Breeching "The Goldilocks Zone”: Tetraplegia as a Rare Life-Altering Infective Complication of Adjuvant Breast Cancer Chemotherapy

Background: Adjuvant chemotherapy has been an integral component of breast cancer care for decades. Advances in supportive care have been made, but despite this, infective complications of therapy remain a significant toxicity concern. Case Presentation: A premenopausal patient presented to the emergency department during the third wave of the Covid-19 pandemic with sepsis after a second course of adjuvant docetaxel-cyclophosphamide chemotherapy. Overnight she developed tetraplegia. An urgent MRI cervical spine revealed a pre-vertebral, vertebral, and epidural abscess. This was treated with an emergency C4-C7 posterior cervical laminectomy and decompression. Her inpatient care involved a protracted ICU admission followed by rehabilitation. She remains tetraplegic and requires continued inpatient care over a year after presentation. Restricted pandemic-related hospital visiting has compounded the impact of her illness. Conclusion: Infective complications of adjuvant breast cancer chemotherapy remain an issue despite advances in supportive care. This case highlights the devastating, life-altering impact that these complications can have as emphasized by the inclusion of the patient's perspective. Copyright © 2022.

Impact of the COVID-19 pandemic on referral processes to a regional Occupational lung disease service – a single centre experience

P76 Figure 1ConclusionDuring the Covid-19 pandemic, we identified a 40% drop in referrals between 2019 and 2021, including a substantial reduction in referrals from workplace based occupational healthcare providers and primary care. Similarly, we diagnosed half as many patients with airway diseases, including occupational asthma.Our observations are in line with the experience of other regional OLD services, and are most likely explained by: workers being furloughed or working from home, thereby removing harmful workplace exposures;or the cessation of routine workplace surveillance and community spirometry. British Thoracic Society has recently published a clinical statement on occupational asthma which reiterates that delayed diagnosis of occupational asthma has a poorer prognosis, so it is crucial that we ensure patients with suspected occupational asthma are referred early.