Management of Early Breast Cancer at an Australian NSW Cancer Centre During the Early Phase of COVID-19 Pandemic

Abstract

Background: This study aimed to prospectively record changes to treatment for early breast cancer patients during the first wave of the COVID-19 pandemic in Australia. The purpose was to assess the impact on breast cancer outcomes and to determine the need for any mitigative actions. Methods: The study was conducted in the breast cancer unit of a tertiary referral hospital. Consecutive patients with invasive cancer or ductal cancer in situ (DCIS) discussed in multidisciplinary team (MDT) meetings three times a week between March and June 2020 were included. Patients were newly diagnosed, post-operative or post-neoadjuvant chemotherapy. Standard treatment was defined by Westmead Breast Cancer Institute protocols and any variations related to the pandemic were recorded. Results:145 patients were included (median age 59 years). Pandemic related changes to management were noted in 13 of 145 (9·0%) patients discussed in the MDT meeting. Four patients experienced a delay to cancer treatments, four were not offered reconstructive/symmetrisation surgical procedures, three had altered radiotherapy protocols and two patients were not offered enrolment to a clinical trial. These impacts affected the groups presenting with new cancers (n=7/86, 8·1%), post-operative cases (n=4/25, 16·0%) and post-neoadjuvant chemotherapy cases presenting for surgical planning (n=2/34, 5·9%). Conclusion: Most patients (91·0%) received standard treatment during the first wave of the pandemic. Variations from institutional protocols are not expected to affect local control or survival in this patient cohort and no mitigative actions have been implemented. Quality of life may have been affected for four patients who had downgraded or delayed reconstructive procedures. Institutional strategies such as utilising telemedicine and COVID-free facilities were successfully implemented within the study period.Trial Registration: The study was registered with the Australian New Zealand Clinical Trials Registry(ACTRN12620000869976).Funding Statement: None.Declaration of Interests: RH has participated in advisory boards for AstraZeneca, Bristol Myers Squibb, Eli Lilly, Merck, Merck Sharp and Dohme, Novartis, Oncosec, Pfizer, Roche and Seagen; and has received speaker honoraria from Merck Sharp and Dohme, Novartis and Roche. EE has participated in advisory board for Merck Sharp and Dohme. There are no conflicts of interests to declare for the other authors.Ethics Approval Statement: Approval was obtained from the Sydney West Human Research EthicsCommittee (Project ID 2020/PID00900).