The impact of the SARS-COV-2 pandemic on the quality of breast cancer care in EUSOMA certified breast centers

Aims We analyzed the impact of the SARS-CoV-2 pandemic (COVID-19) on the quality of breast cancer care in certified EUSOMA breast centers. Materials and methods The results of the EUSOMA quality indicators (QIs) were compared, based on pseudonymized individual records, for the periods 1 March 2020 till 30 June 2020 (first COVID19 peak in most countries in Europe) and 1 March 2019 till 30 June 2019. In addition, a questionnaire was sent to the participating Centres for investigating the impact of the COVID-19 pandemic on the organization and the quality of breast cancer care. Results Forty-five Centers provided data and 31 (67%) responded to the questionnaire. There was a small significant higher tumour (p=0.003) and lymph node (p=0.011) stage at presentation. Comparing QIs (12736 patients) by multivariable analysis showed non-significant differences. Surgery could be performed in a COVID-free zone in 94% of the Centres, COVID testing was performed before surgery in 96% of the Centres and surgical case load was reduced in 55% of the Centres. Modifications of the indications for neoadjuvant endocrine therapy, chemotherapy and targeted therapy were necessary in 23%, 23% and 10% of the Centres;changes in indications for adjuvant endocrine, chemo-, targeted, immune and radiotherapy in 3%, 19%, 3%, 6% and 10%, respectively. Conclusion Quality of breast cancer care was well maintained in EUSOMA breast Centres during the first wave of the COVID-19 pandemic. A small but significantly higher tumour and lymph node stage at presentation was observed.

Adapting care for older cancer patients during the COVID-19 pandemic: Recommendations from the International Society of Geriatric Oncology (SIOG) COVID-19 Working Group.

The COVID-19 pandemic poses a barrier to equal and evidence-based management of cancer in older adults. The International Society of Geriatric Oncology (SIOG) formed a panel of experts to develop consensus recommendations on the implications of the pandemic on several aspects of cancer care in this age group including geriatric assessment (GA), surgery, radiotherapy, systemic treatment, palliative care and research. Age and cancer diagnosis are significant predictors of adverse outcomes of the COVID-19 infection. In this setting, GA is particularly valuable to drive decision-making. GA may aid estimating physiologic reserve and adaptive capability, assessing risk-benefits of either providing or temporarily withholding treatments, and determining patient preferences to help inform treatment decisions. In a resource-constrained setting, geriatric screening tools may be administered remotely to identify patients requiring comprehensive GA. Tele-health is also crucial to ensure adequate continuity of care and minimize the risk of infection exposure. In general, therapeutic decisions should favor the most effective and least invasive approach with the lowest risk of adverse outcomes. In selected cases, this might require deferring or omitting surgery, radiotherapy or systemic treatments especially where benefits are marginal and alternative safe therapeutic options are available. Ongoing research is necessary to expand knowledge of the management of cancer in older adults. However, the pandemic presents a significant barrier and efforts should be made to ensure equitable access to clinical trials and prospective data collection to elucidate the outcomes of COVID-19 in this population.