ABSTRACT
Background: In March 2020, due to the spread of Sars- Cov2 infection and the subsequent declaration of global pandemic by the World Health Organization, several services provided by the Italian Healthcare System were interrupted or heavily limited until May 2020, including breast cancer screening and surgery. We conducted a retrospective analysis to evaluate the impact of these 3-monthlimitation on breast cancer stage at surgery in the Breast Unit of San Martino Hospital in Genoa. Material and methods: In this retrospective study we compared the pathological stage of breast cancer patients who underwent surgery in our Breast Unit (San Martino Hospital, Genova) in 2020 with those treated in 2019, focusing on the period between March and May. Results: We observed a remarkable reduction in breast cancer surgical interventions in 2020 compared to 2019 (671 vs 491, -26.8%). As expected, the most relevant reduction was observed during the lockdown period, accounting for 39% (70 out of 180) of the total reduction. Out of 671 surgical interventions performed in 2019, 96 were ductal carcinoma in situ (14.3%). Out of the 491 in 2020, 44 were ductal carcinoma in situ (9%), which represents a 5.3% reduction compared to 2019 (p-value 0.0061). Notably, there was no relevant increase in pT and nodal involvement between breast cancer patients treated in 2020 compared to 2019, irrrespective of biological subtype. Similar data were observed focusing on the period between March and May 2019 and 2020. Conclusions: This single-centre analysis showed a decrease in the number of breast cancer surgeries in 2020 compared to 2019, particularly in the period between March and and May, with a significant reduction of in situ ductal carcinoma diagnoses in 2020 compared to 2019. We did not observe a statistically significant increase in breast cancer pathological stage in 2020 compared to 2019. These results were confirmed across different breast cancer subtypes and after restricting the analysis on the March-May period. Our data show that the 3-month-limitation on breast cancer screening and surgery did not turn into increased dimensions or nodal involvement of breast cancer patients treated in 2020 compared to 2019.
ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) outbreak is changing the approach of medical oncologists to cancer management. However, the real impact on cancer care and its potential negative consequences are currently unknown. Methods: A 29-multiple choice question anonymous online survey was shared with members of the Italian Association of Medical Oncology and the Gruppo Italiano Mammella on April 3, 2020. The objectives of the survey were to investigate the attitudes and practice of Italian oncologists before and during COVID-19 outbreak on three relevant areas in breast cancer care: 1) (neo)adjuvant setting;2) metastatic setting;3) research activities. Results: The survey was completed by 165 oncologists, of whom 121 (73.3.%) worked in Breast Units. In the (neo) adjuvant setting, compared to before the emergency, a lower rate of oncologists adopted during COVID-19 outbreak weekly paclitaxel (68.5% vs. 93.9%, P<.001) and dose-dense schedule for anthracycline-based chemotherapy (43% vs. 58.8%, P<.001). In the metastatic setting, compared to before the emergency, a lower number of oncologists adopted during COVID-19 outbreak first-line weekly paclitaxel for HER2-positive disease (41.8% vs. 53.9%, P=.002) or CDK4/6 inhibitors for luminal tumors with less aggressive characteristics (55.8% vs. 80.0%, P<.001). A significant change was also observed in terms of delaying the timing for monitoring CDK4/6 inhibitors therapy, assessing treatment response with imaging and flushing central venous devices. Clinical research and scientific activities were reduced in 80.3% and 80.1% of respondents previously involved in these activities, respectively. Conclusions: Most of the changes in the attitudes and practice of Italian oncologists were reasonable responses to the current health emergency without expected major negative impact on patients' outcomes, although some potentially alarming signals of undertreatment were observed. These data invite developing cautious recommendations to help oncologists ensuring continuous effective and safe cancer care.