Breast Cancer Management Pathways during the COVID-19 pandemic. Outcomes from the UK ‘alert level 4’ phase of the B-MaP-C study.


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Baek Kim, Rajiv Dave1, Alona Courtney, Rachel O'Connell, Tim Rattay, Vicky P Taxiarchi, Jamie J Kirkham, Elizabeth Camacho, Patricia Fairbrother, Nisha Sharma, Christopher WJ Cartlidge, Kieran Horgan, Stuart A McIntosh, Daniel R Leff, Raghavan Vidya, Shelley Potter, Chris Holcombe, Ellen Copson, Charlotte E Coles, Ramsey I Cutress, Ashu Gandhi, Cliona Kirwan
1Manchester University NHS Foundation Trust

Abstract

Background

The COVID-19 pandemic has impacted healthcare delivery globally. The aim of the B-MaP-C study was to determine changes to breast cancer (BC) management during the UK government 'alert level 4' of the COVID-19 pandemic.

Method

This was a national cohort study of consecutive patients with early BC undergoing multi-disciplinary team (MDT)-guided treatment recommendations during the peak transmission period of the UK COVID-19 pandemic (16th March - 8th May 2020). Patient demographic data, cancer-specific data and treatment recommendations (designated 'standard' or 'COVID-altered') in the pre-operative, operative and post-operative setting was collected. The extent of alterations to management decisions, national variation, and the potential impact of these decisions were assessed.

Results

Of 3776 patients (from 64 UK breast units) included in the study, 2246 (59%) had 'COVID-altered' management. Pre-operatively, neoadjuvant chemotherapy was omitted (n=160, although 92% of these received adjuvant chemotherapy) and 'bridging' endocrine therapy was used (n=951) where theatre capacity was affected. There was increasing access to COVID-19 low-risk theatres, with 59.2% of operations performed in this setting. In line with national guidance, all immediate breast reconstruction was stopped (n=299 in this study). Post-operatively, 81 patients had omitted chemotherapy, due to low benefit against the risk of treatment-induced immunocompromise. Radiotherapy delivery was rationalised, with rapid adaptation of evidence-based hypofractionated radiotherapy (n=781 having 5 fractions of radiotherapy). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey.

Conclusion

Although 59% had 'COVID-altered' management, the majority of these alterations were largely in line with evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, out with this study, the potential impact of any delays to BC presentation or diagnosis that may have occurred due to the pandemic, remains unknown.

Impact statement

This national multicentre study findings demonstrate that high quality breast cancer treatment was delivered throughout the UK during the COVID-19 pandemic, whilst highlighting the healthcare resource implications for the COVID-19 'recovery' phase.