Presenter: Fangzheng Yuan, PharmD, BCPS, Clinical Pharmacy Specialist, Baptist Hospitals of Southeast Texas
Co-Authors: Ahmed Abdelhakeem, MD, Baptist Hospitals of Southeast Texas; Samantha Blevins, RN, Baptist Hospitals of Southeast Texas; Chelsey Peters, RN, OSN, Baptist Hospitals of Southeast Texas; Susan Whalen, BSN, CTR, Baptist Hospitals of Southeast Texas; Ernest Hymel, MD, PhD, Baptist Regional Cancer Network
BACKGROUND: Delays in breast cancer treatment have been associated with increased mortality.1 The COVID-19 pandemic has posed prolonged and significant stress on healthcare resources, which may have affected the quality and outcomes of breast cancer care.2
OBJECTIVE: To compare the time to treatment initiation (TTI) and outcomes in patients with nonmetastatic breast cancer before and during the COVID-19 pandemic.
METHOD: This retrospective study included adult patients with newly diagnosed nonmetastatic breast cancer at 2 community cancer centers of the Baptist Regional Cancer Network (BRCN) in Southeast Texas. Patients diagnosed between January 2018 and June 2019 were included in the control group. Patients diagnosed between April 2020 and September 2021 were included in the COVID-19 group. Patients were excluded if they received initial treatment outside of the BRCN network or for palliative intent. The primary outcome was TTI, defined as time from histologic diagnosis to treatment initiation. The primary analysis was done by t-test. The study had 80% power to detect an absolute increase of 10 days in TTI using a 2-sided alpha of 0.05.
RESULTS: The study included 156 patients—87 patients in the control group and 69 in the COVID-19 group. The median follow-up periods were 37 months (IQR, 32-40 months) in the control group and 8 months (IQR, 6-14 months) in the COVID-19 group. No significant difference in TTI was observed between the control (48.3 days) and the COVID-19 (47.7 days) groups (absolute difference, 0.7; 95% confidence interval, 8.6-10.0; P = .88). After adjusting for initial treatment modality, histology, and clinical stage, the TTI remained similar between the control group and the COVID-19 group (P = .92). No association was noted between the TTI and the number of new COVID-19 cases in the county in the COVID-19 group (P = .85). The proportion of patients diagnosed at disease stage II or III was higher in the COVID-19 group (52.2%) compared with the control group (42.3%), although this was not statistically significant (P = .23). Breast-conserving surgery was done in 26.5% (9/34) of the control group and 55% (11/20) of the COVID-19 group among patients who completed neoadjuvant systemic therapy and surgeries (P = .04). Pathologic complete response was achieved in 58.3% (7/12) of the control group and 14% (1/7) of the COVID-19 group among patients with triple-negative or HER2-positive breast cancer who completed neoadjuvant systemic therapy and surgeries. Overall survival rates at 1 year were 89.7% (78/87) in the control group and 100% (25/25) in the COVID-19 group among patients who reached 1 year after diagnosis (P = .09).
DISCUSSION: No significant delay in breast cancer treatment initiation was observed during the COVID-19 pandemic. Although preliminary outcomes were similar before and during the COVID-19 pandemic, further assessment of the long-term impact of COVID-19 on breast cancer outcomes is needed.
- Cone EB, Marchese M, Paciotti M, et al. Assessment of time-to-treatment initiation and survival in a cohort of patients with common cancers. JAMA Netw Open. 2020;3:e2030072. doi: 10.1001/jamanetworkopen.2020.30072.
- Bartlett DL, Howe JR, Chang G, et al. Management of cancer surgery cases during the COVID-19 pandemic: considerations. Ann Surg Oncol. 2020;27:1717-1720.