe the global burden of breast cancer in 2020 and predictions for the year 2040. METHODS Estimates of new female breast cancer cases and deaths in 2020 were abstracted from the GLOBOCAN database. Age-standardized incidence and mortality rates were calculated per 100,000 females by country, world region, and level of human development. Predicted cases and deaths were computed based on global demographic projections for the year 2040. RESULTS Over 2.3 million new cases and 685,000 deaths from breast cancer occurred in 2020. Large geographic variation across countries and world regions exists, with incidence rates ranging from <40 per 100,000 females in some Asian and African countries, to over 80 per 100,000 in Australia/New Zealand, Northern America, and parts of Europe. Smaller geographical variation was observed for mortality; however, transitioning countries continue to carry a disproportionate share of breast cancer deaths relative to transitioned countries. By 2040, the burden from breast cancer is predicted to increase to over 3 million new cases and 1 million deaths every year because of population growth and ageing alone. CONCLUSION Breast cancer is the most common cancer worldwide and continues to have a large impact on the global number of cancer deaths. Global efforts are needed to counteract its growing burden, especially in transitioning countries where incidence is rising rapidly, and mortality rates remain high.
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Affiliation(s)
- Melina Arnold
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Eileen Morgan
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France.
| | - Harriet Rumgay
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Allini Mafra
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Deependra Singh
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Mathieu Laversanne
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Jerome Vignat
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Julie R Gralow
- American Society of Clinical Oncology, Alexandria VA, USA
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands; Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, Netherlands
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23
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The impact of the SARS-COV-2 pandemic on the quality of breast cancer care in EUSOMA-certified breast centres. Eur J Cancer 2022; 177:72-79. [PMID: 36332437 PMCID: PMC9554010 DOI: 10.1016/j.ejca.2022.09.027] [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] [Received: 08/09/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 01/06/2023]
Abstract
AIMS We analysed the impact of the SARS-CoV-2 pandemic (COVID-19) on the quality of breast cancer care in certified EUSOMA (European Society of Breast Cancer Specialists) breast centres. MATERIALS AND METHODS The results of the EUSOMA quality indicators were compared, based on pseudonymised individual records, for the periods 1 March 2020 till 30 June 2020 (first COVID-19 peak in most countries in Europe) and 1 March 2019 till 30 June 2019. In addition, a questionnaire was sent to the participating Centres for investigating the impact of the COVID-19 pandemic on the organisation and the quality of breast cancer care. RESULTS Forty-five centres provided data and 31 (67%) responded to the questionnaire. The total number of new cases dropped by 19% and there was a small significant higher tumour (p = 0.003) and lymph node (p = 0.011) stage at presentation. Comparing quality indicators (12,736 patients) by multivariable analysis showed mostly non-significant differences. Surgery could be performed in a COVID-free zone in 94% of the centres, COVID testing was performed before surgery in 96% of the centres, and surgical case load was reduced in 55% of the centres. Modifications of the indications for neoadjuvant endocrine therapy, chemotherapy, and targeted therapy were necessary in 23%, 23%, and 10% of the centres; changes in indications for adjuvant endocrine, chemo-, targeted, immune, and radiotherapy in 3%, 19%, 3%, 6%, and 10%, respectively. CONCLUSION Quality of breast cancer care was well maintained in EUSOMA breast centres during the first wave of the COVID-19 pandemic. A small but significantly higher tumour and lymph node stage at presentation was observed.
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Lymphadenopathies before and during the Pandemic COVID-19: Increasing Incidence of Metastases from Solid Tumors. J Clin Med 2022; 11:jcm11236979. [PMID: 36498559 PMCID: PMC9739990 DOI: 10.3390/jcm11236979] [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] [Received: 10/21/2022] [Revised: 11/20/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Since December 2019, the world has experienced a pandemic caused by SARS-CoV-2, a virus which spread throughout the world. Anti-COVID19 measures were applied to limit the spread of the infection, affecting normal clinical practice. In 2020, studies on the possible impact of the pandemic considering the screening programs for early diagnosis of cancer were conducted, resulting in a prediction of delayed diagnosis of cancer. We performed a retrospective monocentric study on patients who present with the onset of lymphadenomegalies evaluated at our Hematological Department from February 2019 to October 2021 and undergoing excisional lymph-node biopsy. Three periods were considered: pre-pandemic, first pandemic period and second pandemic period (Group A, B and C). We included 258 patients who underwent a surgical biopsy and received a histological diagnosis. Hematological evaluation of outpatients sent by the general practitioner and surgical biopsies did not decrease among the three groups, despite limitations placed during this pandemic as well as new diagnoses of hematological malignancies. However, the diagnosis of metastatic cancer significantly increased from 2019 (7.8%) to 2021 (22.1%) (p = 0.042). Our data supports the hypothesis that the pandemic affected the national screening programs of early cancer detection.
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Petropoulou Z, Arkadopoulos N, Michalopoulos NV. Breast Cancer and COVID-19: Challenges in Surgical Management. Cancers (Basel) 2022; 14:5360. [PMID: 36358779 PMCID: PMC9653580 DOI: 10.3390/cancers14215360] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/06/2022] [Accepted: 10/28/2022] [Indexed: 09/17/2023] Open
Abstract
The harsh healthcare reality imposed by the COVID-19 pandemic resulted in wide clinical practice alterations, postponements, and shortages, affecting both patients and caregivers. Breast-cancer management, from diagnosis to treatment and follow up, was a field that did not escape such changes, facing a challenging set of obstacles in order to maintain adequate cancer care services while diminishing viral spread among patients and personnel. In this review article, we discuss the impact of the COVID-19 pandemic on several aspects of breast-cancer management, and the subsequent modifications adopted by clinicians, scientific groups, and governments as a response to the novel conditions. Screening and diagnosis, as well as breast-cancer treatment paths-especially surgical interventions-were the most affected domains, while patients' psychological burden also emerged as a notable consequence. The aftermath of diagnostic and surgical delays is yet to be assessed, while the treatment alterations and the introduction of new therapeutic schemes might signify the opening of a novel era in breast-cancer management.
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Affiliation(s)
- Zoe Petropoulou
- 4th Department of Surgery, Medical School, “Attikon” University Hospital, University of Athens, 12462 Athens, Greece
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Smith AF, Frempong SN, Sharma N, Neal RD, Hick L, Shinkins B. An exploratory assessment of the impact of a novel risk assessment test on breast cancer clinic waiting times and workflow: a discrete event simulation model. BMC Health Serv Res 2022; 22:1301. [PMID: 36309678 PMCID: PMC9617530 DOI: 10.1186/s12913-022-08665-0] [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: 11/04/2021] [Accepted: 10/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background Breast cancer clinics across the UK have long been struggling to cope with high demand. Novel risk prediction tools – such as the PinPoint test – could help to reduce unnecessary clinic referrals. Using early data on the expected accuracy of the test, we explore the potential impact of PinPoint on: (a) the percentage of patients meeting the two-week referral target, and (b) the number of clinic ‘overspill’ appointments generated (i.e. patients having to return to the clinic to complete their required investigations). Methods A simulation model was built to reflect the annual flow of patients through a single UK clinic. Due to current uncertainty around the exact impact of PinPoint testing on standard care, two primary scenarios were assessed. Scenario 1 assumed complete GP adherence to testing, with only non-referred cancerous cases returning for delayed referral. Scenario 2 assumed GPs would overrule 20% of low-risk results, and that 10% of non-referred non-cancerous cases would also return for delayed referral. A range of sensitivity analyses were conducted to explore the impact of key uncertainties on the model results. Service reconfiguration scenarios, removing individual weekly clinics from the clinic schedule, were also explored. Results Under standard care, 66.3% (95% CI: 66.0 to 66.5) of patients met the referral target, with 1,685 (1,648 to 1,722) overspill appointments. Under both PinPoint scenarios, > 98% of patients met the referral target, with overspill appointments reduced to between 727 (707 to 746) [Scenario 1] and 886 (861 to 911) [Scenario 2]. The reduced clinic demand was sufficient to allow removal of one weekly low-capacity clinic [N = 10], and the results were robust to sensitivity analyses. Conclusion The findings from this early analysis indicate that risk prediction tools could have the potential to alleviate pressure on cancer clinics, and are expected to have increased utility in the wake of heightened pressures resulting from the COVID-19 pandemic. Further research is required to validate these findings with real world evidence; evaluate the broader clinical and economic impact of the test; and to determine outcomes and risks for patients deemed to be low-risk on the PinPoint test and therefore not initially referred. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08665-0.
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Soto-Ruiz N, Escalada-Hernández P, Martín-Rodríguez LS, Ferraz-Torres M, García-Vivar C. Web-Based Personalized Intervention to Improve Quality of Life and Self-Efficacy of Long-Term Breast Cancer Survivors: Study Protocol for a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12240. [PMID: 36231542 PMCID: PMC9564785 DOI: 10.3390/ijerph191912240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Long-term breast cancer survivors (>5 years free of disease) may suffer late sequelae of cancer that impact on their quality of life. The use of telehealth for cancer care is recommended but little is known about the effectiveness of digital interventions for long-term cancer survivors. This study aims to evaluate the effectiveness of a web-based personalized intervention based on artificial intelligence instead of usual primary health care to improve the quality of life of long-term survivors of breast cancer and self-efficacy for the management of late sequelae. A randomized controlled trial will be conducted. The sample will consist of long-term breast cancer survivors recruited from primary health centers. Women will be randomly assigned to the intervention group to receive a web-based personalized intervention or to the control group to receive standard primary health care by nurses. Data on quality of life of cancer survivors and self-efficacy for the management of late sequelae of cancer will be collected and assessed at preintervention, and at 3, 6, and 9 months. It is expected that, at the end of the programme, the experimental group will have improved quality of life and improved self-efficacy for the management of late sequelae of cancer.
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Affiliation(s)
- Nelia Soto-Ruiz
- Department of Health Science, Public University of Navarre, 31008 Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - Paula Escalada-Hernández
- Department of Health Science, Public University of Navarre, 31008 Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - Leticia San Martín-Rodríguez
- Department of Health Science, Public University of Navarre, 31008 Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - Marta Ferraz-Torres
- Department of Health Science, Public University of Navarre, 31008 Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - Cristina García-Vivar
- Department of Health Science, Public University of Navarre, 31008 Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
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Yin X, Cheng Y, Yao S, Wu J, Liu S, Li W, Yu S, Tang L, Jing Y, Pang L, Cheng H. Fear of cancer recurrence is related to the efficacy of immunotherapy and quality of life in patients with NSCLC during the COVID-19 pandemic in China. Am J Cancer Res 2022; 12:4040-4049. [PMID: 36119842 PMCID: PMC9442025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023] Open
Abstract
The outbreak of the COVID-19 pandemic has greatly impacted patients with non-small cell lung cancer (NSCLC), making the fear of cancer recurrence (FCR) more pronounced. We explored the effects of FCR on immunotherapy efficacy and quality of life during the COVID-19 pandemic in China among the 124 NSCLC patients enrolled in this study. Quality of life and immunotherapy efficacy were compared between high- and low-FCR groups after completing 4-6 courses of treatment or cancer progression. Worse immunotherapy efficacy and quality of life were reported for the high-FCR group than for the low-FCR group. These findings emphasize the need to pay close attention to the level of FCR in NSCLC patients. Efforts should be taken to alleviate FCR levels among NSCLC patients. Moreover, research is needed to investigate the possible link between immunotherapy efficacy and FCR.
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Affiliation(s)
- Xiangxiang Yin
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical UniversityHefei, Anhui, China
- Cancer and Cognition Laboratory, Anhui Medical UniversityHefei, Anhui, China
| | - Yuhang Cheng
- Department of Public Health, Cancer Hospital, Hefei Institutes of Physical Science, Chinese Academy of SciencesHefei, Anhui, China
| | - Senbang Yao
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical UniversityHefei, Anhui, China
- Cancer and Cognition Laboratory, Anhui Medical UniversityHefei, Anhui, China
| | - Junxu Wu
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical UniversityHefei, Anhui, China
| | - Shaochun Liu
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical UniversityHefei, Anhui, China
- Cancer and Cognition Laboratory, Anhui Medical UniversityHefei, Anhui, China
| | - Wen Li
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical UniversityHefei, Anhui, China
- Cancer and Cognition Laboratory, Anhui Medical UniversityHefei, Anhui, China
| | - Sheng Yu
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical UniversityHefei, Anhui, China
- Cancer and Cognition Laboratory, Anhui Medical UniversityHefei, Anhui, China
| | - Lingxue Tang
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical UniversityHefei, Anhui, China
- Cancer and Cognition Laboratory, Anhui Medical UniversityHefei, Anhui, China
| | - Yanyan Jing
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical UniversityHefei, Anhui, China
- Cancer and Cognition Laboratory, Anhui Medical UniversityHefei, Anhui, China
| | - Lulian Pang
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical UniversityHefei, Anhui, China
- Cancer and Cognition Laboratory, Anhui Medical UniversityHefei, Anhui, China
| | - Huaidong Cheng
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical UniversityHefei, Anhui, China
- Cancer and Cognition Laboratory, Anhui Medical UniversityHefei, Anhui, China
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Mitchell H, Alford BS, O'Hare S, O'Callaghan E, Fox C, Gavin AT. Impact of the COVID-19 pandemic on emergency hospital cancer admissions in a UK region. BMC Cancer 2022; 22:850. [PMID: 35927617 PMCID: PMC9351130 DOI: 10.1186/s12885-022-09932-3] [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: 05/17/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The pandemic disrupted society and health services through lockdowns and resource reallocation to care for COVID-19 patients. Reductions in numbers of cancer patients having surgery, being diagnosed pathologically or via 2-week wait, and screening programs pauses have been described. The effect on emergency presentation, which represents an acute episode with poor outcomes, has not been investigated. This study explored the pandemic's impact on emergency hospital admissions for cancer patients in a UK region. METHODS Hospital discharge data for cancer patients in Northern Ireland, which included route to admission, were analysed for the pandemic era in 2020 compared to averages for March to December 2017-2019, focusing on volume and route of emergency admissions by demography and tumour site. FINDINGS Compared with the pre-pandemic era, the number of cancer emergency admissions fell by 12·3% in 2020. Emergency admissions for cancer were significantly reduced when COVID-19 levels were highest (- 18·5% in April and - 16.8% in October). Females (- 15·8%), urban residents (- 13·2%), and age groups 0 to 49 and 65-74 years old (- 17%) experienced the largest decreases as did those with haematological (- 14·7%), brain and CNS (- 27·9%), and lung cancers(- 14·3%). Significant reductions in referrals from outpatient departments (- 51%) and primary care (- 43%) (p < 0·001) were counterbalanced by admissions from other routes including confirmed or suspected COVID-19 infection (increase 83·6%). INTERPRETATION Reductions in emergency admissions, and pathologically diagnosed cancers, as reported by the Northern Ireland Cancer Registry (NICR), indicate undiagnosed patients in the community which has implications for future workloads and survival. Data suggest undiagnosed cases may be higher for haematological, brain and CNS, and lung cancers and among females. Efforts should be made to encourage people with symptoms to present for diagnosis or reassurance. FUNDING The NICR is funded by the Public Health Agency of Northern Ireland. This work was supported by Macmillan Cancer Support and uses data collected by health services as part of their care and support functions.
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Affiliation(s)
- Helen Mitchell
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
| | - Ben S Alford
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Simon O'Hare
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.,Macmillan Cancer Support, London, England
| | - Eamon O'Callaghan
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Colin Fox
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Anna T Gavin
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
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Lyu PF, Li JT, Deng T, Lin GX, Fan PM, Cao XC. Research trends and hotspots of breast cancer management during the COVID-19 pandemic: A bibliometric analysis. Front Oncol 2022; 12:918349. [PMID: 35992886 PMCID: PMC9381881 DOI: 10.3389/fonc.2022.918349] [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: 04/12/2022] [Accepted: 07/11/2022] [Indexed: 12/24/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic is disrupting routine medical care of cancer patients, including those who have cancer or are undergoing cancer screening. In this study, breast cancer management during the COVID-19 pandemic (BCMP) is reviewed, and the research trends of BCMP are evaluated by quantitative and qualitative evaluation. Methods In this study, published studies relating to BCMP from 1 January 2020 to 1 April 2022 were searched from the Web of Science database (WoS). Bibliometric indicators consisted of publications, research hotspots, keywords, authors, journals, institutions, nations, and h-index. Results A total of 182 articles investigating BCMP were searched. The United States of America and the University of Rome Tor Vergata were the nation and the institution with the most publications on BCMP. The first three periodicals with leading published BCMP studies were Breast Cancer Research and Treatment, Breast, and In Vivo. Buonomo OC was the most prolific author in this field, publishing nine articles (9/182, 4.94%). The co-keywords analysis of BCMP suggests that the top hotspots and trends in research are screening, surgery, rehabilitation, emotion, diagnosis, treatment, and vaccine management of breast cancer during the pandemic. The hotspot words were divided into six clusters, namely, screening for breast cancer patients in the pandemic, breast cancer surgery in the pandemic, recovery of breast cancer patients in the pandemic, motion effect of the outbreak on breast cancer patients, diagnosis and treatment of breast cancer patients in the pandemic, and vaccination management for breast cancer patients during a pandemic. Conclusion BCMP has received attention from scholars in many nations over the last 3 years. This study revealed significant contributions to BCMP research by nations, institutions, scholars, and journals. The stratified clustering study provided the current status and future trends of BCMP to help physicians with the diagnosis and treatment of breast cancer through the pandemic, and provide a reference for in-depth clinical studies on BCMP.
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Affiliation(s)
- Peng-fei Lyu
- The First Department of Breast Cancer, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China
- Department of Breast Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Jing-tai Li
- Department of Breast Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Tang Deng
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Guang-Xun Lin
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
- *Correspondence: Guang-Xun Lin, ; Ping-ming Fan, ; Xu-Chen Cao,
| | - Ping-ming Fan
- Department of Breast Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, China
- *Correspondence: Guang-Xun Lin, ; Ping-ming Fan, ; Xu-Chen Cao,
| | - Xu-Chen Cao
- The First Department of Breast Cancer, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China
- *Correspondence: Guang-Xun Lin, ; Ping-ming Fan, ; Xu-Chen Cao,
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Saatci D, Oke J, Harnden A, Hippisley-Cox J. Childhood, teenage and young adult cancer diagnosis during the first wave of the COVID-19 pandemic: a population-based observational cohort study in England. Arch Dis Child 2022; 107:740-746. [PMID: 35318196 PMCID: PMC8960459 DOI: 10.1136/archdischild-2021-322644] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 02/11/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate childhood, teenage and young adult cancer diagnostic pathways during the first wave of the COVID-19 pandemic in England. DESIGN Population-based cohort study. SETTING AND PARTICIPANTS QResearch, a nationally representative primary care database, linked to hospital admission, mortality and cancer registry data, was used to identify childhood, teenage and young adult cancers (0-24 years) diagnosed between 1 January 2017 and 15 August 2020. MAIN OUTCOMES Main outcomes of interest were: (1) number of incident cancer diagnoses per month, (2) diagnostic, treatment time intervals and (3) cancer-related intensive care admissions. RESULTS 2607 childhood, teenage and young adult cancers were diagnosed from 1 January 2017 to 15 August 2020; 380 were diagnosed during the pandemic period. Overall, 17% (95% CI -28.0% to -4.0%) reduction in the incidence rate ratio of cancers was observed during the pandemic. Specific decreases were seen for central nervous system tumour (-38% (95% CI -52% to -21%)) and lymphoma (-28% (95% CI -45% to -5%)) diagnoses. Additionally, childhood cancers diagnosed during the pandemic were significantly more likely to have intensive care admissions (adjusted OR 2.2 (95% CI 1.33 to 3.47)). Median time-to-diagnosis did not significantly differ across periods (+4.5 days (95% CI -20.5 to +29.5)), while median time-to-treatment was shorter during the pandemic (-0.7 days (95% CI -1.1 to -0.3)). CONCLUSIONS Collectively, our findings of a significant reduction in cancer diagnoses and increase in intensive care admissions provide initial insight into the changes that occurred to childhood, teenage and young adult cancer diagnostic pathways during the first wave of the pandemic.
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Affiliation(s)
- Defne Saatci
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jason Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Anthony Harnden
- Department of Primary Health Care, Oxford University, Oxford, UK
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Tari DU, Santonastaso R, Pinto F. Consequences of the impact of COVID-19 pandemic on breast cancer at a single Italian institution. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2022; 3:414-422. [PMID: 36046222 PMCID: PMC9400757 DOI: 10.37349/etat.2022.00091] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/08/2022] [Indexed: 11/19/2022] Open
Abstract
Aim: To evaluate the local impact of the coronavirus disease 2019 (COVID-19) pandemic on breast cancer (BC) care, with particular attention to the economical and psychological consequences of the possible delay of new diagnoses and treatments.
Methods: Three years’ activity (from 2019 to 2021) has been compared. The number of BCs diagnosed from the total amount of mammographic and ultrasound (US) examinations performed in women aged more than 40 years old has been considered. A Pearson’s chi-squared test was performed to verify differences between results. Statistical significance was set at P ≤ 0.01.
Results: A statistically significant difference was found in the number of BC diagnosed between screening and ambulatory care patients in both the 2019–2020 (χ2 = 24.93, P < 0.01) and 2019–2021 (χ2 = 29.93, P < 0.01) comparisons. No statistically significant difference was found in the data recorded between 2020 and 2021 (χ2 = 2.35, P > 0.01). By evaluating the specific age groups for each year, a statistically significant difference (P < 0.01) was found in the number of BC diagnosed in screening patients aged 50–69 years old in both 2019–2020 and 2019–2021 comparisons. The percentages of early BC diagnosed in 2019, 2020, and 2021 were 80.9%, 91.7%, and 89.8%, respectively. The adherence rates to screening in 2019, 2020, and 2021 were 67.5%, 45.2%, and 56.9%, respectively.
Conclusions: Results showed a reduction of new diagnoses in the screening range during the pandemic in comparison with the previous period. The high percentage of early BC would seem to have prevented worsening outcomes. Nevertheless, women who have not undergone screening could present a more advanced stage disease in the following years. Consequently, the evaluation of possible solutions to guarantee an essential level of care with the purpose to avoid worsening patients’ outcomes and the increase in healthcare costs is mandatory.
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Affiliation(s)
- Daniele Ugo Tari
- Department of Diagnostic Senology, District 12, Caserta Local Health Authority, 81100 Caserta, Italy
| | | | - Fabio Pinto
- Department of Radiology, “A. Guerriero” Hospital, Caserta Local Health Authority, 81025 Marcianise, Italy
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Prompt Resumption of Screening Programme Reduced the Impact of COVID-19 on New Breast Cancer Diagnoses in Northern Italy. Cancers (Basel) 2022; 14:cancers14123029. [PMID: 35740694 PMCID: PMC9221346 DOI: 10.3390/cancers14123029] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary The aim of this study was to compare 2020 tumours with 2019 tumours by age, stage and treatment in four different periods. In 2020 there was no decrease of invasive tumours nor in situ (513 vs. 493 and 76 vs. 73, respectively), while there was a significant decrease in surgery and an increase in neoadjuvant chemotherapy (p = 0.016). During the Italian lockdown period (March–May), we observed a decrease in all ages and a significant one among people aged 75+ [IRR 0.45 (95% CI 0.25–0.79)], but in the last period there was a significant increase among people of the screening age range of 45–74 [IRR 1.48 (95% CI 1.11–1.98)]. Screening activities were suspended from March to May, but over the summer and the autumn the backlog was eliminated. This suggests that a prompt resumption of programmed screening may have limited the impact of the pandemic on the delay of breast cancer diagnoses. Abstract The aim of this study is to evaluate the real impact of COVID-19 during the entire 2020 period, compared with 2019. The data comes from a Cancer Registry in Northern Italy and we compared clinical and treatment characteristics of breast cancer by age, stage, treatment, and status screening. In 2020 there was no decrease in invasive tumours nor in in situ (513 vs. 493 and 76 vs. 73, respectively), while there was a significant decrease in surgery and increase in neoadjuvant chemotherapy (p = 0.016). In the screening range (aged 45–74), no change in stage and grading was observed. In the four periods examined there was an increase in new diagnoses during pre-lockdown, a decrease in tumours especially at age 75+ [IRR 0.45; 95%CI 0.25–0.79] during lockdown, a recovery of new diagnoses in women 45+ in the low incidence period while in the last period there was a significant increase only for ages 45–74 [IRR 1.48; 95% CI 1.11–1.98]. Screening activities were suspended from March to May, but over the summer and autumn the backlog was addressed. This suggests that a prompt resumption of programmed screening may have limited the impact of the pandemic on the delay of breast cancer diagnoses.
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Tokode OM, Rastall S. A Single-Center Audit of Symptomatic Breast Cancer Patient Referrals During COVID-19 Pandemic Restrictions. Cureus 2022; 14:e26038. [PMID: 35734027 PMCID: PMC9205378 DOI: 10.7759/cureus.26038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background Recommendations to balance cancer care with patient and hospital staff safety have been issued to hospitals during the coronavirus disease (COVID-19) pandemic. Concerns have been raised that service restrictions could jeopardize effective cancer management. Thus, this study aimed to conduct an audit to verify this proposition. Methods We conducted an audit comparing two-week wait (2ww) breast cancer referrals in our center between May and July 2019 and 2020. The primary endpoints were changes in the overall referral rates, differences in the waiting time, and breast cancer diagnosis rates between the two cohorts. Group differences were evaluated using the chi-square test (χ2). A p-value of <0.05 at 95% CI was considered significant. Results The 2ww referrals decreased by 442 (28.3%) in 2020 (2019 N=1564 vs. 2020, N=1122). Referrals in 2020 were associated with a higher rate of two-week specialist consultation than referrals in 2019 (p<0.05). The 2020 patient cohort was associated with a higher rate of breast cancer diagnosis than the 2019 cohort (6.9% vs. 4.9%, p<0.05). Of the 521 patients who had telephone consultations, 29.2% were discharged, and 367 (70.4%) had post-telephone one-stop clinic visits, of which 9.0% had breast cancer. Conclusions The audit provided evidence of effective breast cancer services during the COVID-19 pandemic restrictions. The study results could inform patients and the general public at large that the waiting time and breast cancer diagnosis are not compromised during COVID-19 pandemic management. The high rates of post-telephone one-stop clinic visits and cancer diagnosis may indicate weakness in triage and difficulties in diagnosing nonspecific presentation of cancer over the telephone.
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Carvalho AS, Brito Fernandes Ó, de Lange M, Lingsma H, Klazinga N, Kringos D. Changes in the quality of cancer care as assessed through performance indicators during the first wave of the COVID-19 pandemic in 2020: a scoping review. BMC Health Serv Res 2022; 22:786. [PMID: 35715795 PMCID: PMC9204363 DOI: 10.1186/s12913-022-08166-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/06/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cancer comprises a high burden on health systems. Performance indicators monitoring cancer outcomes are routinely used in OECD countries. However, the development of process and cancer-pathway based information is essential to guide health care delivery, allowing for better monitoring of changes in the quality of care provided. Assessing the changes in the quality of cancer care during the COVID-19 pandemic requires a structured approach considering the high volume of publications. This study aims to summarize performance indicators used in the literature to evaluate the impact of the COVID-19 pandemic on cancer care (January-June 2020) in OECD countries and to assess changes in the quality of care as reported via selected indicators. METHODS Search conducted in MEDLINE and Embase databases. Performance indicators and their trends were collated according to the cancer care pathway. RESULTS This study included 135 articles, from which 1013 indicators were retrieved. Indicators assessing the diagnostic process showed a decreasing trend: from 33 indicators reporting on screening, 30 (91%) signalled a decrease during the pandemic (n = 30 indicators, 91%). A reduction was also observed in the number of diagnostic procedures (n = 64, 58%) and diagnoses (n = 130, 89%). The proportion of diagnoses in the emergency setting and waiting times showed increasing trends (n = 8, 89% and n = 14, 56%, respectively). A decreasing trend in the proportion of earliest stage cancers was reported by 63% of indicators (n = 9), and 70% (n = 43) of indicators showed an increasing trend in the proportion of advanced-stage cancers. Indicators reflecting the treatment process signalled a reduction in the number of procedures: 79%(n = 82) of indicators concerning surgeries, 72%(n = 41) of indicators assessing radiotherapy, and 93%(n = 40) of indicators related to systemic therapies. Modifications in cancer treatment were frequently reported: 64%(n = 195) of indicators revealed changes in treatment. CONCLUSIONS This study provides a summary of performance indicators used in the literature to assess the cancer care pathway from January 2020 to June 2020 in OECD countries, and the changes in the quality of care signalled by these indicators. The trends reported inform on potential bottlenecks of the cancer care pathway. Monitoring this information closely could contribute to identifying moments for intervention during crises.
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Affiliation(s)
- Ana Sofia Carvalho
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands.
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Óscar Brito Fernandes
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Mats de Lange
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - Hester Lingsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Niek Klazinga
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Dionne Kringos
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
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Women's attitudes towards healthy life awareness and breast cancer screening during the coronavirus disease 2019 pandemic: a cross-sectional descriptive study. Eur J Cancer Prev 2022; 31:346-353. [PMID: 35579177 DOI: 10.1097/cej.0000000000000756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the COVID-19 pandemic, fear of coronavirus infection has caused individuals to hesitate to access medical services and postpone their participation in diagnostic and screening programs. With this research, it was aimed to examine the relationship between women's wellness awareness and attitudes towards breast cancer screening during the COVID-19 pandemic. METHODS The descriptive cross-sectional type research was conducted between 30 January 2021 and 30 July 2021. The sample of the study consisted of 396 women between the ages of 40 and 69 who were in the breast cancer screening population under national cancer screening standards and met the criteria for inclusion. The data of the study were collected using a web-based and self-reported questionnaire, Personal Information Form, Healthy Life Awareness Scale and Cancer Screening Attitude Scale. RESULTS It was determined that more than half of women postponed breast cancer screening during the COVID-19 pandemic, and the reasons for the postponement were often fear of contamination. It was determined that there was a relationship between the participants' awareness of healthy living and their attitudes towards cancer screening (P < 0.05). CONCLUSION It was found that approximately two out of every three women in the screening population during the pandemic did not have screening or postponed it due to fear of contamination. It was determined that women who had awareness of healthy living and had breast cancer screening before the pandemic had a positive attitude towards cancer screening during the COVID-19 pandemic period.
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Lowry KP, Bissell MCS, Miglioretti DL, Kerlikowske K, Alsheik N, Macarol T, Bowles EJA, Buist DSM, Tosteson ANA, Henderson L, Herschorn SD, Wernli KJ, Weaver DL, Stout NK, Sprague BL. Breast Biopsy Recommendations and Breast Cancers Diagnosed during the COVID-19 Pandemic. Radiology 2022; 303:287-294. [PMID: 34665032 PMCID: PMC8544262 DOI: 10.1148/radiol.2021211808] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/19/2021] [Accepted: 09/30/2021] [Indexed: 12/23/2022]
Abstract
Background The COVID-19 pandemic reduced mammography use, potentially delaying breast cancer diagnoses. Purpose To examine breast biopsy recommendations and breast cancers diagnosed before and during the COVID-19 pandemic by mode of detection (screen detected vs symptomatic) and women's characteristics. Materials and Methods In this secondary analysis of prospectively collected data, monthly breast biopsy recommendations after mammography, US, or both with subsequent biopsy performed were examined from 66 facilities of the Breast Cancer Surveillance Consortium between January 2019 and September 2020. The number of monthly and cumulative biopsies recommended and performed and the number of subsequent cancers diagnosed during the pandemic period (March 2020 to September 2020) were compared with data from the prepandemic period using Wald χ2 tests. Analyses were stratified by mode of detection and race or ethnicity. Results From January 2019 to September 2020, 17 728 biopsies were recommended and performed, with 6009 cancers diagnosed. From March to September 2020, there were substantially fewer breast biopsy recommendations with cancer diagnoses when compared with the same period in 2019 (1650 recommendations in 2020 vs 2171 recommendations in 2019 [24% fewer], P < .001), predominantly due to fewer screen-detected cancers (722 cancers in 2020 vs 1169 cancers in 2019 [38% fewer], P < .001) versus symptomatic cancers (895 cancers in 2020 vs 965 cancers in 2019 [7% fewer], P = .27). The decrease in cancer diagnoses was largest in Asian (67 diagnoses in 2020 vs 142 diagnoses in 2019 [53% fewer], P = .06) and Hispanic (82 diagnoses in 2020 vs 145 diagnoses in 2019 [43% fewer], P = .13) women, followed by Black women (210 diagnoses in 2020 vs 287 diagnoses in 2019 [27% fewer], P = .21). The decrease was smallest in non-Hispanic White women (1128 diagnoses in 2020 vs 1357 diagnoses in 2019 [17% fewer], P = .09). Conclusion There were substantially fewer breast biopsies with cancer diagnoses during the COVID-19 pandemic from March to September 2020 compared with the same period in 2019, with Asian and Hispanic women experiencing the largest declines, followed by Black women. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Heller in this issue.
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Affiliation(s)
- Kathryn P. Lowry
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Michael C. S. Bissell
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Diana L. Miglioretti
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Karla Kerlikowske
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Nila Alsheik
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Tere Macarol
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Erin J. A. Bowles
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Diana S. M. Buist
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Anna N. A. Tosteson
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Louise Henderson
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Sally D. Herschorn
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Karen J. Wernli
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Donald L. Weaver
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Natasha K. Stout
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Brian L. Sprague
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
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Johansson AL, Larønningen S, Skovlund CW, Kristiansen MF, Mørch LS, Friis S, Johannesen TB, Myklebust TÅ, Skog A, Pettersson D, Birgisson H, Virtanen A, Malila N, Pitkäniemi J, Tanskanen T, Tryggvadóttir L, Ursin G, Lambe M. The impact of the COVID-19 pandemic on cancer diagnosis based on pathology notifications: A comparison across the Nordic countries during 2020. Int J Cancer 2022; 151:381-395. [PMID: 35419824 PMCID: PMC9087674 DOI: 10.1002/ijc.34029] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/06/2022]
Abstract
The severity of the COVID-19 pandemic and subsequent mitigation strategies have varied across the Nordic countries. In a joint Nordic population-based effort, we compared patterns of new cancer cases and notifications between the Nordic countries during 2020. We used pathology notifications to cancer registries in Denmark, the Faroe Islands, Finland, Iceland, Norway and Sweden to determine monthly numbers of pathology notifications of malignant and in-situ tumors from January to December 2020 compared to 2019 (2017-2019 for Iceland and the Faroe Islands). We compared new cancer cases per month based on unique individuals with pathology notifications. In April and May 2020, the numbers of new malignant cases declined in all Nordic countries, except the Faroe Islands, compared to previous year(s). The largest reduction was observed in Sweden (May: -31.2%, 95% CI -33.9, -28.3), followed by significant declines in Finland, Denmark and Norway, and a non-significant decline in Iceland. In Denmark, Norway, Sweden and Finland the reporting rates during the second half of 2020 rose to almost the same level as in 2019. However, in Sweden and Finland, the increase did not compensate for the spring decline (annual reduction -6.2% and -3.6%, respectively). Overall, similar patterns were observed for in-situ tumors. The COVID-19 pandemic led to a decline in rates of new cancer cases in Sweden, Finland, Denmark and Norway, with the most pronounced reduction in Sweden. Possible explanations include the severity of the pandemic, temporary halting of screening activities and changes in healthcare seeking behaviour.
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Affiliation(s)
- Anna Lv Johansson
- Cancer Registry of Norway, Oslo, Norway.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Marnar Fríðheim Kristiansen
- Center of Health Science, Faculty of Health Sciences, Tórshavn, Faroe Islands.,National Hospital of the Faroe Islands, Tórshavn, Faroe Islands
| | - Lina Steinrud Mørch
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Søren Friis
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | | | - Tor Åge Myklebust
- Cancer Registry of Norway, Oslo, Norway.,Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Anna Skog
- Cancer Registry of Norway, Oslo, Norway
| | | | - Helgi Birgisson
- Cancer Registry of Iceland, Icelandic Cancer Society, Reykjavik, Iceland
| | - Anni Virtanen
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
| | - Nea Malila
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland.,Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tomas Tanskanen
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
| | - Laufey Tryggvadóttir
- Cancer Registry of Iceland, Icelandic Cancer Society, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway.,Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Regional Cancer Center Central Sweden, Uppsala, Sweden
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Ribes J, Pareja L, Sanz X, Mosteiro S, Escribà JM, Esteban L, Gálvez J, Osca G, Rodenas P, Pérez-Sust P, Borràs JM. Cancer diagnosis in Catalonia (Spain) after two years of COVID-19 pandemic: an incomplete recovery. ESMO Open 2022; 7:100486. [PMID: 35714476 PMCID: PMC9197337 DOI: 10.1016/j.esmoop.2022.100486] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- J Ribes
- Catalan Pathology Registry, Catalan Cancer Plan, Department of Health of Catalonia, Barcelona, Spain; Department of Clinical Sciences, University of Barcelona (UB), Barcelona, Spain; Hospital Cancer Registry Unit, Catalan Institute of Oncology, Barcelona, Spain.
| | - L Pareja
- Hospital Cancer Registry Unit, Catalan Institute of Oncology, Barcelona, Spain
| | - X Sanz
- Catalan Pathology Registry, Catalan Cancer Plan, Department of Health of Catalonia, Barcelona, Spain
| | - S Mosteiro
- Hospital Cancer Registry Unit, Catalan Institute of Oncology, Barcelona, Spain
| | - J M Escribà
- Department of Clinical Sciences, University of Barcelona (UB), Barcelona, Spain; Hospital Cancer Registry Unit, Catalan Institute of Oncology, Barcelona, Spain
| | - L Esteban
- Catalan Pathology Registry, Catalan Cancer Plan, Department of Health of Catalonia, Barcelona, Spain
| | - J Gálvez
- Hospital Cancer Registry Unit, Catalan Institute of Oncology, Barcelona, Spain
| | - G Osca
- Hospital Cancer Registry Unit, Catalan Institute of Oncology, Barcelona, Spain
| | - P Rodenas
- Catalan Electronic Health Record, EHealth Office, Health/Catalan Health Service, Department of Health of Catalonia, Barcelona, Spain
| | - P Pérez-Sust
- CatSalut Information Systems and Health Department ICT Unit, Barcelona, Spain
| | - J M Borràs
- Catalan Pathology Registry, Catalan Cancer Plan, Department of Health of Catalonia, Barcelona, Spain; Department of Clinical Sciences, University of Barcelona (UB), Barcelona, Spain
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Monitoring the impact of COVID-19 in France on cancer care: a differentiated impact. Sci Rep 2022; 12:4207. [PMID: 35273304 PMCID: PMC8908298 DOI: 10.1038/s41598-022-07984-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/23/2022] [Indexed: 11/08/2022] Open
Abstract
The COVID-19 pandemic has had a substantial and lasting impact on care provision, particularly in the field of cancer care. National steering has helped monitor the health situation and adapt the provision and organisation of care. Based on data from the French administrative healthcare database (SNDS) on the entire French population (67 million people), screening, diagnostic and therapeutic activity was monitored and compared 2019 on a monthly basis. A noteworthy decline in all activities (with the exception of chemotherapy) was observed during the first lockdown in France. Over the months that followed, this activity returned to normal but did not make up for the shortfall from the first lockdown. Finally, during the lockdown in late 2020, cancer care activity was conserved. In brief, in 2020, the number of mammograms decreased by 10% (− 492,500 procedures), digestive endoscopies by 19% (− 648,500), and cancer-related excision by 6% (− 23,000 surgical procedures). Hospital radiotherapy activity was down 3.8% (− 4400 patients) and that in private practice was down 1.4% (− 1600 patients). Chemotherapy activity increased by 2.2% (7200 patients), however. To summarize, COVID-19 had a very substantial impact during the first lockdown. Safeguarding cancer care activity helped limit this impact over the months that followed, but the situation remains uncertain. Further studies on the medium- and long-term impact on individuals (survival, recurrence, after-effects) will be conducted.
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US Cancer Screening Recommendations: Developments and the Impact of COVID-19. Med Sci (Basel) 2022; 10:medsci10010016. [PMID: 35323215 PMCID: PMC8949858 DOI: 10.3390/medsci10010016] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 12/19/2022] Open
Abstract
The USPSTF and ACS recommend screening for breast, cervical, colorectal, and lung cancers. Rates of cancer screening, diagnosis, and treatment decreased significantly in the US and other developed nations during the height of the COVID-19 pandemic and lockdown (April 2020) and have since recovered, although not to baseline levels in many cases. For breast cancer, the USPSTF recommends biennial screening with mammography for women aged 50−74, while the ACS recommends annual screening for women aged 45−54, who may transition to biennial after 55. Minority and rural populations have lower rates of screening and lower utilization of DBT, which offers superior sensitivity and specificity. Among 20 US health networks in April 2020, mammography rates were down 89.2% and new breast cancer diagnoses down by 50.5%. For cervical cancer, the USPSTF recommends cervical cytology every three years for women 21−65, or cytology+hrHPV co-testing every five years for women aged 30−65. Cervical cancer screening rates declined by 87% in April 2020 and recovered to a 40% decline by June 2020, with American Indians and Asians most severely affected. For colorectal cancer (CRC), the USPSTF and ACS recommend screening for ages 45−75, recently lowered from a starting age of 50. Most commonly-used modalities include annual FIT testing, FIT+DNA testing every three years, and colonoscopy every ten years, with shorter repeat if polyps are found. In the US, CRC screenings were down by 79−84.5% in April 2020 across several retrospective studies. Patient encounters for CRC were down by 39.9%, and a UK-based model predicted that 5-year-survival would decrease by 6.4%. The USPSTF recommends screening low dose CT scans (LDCTs) for ages 50−80 with a >20 pack-year smoking history who have smoked within the past 15 years. In April 2020, screening LDCTs fell by 72−78% at one US institution and lung cancer diagnoses were down 39.1%.
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Nowikiewicz T, Szymankiewicz M, Drzewiecka M, Głowacka-Mrotek I, Tarkowska M, Nowikiewicz M, Zegarski W. Did the COVID-19 Pandemic Truly Adversely Affect Disease Progress and Therapeutic Options in Breast Cancer Patients? A Single-Centre Analysis. J Clin Med 2022; 11:1014. [PMID: 35207286 PMCID: PMC8879378 DOI: 10.3390/jcm11041014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/03/2022] [Accepted: 02/11/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The uncontrolled spread and transmission of SARS-CoV-2 infections has disrupted most areas of social and economic life all over the world. The most important changes concern problems related to the functioning of healthcare systems. The aim of this study was to evaluate clinical consequences associated with the COVID-19 pandemic for patients with newly diagnosed breast cancer, treated at our centre. METHODS The study participants were patients first time diagnosed with breast cancer, treated between January 2019 and March 2021, who were provided any type of cancer treatment at our centre. The study determined the grade of clinical and pathological progress of the disease and types of cancer treatment applied in patients. RESULTS In total, 2863 patients were included in the analysis. The number of hospitalized patients was 1228 (1123 treated surgically, 105 receiving conservative treatment) in 2019, 1318 (1206 and 112 patients, respectively) in 2020, and 317 (288 and 29 patients, respectively) in 2021. CONCLUSIONS Despite many hazards associated with the new epidemiological situation, we were able to maintain the continuous operation of our centre. We have achieved a measurable success, and even managed to increase the number of treated breast cancer patients.
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Affiliation(s)
- Tomasz Nowikiewicz
- Department of Surgical Oncology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 85-067 Bydgoszcz, Poland;
- Department of Clinical Breast Cancer and Reconstructive Surgery, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland;
| | - Maria Szymankiewicz
- Department of Microbiology, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland;
| | - Marta Drzewiecka
- Department of Clinical Breast Cancer and Reconstructive Surgery, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland;
| | - Iwona Głowacka-Mrotek
- Department of Rehabilitation, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland;
| | - Magdalena Tarkowska
- Department of Urology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland;
| | - Magdalena Nowikiewicz
- Department of Hepatobiliary and General Surgery, A. Jurasz University Hospital, 85-094 Bydgoszcz, Poland;
| | - Wojciech Zegarski
- Department of Surgical Oncology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 85-067 Bydgoszcz, Poland;
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43
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Kara H, Arikan AE, Dulgeroglu O, Tutar B, Tokat F, Uras C. Has the COVID-19 Pandemic Affected Breast Cancer Stage and Surgical Volume? Front Surg 2022; 9:811108. [PMID: 35198597 PMCID: PMC8859320 DOI: 10.3389/fsurg.2022.811108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/12/2022] [Indexed: 01/12/2023] Open
Abstract
Background This study investigates the effects of COVID-19 on the breast cancer stage and the volume of breast cancer surgery in a specialized breast institute. Methods Data of 332 patients who were diagnosed and treated for breast cancer between December 2019 and November 2020 were evaluated retrospectively according to periods of pandemic. Results A significant decrease in the number of operations, especially upfront surgeries rather than surgeries after neoadjuvant chemotherapy, was detected in the early period of the COVID-19 pandemic. It was found that patients with complaints were mostly admitted during this period (p = 0.024). No statistical significance was found for age, sex, side of the tumor, type of tumor, surgery to breast, and axilla. Following the early period of the pandemic, it was observed that patients with mostly luminal, early-stage, and less axillary nodal involvement (p < 0.05) were admitted, and as a result, it was founded that upfront surgeries increased, although no change in TNM staging was observed. However, it did affect the decision of initial treatment. Thus, the number of upfront surgeries was significantly higher than the NCT group (p = 0.027) following the early period. Conclusion Surgical volume is significantly affected in the early period of the COVID-19 pandemic. To overcome overload due to delayed surgeries related to pandemics, some hospitals should be spared for oncological treatments. Following the early period, mostly luminal type, early-stage patients were admitted, probably because of increased self-awareness and short wave duration, but the breast cancer stage was not affected.
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Affiliation(s)
- Halil Kara
- Vocational School of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- Department of General Senology, Research Institute of Senology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Akif Enes Arikan
- Department of General Senology, Research Institute of Senology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- *Correspondence: Akif Enes Arikan
| | - Onur Dulgeroglu
- Vocational School of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- Department of General Senology, Research Institute of Senology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Burcin Tutar
- Department of Radiology, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Fatma Tokat
- Department of General Senology, Research Institute of Senology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- Department of Pathology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Cihan Uras
- Department of General Senology, Research Institute of Senology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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44
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Gathani T, Reeves G, Dodwell D, Horgan K, Kearins O, Kan SW, Sweetland S. Impact of the COVID-19 pandemic on breast cancer referrals and diagnoses in 2020 and 2021: a population-based study in England. Br J Surg 2022; 109:e29-e30. [PMID: 34904165 PMCID: PMC8807144 DOI: 10.1093/bjs/znab426] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/13/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Toral Gathani
- Cancer Epidemiology Unit, Nuffield Department of Population Health, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Gillian Reeves
- Cancer Epidemiology Unit, Nuffield Department of Population Health, Oxford, UK
| | - David Dodwell
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Clinical Trials Service Unit, Nuffield Department of Population Health, Oxford, UK
| | - Kieran Horgan
- Department of Breast Surgery, St James’ Hospital, Leeds, UK
| | - Olive Kearins
- Breast Cancer Screening Programme, Screening Division, Public Health England, Birmingham, UK
| | - Sau Wan Kan
- Cancer Epidemiology Unit, Nuffield Department of Population Health, Oxford, UK
| | - Sian Sweetland
- Cancer Epidemiology Unit, Nuffield Department of Population Health, Oxford, UK
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45
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El-Sheikh S, Rathbone M, Chaudhary K, Joshi A, Lee J, Muthukumar S, Mylona E, Roxanis I, Rees J. Rates and Outcomes of Breast Lesions of Uncertain Malignant Potential (B3) benchmarked against the National Breast Screening Pathology Audit; Improving Performance in a High Volume Screening Unit. Clin Breast Cancer 2022; 22:381-390. [DOI: 10.1016/j.clbc.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 11/29/2022]
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46
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The Global Reading Room: Recovery of Breast Cancer Screening Services After the COVID-19 Pandemic First Wave. AJR Am J Roentgenol 2022; 219:521-522. [PMID: 35080456 DOI: 10.2214/ajr.22.27416] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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47
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Jacob L, Kalder M, Kostev K. Decrease in the number of patients diagnosed with cancer during the COVID-19 pandemic in Germany. J Cancer Res Clin Oncol 2022; 148:3117-3123. [PMID: 35041059 PMCID: PMC8764247 DOI: 10.1007/s00432-022-03922-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/11/2022] [Indexed: 12/17/2022]
Abstract
Purpose Little is known on how coronavirus disease 2019 (COVID-19) has impacted cancer diagnosis in Germany since the first lockdown in March 2020. Therefore, this retrospective study aimed to compare the number of patients newly diagnosed with cancer in general and specialized practices in Germany between April 2020–March 2021 and April 2019–March 2020. Methods Patients aged ≥ 18 years with at least 1 visit to 1 of 1403 general and specialized practices in Germany in April 2020–March 2021 (n = 3,804,596) and April 2019–March 2020 (n = 3,913,386) were included in this retrospective study. Specialized practices were composed of gynecology, dermatology and urology practices. Cancer diagnoses included all types of cancer documented using the International Classification of Diseases, 10th revision (ICD-10 codes: C00-C97). The number of patients newly diagnosed with cancer per practice was compared between April 2020–March 2021 and April 2019–March 2020 using Wilcoxon tests. Results There were 126,379 and 138,996 patients diagnosed with cancer in April 2020–March 2021 and April 2019–March 2020, respectively. The number of patients diagnosed with cancer decreased in all types of practice, and this decrease was significant in general practices (− 7.1%, p value = 0.038). In terms of cancer type, this decrease was particularly pronounced for skin cancers (− 12.8%, p value = 0.025). Conclusion The COVID-19 pandemic has been associated with a decrease in the number of patients newly diagnosed with cancer in general and specialized practices in Germany. Public health interventions are urgently warranted to mitigate the deleterious effects of this health crisis on cancer diagnosis.
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Affiliation(s)
- Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu/CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain.,Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, 78180, Montigny-le-Bretonneux, France
| | - Matthias Kalder
- Department of Gynecology and Obstetrics, Philipps University of Marburg, 35037, Marburg, Germany
| | - Karel Kostev
- Department of Epidemiology, IQVIA, Unterschweinstiege 2-14, 60549, Frankfurt am Main, Germany.
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48
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Borsky K, Shah K, Cunnick G, Tsang-Wright F. Pattern of breast cancer presentation during the coronavirus disease pandemic: results from a cohort study in the UK. Future Oncol 2022; 18:437-443. [PMID: 35018787 PMCID: PMC8763213 DOI: 10.2217/fon-2021-0970] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: This study aimed to explore the hypothesis that the stage of breast cancer at initial diagnosis in 2020 is more advanced compared with 2019. Methods: Tumor, node, metastasis and Union for International Cancer Control (UICC) stages of new breast cancer diagnoses at the Bucks Breast Unit from May to October 2019 and 2020 were reviewed. A p < 0.05 was considered significant. Results: Average UICC stage increased from 1a in 2019 to 2a in 2020 (p < 0.01). Excluding cancers detected through screening, UICC stage still increased from 1b in 2019 to 2a in 2020 (p = 0.0184). There was a significant increase in the percentage of node-positive patients (p = 0.0063) and patients with metastatic disease (p = 0.0295) on initial presentation. Conclusion: Overall, patients presented with higher UICC stages and more node-positive and metastatic disease on initial diagnosis in 2020 compared with 2019.
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Affiliation(s)
- Kim Borsky
- Bucks Breast Unit, Buckinghamshire Healthcare NHS Trust, High Wycombe, HP11 2TT, UK
| | - Ketan Shah
- Bucks Breast Unit, Buckinghamshire Healthcare NHS Trust, High Wycombe, HP11 2TT, UK
| | - Giles Cunnick
- Bucks Breast Unit, Buckinghamshire Healthcare NHS Trust, High Wycombe, HP11 2TT, UK
| | - Fiona Tsang-Wright
- Bucks Breast Unit, Buckinghamshire Healthcare NHS Trust, High Wycombe, HP11 2TT, UK
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Seneviratne SL, Wijerathne W, Yasawardene P, Somawardana B. OUP accepted manuscript. Trans R Soc Trop Med Hyg 2022; 116:767-797. [PMID: 35276734 PMCID: PMC8992310 DOI: 10.1093/trstmh/trac015] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/13/2022] [Accepted: 02/08/2022] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has currently affected >220 million individuals worldwide. The complex interplay of immune dysfunction, active malignancy, the effect of cancer treatment on the immune system and additional comorbidities associated with cancer and COVID-19 all affect the outcomes of COVID-19 in patients with cancer. We have discussed the published findings (through the end of September 2021) on the effects of cancer on the morbidity and mortality of COVID-19, common factors between cancer and COVID-19, the interaction of cancer and COVID-19 treatments, the impact of COVID-19 on cancer clinical services, immune test findings in cancer patients with COVID-19 and the long-term effects of COVID-19 on cancer survivors.
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50
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OpenSAFELY NHS Service Restoration Observatory 1: primary care clinical activity in England during the first wave of COVID-19. Br J Gen Pract 2022; 72:e63-e74. [PMID: 34750105 PMCID: PMC8589464 DOI: 10.3399/bjgp.2021.0380] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has disrupted healthcare activity. The NHS stopped non-urgent work in March 2020, later recommending services be restored to near-normal levels before winter where possible. AIM To describe the volume and variation of coded clinical activity in general practice, taking respiratory disease and laboratory procedures as examples. DESIGN AND SETTING Working on behalf of NHS England, a cohort study was conducted of 23.8 million patient records in general practice, in situ using OpenSAFELY. METHOD Activity using Clinical Terms Version 3 codes and keyword searches from January 2019 to September 2020 are described. RESULTS Activity recorded in general practice declined during the pandemic, but largely recovered by September. There was a large drop in coded activity for laboratory tests, with broad recovery to pre-pandemic levels by September. One exception was the international normalised ratio test, with a smaller reduction (median tests per 1000 patients in 2020: February 8.0; April 6.2; September 6.9). The pattern of recording for respiratory symptoms was less affected, following an expected seasonal pattern and classified as 'no change'. Respiratory infections exhibited a sustained drop, not returning to pre-pandemic levels by September. Asthma reviews experienced a small drop but recovered, whereas chronic obstructive pulmonary disease reviews remained below baseline. CONCLUSION An open-source software framework was delivered to describe trends and variation in clinical activity across an unprecedented scale of primary care data. The COVD-19 pandemic led to a substantial change in healthcare activity. Most laboratory tests showed substantial reduction, largely recovering to near-normal levels by September, with some important tests less affected and recording of respiratory disease codes was mixed.
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