ABSTRACT
INTRODUCTION: The COVID-19 pandemic poses challenges to the healthcare systems including cancer treatment. We aim to evaluate the impact of lockdown during COVID-19 on breast cancer (BC) care in terms of BC stage at presentation, treatment compliance and delays, and follow-up in a tertiary care center in Lebanon. METHOD(S): This is a retrospective observational study comparing patients with BC who presented to a tertiary care center in Lebanon in the pre-COVID period (Sep 2019-Dec 2019) and during COVID (Sep 2020-Dec 2020). After receiving the IRB approval, we retrieved the charts of BC patients who had their initial presentation, were under treatment or were on follow-up during our period of interest. We extracted data from electronic medical records of patients related to demographic parameters, cause of visit, tumor description, and type of treatment received. Descriptive analysis, as well as multivariate analysis, were done using SPSS. RESULT(S): Out of the 497 patients included, 274 visited the hospital in the pre-COVID period (median age 52.5 years) and 223 patients during COVID (median age 54.7 years). More than half of patients presented for BC screening in the pre-COVID (52%), while 52% came symptomatic during COVID. Almost 54% had advanced BC at presentation in the COVID period compared to 48% pre-COVID but with no statistical significance (p=0.36). During the COVID period, almost 39% of patients had surgery, 79.7% received chemotherapy, and 21.2% received radiotherapy, but with no significant difference between the two periods. Also, no difference was found in the type of surgery done between the two periods. The mean time between the onset of symptoms and biopsy was significantly longer in the COVID period (4.8 +/- 3.5 months) than that in the pre-COVID (3.2 +/- 5.1 months). The mean time between the biopsy and first treatment was not significantly different between the two periods (1.5 +/- 2.2 months versus 2.1+/-3.8 months). For patients who received neoadjuvant chemotherapy, the mean time between the last chemotherapy and surgery was longer in the COVID period (1.9 +/- 1.4 months) than in the pre-COVID period (1.2 +/- 1.1 months). Multivariate analysis showed that age at diagnosis (p=0.014) and time to diagnosis (p=0.01) were significantly associated with the advanced stage of BC. CONCLUSION(S): This study showed that COVID pandemic has resulted in a delay in the initial presentation of patients resulting in more advanced stages at presentation. However, the management of breast cancer was not substantially impacted by the COVID-19 lockdown.
ABSTRACT
Background: The mortality rate of cancer patients diagnosed with COVID-19 infection has reached 25%. The time from symptom onset to admission to the intensive care unit (ICU) was on average 10 days, with approximately 26% of patients requiring ICU admission. A higher mortality attributed to COVID-19 was seen in older patients, patients with certain cancer types, and patients with a higher Charslon comorbidity score. Moreover, male sex and leukopenia at diagnosis were associated with an increased risk of worse clinical outcomes. Furthermore, a study done at Memorial Sloan Kettering showed that patients with hematological malignancies had a worse prognosis than those with solid tumors. Our aim is to identify the predictive factors for ICU admission in the setting of positive COVID-19 infection in cancer patients. Differences in prognosis were compared between cancer and non-cancer patients admitted to the ICU due to COVID-19 infection. We also compared the overall outcome between patients with solid cancers and hematologic malignancies. Methods: This is a single institution retrospective study based on chart review analysis conducted at the American University of Beirut Medical Center (AUBMC). 248 patients were diagnosed with COVID-19 from 1 January 2020 to 31 December 2021. The patient groups were (1) all cancer patients admitted to the COVID unit, (2) all cancer patients admitted to ICU, and (3) all other patients without cancer admitted to the ICU. The main outcomes were ICU admission and mortality. Results: 173 cancer patients were admitted to our institution for the management of COVID-19 with a mean age of 63 years. 52 patients (30%) required ICU admission and 50 patients (29%) died during hospital stay or 1 month following discharge. The time from symptom onset to ICU admission and death were 12.8 and 35 days, respectively. Patients admitted to the ICU were more likely to have anemia (Hb < 8 g/dL) and thrombocytopenia (< 50,000/ mm3) on admission (p = 0.001). Age, male sex and history of smoking, diabetes or cardiopulmonary diseases were not associated with greater risk of ICU admission or death. Among cancer patients, those with uncontrolled disease at the onset of COVID-19 had greater risk of death from COVID-19 (p = 0.001). Cancer type, number of lines of treatment, history of radiation to the chest, recent cytotoxic therapy, and neutropenia were not associated with ICU admission or death from COVID-19. There was no statistical significance in mortality or disease progression between patients with solid or hematologic malignancies. Conclusions: Our data reaffirms previously reported findings of high mortality in cancer patients who contract COVID-19. In particular, patients with anemia, thrombocytopenia, and uncontrolled disease at diagnosis had unfavorable outcomes. Contrary to the literature, age, male sex, cancer type, and neutropenia were not predictive factors for mortality in cancer patients in the setting of COVID-19 infections.