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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: Patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection and a diagnosis of cancer are at high risk of severe symptomatic disease (COVID-19) and death. We performed a systematic review and meta-analysis of published studies, to estimate the case-fatality rate (CFR) of patients with solid or hematological tumors and SARS-CoV-2 infection. Methods: A systematic search of PubMed library up to 31 January, 2021, was performed in order to identify publications reporting the CFR among adult patients with solid or hematological tumors and SARS-CoV-2 infection. CFR was defined as the rate of deaths among SARS-CoV-2-positive cancer patients. Moreover, we separately assessed the CFR among patients with lung and breast cancer. Studies with at least 10 patients were included. The CFR was assessed through a random effect model, and 95% confidence intervals (CI) were calculated. The Higgins I2 index was computed to assess the heterogeneity between studies. Results: The systematic search of the literaturereturned 1,727studies. 1,551 were excluded on the basis of the title, 29 based on the abstract, and 3 were duplicates. A total of 144 studies were selected, including 35,725 patients with solid or hematological tumors and SARS-CoV-2 infection. In total, 46 and 32 studies reported the CFR among COVID-19 patients with lung (total N = 1,555) and breast (total N = 1.398) cancer, respectively. Overall, the CFR was 25.5% (95% CI 23.1%-28.1%, Egger test p < 0.001). A sensitivity analysis, after excluding studies with less than 100 patients, showed a CFR of 22.1% (95% CI 19.4%-25.2%). The CFR among patients with lung cancer and SARSCoV2 infection was 33.4% (95% CI 28.1%-39.6%) when including all studies and 26.3% (95% CI 17.6%-39.2%) at the sensitivity analysis after excluding studies with less than 100 patients. The CFR among patients with breast cancer and SARS-CoV2 infection was 13.7% (95% CI 9.1%-20.7%) when including all studies and 13.0% (95% CI 7.6%-22.1%) at the sensitivity analysis after excluding studies with less than 100 patients. Conclusions: One year after the outbreak of the pandemic, this large metaanalysis reports the impact of SARS-CoV-2 infection in patients with cancer. This population experienced a high probability of mortality, with a comparatively higher CFR in patients with lung cancer, and a comparatively lower CFR in patients with breast cancer. Patients with an underlying diagnosis of cancer require special attention with aggressive preventive measures that also include early access to COVID-19 vaccination.
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Background: During the COVID-19 outbreak oncological care has been reorganized to face the emergency. Cancer patients have been reported to be at higher risk of severe events related to SARS-CoV-2. Moreover, there are concerns of a possible interference between immune checkpoint inhibitors (ICIs) and the pathogenesis of the infection. Material and Methods: A 22-item questionnaire was shared with Italian physicians managing ICIs, between May 6 and 16, 2020. This survey aimed at exploring the perception about SARS-CoV-2 related risks in cancer patients receiving ICIs, and whether the management of these patients has been modified during COVID-19 outbreak. Results: Respondents were 104, with a median age of 35.5 years, mainly females (58.7%), mainly working in Northern Italy (71.2%). 47.1% of respondents were afraid that a synergism could exist between ICIs mechanism of action and SARS-CoV-2 pathogenesis, leading to worse outcomes. 97.1% of respondents would not deny an ICI only for the possible occurrence of COVID-19. Measures for reducing hospital visits have been adopted by choosing the ICIs schedule with fewer administrations, adopting the highest labeled dose of each drug (55.8%) and/or choosing, among different ICIs for the same indication, the one with the longer interval between cycles (30.8%). 53.8% of respondents suggested the need to test for SARS-CoV-2 every cancer patient candidate to ICIs. Regarding the differential diagnosis between immune-related adverse events (irAEs) and COVID-19 manifestations, 71.2% of respondents declared to manage a patient with onset of dyspnea and cough like a COVID-19 patient until otherwise proven (ie, waiting for the result of SARS-CoV-2 test before doing other diagnostic or therapeutic procedures), while the same management has been applied only by the 28.8% of respondents when dealing with a patient with onset of diarrhea;however, 96.2% did not reduce the use of steroids to manage irAEs during the pandemic. No major impact of COVID-19 on physicians' attitudes towards the use of ICIs to manage specific clinical situations in different cancer types (ie, lung, breast, melanoma, urothelial) was observed. Conclusions: These results highlight the uncertainty of physicians dealing with ICIs in cancer patients during COVID-19 outbreak, supporting the need of dedicated studies on this regard.
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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.
ABSTRACT
Background: During the COVID-19 outbreak oncological care has been reorganized to face the emergency. Cancer patients have been reported to be at higher risk of severe events related to SARS-CoV-2. Moreover, there are concerns of a possible interference between immune checkpoint inhibitors (ICIs) and the pathogenesis of the infection. Methods: A 22-item questionnaire was shared with Italian physicians managing ICIs, between May 6 and 16, 2020. This survey aimed at exploring the perception about SARS-CoV-2 related risks in cancer patients receiving ICIs, and whether the management of these patients has been modified during COVID-19 outbreak. Results: Respondents were 104, with a median age of 35.5 years, mainly females (58.7%), mainly working in Northern Italy (71%). 47.1% of respondents were afraid that a synergism could exist between ICIs mechanism of action and SARS-CoV-2 pathogenesis, leading to worse outcomes. 97.1% of respondents would not deny an ICI only for the possible occurrence of COVID-19. Measures for reducing hospital visits have been adopted by choosing the ICIs schedule with fewer administrations, adopting the highest labeled dose of each drug (55.8%) and/or choosing, among different ICIs for the same indication, the one with the longer interval between cycles (30.8%). 53.8% of respondents suggested the need to test for SARS-CoV-2 every cancer patient candidate to ICIs. Regarding differential diagnosis between immune-related adverse events (irAEs) and COVID-19 manifestations, 71.2% of respondents declared to manage a patient with onset of dyspnea and cough like a COVID-19 patient until otherwise proven (ie, waiting for the result of SARS-CoV-2 test before doing other diagnostic or therapeutic procedures);however, 96.2% did not reduce the use of steroids to manage irAEs during the pandemic. No major impact of COVID-19 on physicians’ attitudes towards the use of ICIs to manage specific clinical situations in different cancer types (ie, lung, breast, melanoma, urothelial) was observed. Conclusions: These results highlight the uncertainty of physicians dealing with ICIs in cancer patients during COVID-19 outbreak, supporting the need of dedicated studies on this regard. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: M. Tagliamento: Travel/Accommodation/Expenses: Roche, Bristol-Myers Squibb, Astra Zeneca, Takeda. F. Poggio: Travel/Accommodation/Expenses: Takeda, Ely Lilly;Honoraria (self): Merck Sharp & Dohme, Ely Lilly, Novartis. L. Del Mastro: Honoraria (self): Roche, Pfeizer, Ipsen, Eli Lilly, Novartis, Takeda, Merck Sharp & Dohme, Genomic Health, Seattle Genetics;Non-remunerated activity/ies: Celgene. M. Di Maio: Advisory/Consultancy: Eisai, Takeda, Janssen, Astellas, Pfizer, AstraZeneca. M. Lambertini: Advisory/Consultancy: Roche and Ely Lilly;Speaker Bureau/Expert testimony: Roche, Takeda and Theramex. All other authors have declared no conflicts of interest.
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 Italian Breast Cancer Study Group 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. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: F. Poggio: Travel/Accommodation/Expenses: Takeda;Honoraria (self), Travel/Accommodation/Expenses: Ely Lilly;Honoraria (self): Merck Sharp & Dohme;Novartis. M. Tagliamento: Travel/Accommodation/Expenses: Roche;Bristol-Myers Squibb;AstraZeneca;Takeda;Honoraria (self): Novartis. M. Di Maio: Research grant/Funding (institution): Tesaro GSK;Honoraria (self), Advisory/Consultancy: AstraZeneca;Janssen;Astellas;Eisai;Pfizer;Merck Sharp & Dohme;Takeda. L. Del Mastro: Advisory/Consultancy: Roche;Novartis;Eisai;Pfizer;AstraZeneca;Ipsen;Eli Lilly;MSD;Seattle Genetics;Genomic Health. M. Lambertini: Advisory/Consultancy: Roche;Honoraria (self): Theramex, Eli Lilly. All other authors have declared no conflicts of interest.