Analysis of the Impact of the COVID-19 Pandemic on the Multidisciplinary Management of Breast Cancer: Review from the American Society of Breast Surgeons COVID-19 and Mastery Registries

Abstract

Background The coronavirus disease 2019 (COVID-19) pandemic has resulted in rapid and regionally different approaches to breast cancer care. Methods In order to evaluate these changes, a COVID-19-specific registry was developed within the American Society of Breast Surgeons (ASBrS) Mastery that tracked whether decisions were usual or modified for COVID-19. Data on patient care entered into the COVID-19-specific registry and the ASBrS Mastery registry from 1 March 2020 to 15 March 2021 were reviewed. Results Overall, 177 surgeons entered demographic and treatment data on 2791 patients. Mean patient age was 62.7 years and 9.0% (252) were of African American race. Initial consultation occurred via telehealth in 6.2% (173) of patients and 1.4% (40) developed COVID-19. Mean invasive tumor size was 2.1 cm and 17.8% (411) were node-positive. In estrogen receptor-positive/human epidermal growth factor receptor 2-negative (ER+/HER2−) disease, neoadjuvant endocrine therapy (NET) was used as the usual approach in 6.9% (119) of patients and due to COVID-19 in an additional 31% (542) of patients. Patients were more likely to receive NET due to COVID-19 with increasing age and if they lived in the Northeast or Southeast (odds ratio [OR] 1.1, 2.3, and 1.7, respectively; p < 0.05). Genomic testing was performed on 51.5% (781) of estrogen-positive patients, of whom 20.7% (162) had testing on the core due to COVID-19. Patients were less likely to have core biopsy genomic testing due to COVID-19 if they were older (OR 0.89; p = 0.01) and more likely if they were node-positive (OR 4.0; p < 0.05). A change in surgical approach due to COVID-19 was reported for 5.4% (151) of patients. Conclusion The ASBrS COVID-19 registry provided a platform for monitoring treatment changes due to the pandemic, highlighting the increased use of NET.

A Cohort Study on the Immunogenicity and Safety of the Inactivated SARS-CoV-2 Vaccine (BBIBP-CorV) in Patients With Breast Cancer; Does Trastuzumab Interfere With the Outcome?

“…Stratifying patients according to disease progression risks, viral exposure risks, and complications risks, as well as consideration of hospital resources, helped to minimize the disruption in patient care while preventing the spread of SARS-CoV-2. In order to delay the timing of surgery, neoadjuvant endocrine therapy for early-stage, hormone-positive malignancies was recommended (6)(7)(8). Wilke et al described the impact of the COVID-19 pandemic on breast cancer management as "unprecedented", and reported more personalized nonstandard approaches and forced pauses or delays in elective schedules (7).…”

“…In order to delay the timing of surgery, neoadjuvant endocrine therapy for early-stage, hormone-positive malignancies was recommended (6)(7)(8). Wilke et al described the impact of the COVID-19 pandemic on breast cancer management as "unprecedented", and reported more personalized nonstandard approaches and forced pauses or delays in elective schedules (7). These negative impacts have been even more substantial in lowand middle-income countries (9)(10)(11).…”

ASO Authors Reflection: Lessons Learned from the COVID-19 Pandemic—Should We Change Surgical Management of Patients with Breast Cancer?

“…breast cancer, an increase in the use of genomic testing on the initial core needle biopsy specimen, a limited use for telehealth; and delayed reconstruction and in-patient surgical procedures due to the need to avoid hospitalizations during the initial months of COVID-19. 3…”

Communication is the Key to an Improved Patient Experience When it Comes to Surgical Delays

“…This may be why only 6.2% of breast cancer patients utilized telehealth visits according to recently published data from the American Society of Breast Surgeon’s (ASBrS) Breast Cancer COVID registry. 2 …”