ABSTRACT
The COVID-19 pandemic has strained the healthcare system worldwide. Our study aimed to evaluate the impact of the COVID-19 pandemic on the diagnosis and surgical care of patients with breast cancer in Amrita Institute of Medical Sciences, Kochi. This is a single-centre retrospective observational cohort study conducted in a tertiary care institution intended to analyse the management of patients with breast cancer before and after the pandemic outbreak. The number of mammograms dropped from 3689 in the pre-pandemic phase to 1901 in the post-pandemic phase, whilst the number of core biopsies remained almost the same (391 before the pandemic and 367 after the pandemic). The number of new patients decreased by 57.7% (from 614 to 354). However, the number of breast cancer surgeries has remained almost the same (318 before the pandemic and 287 after the pandemic). The number of breast conservation surgeries dropped from 127 in 2019 to 93 in 2020 (p-value = 0.01). Conversely, 24 patients underwent neoadjuvant chemotherapy in 2019, and this number increased to 37 in 2020, representing a statistically significant increase (p = 0.04). Even during a pandemic, cancer care is possible with proper resource allocation and by adopting a multidisciplinary approach.
ABSTRACT
Introduction There is high risk of contracting coronavirus disease 2019 (COVID-19) among patients with cancer with risk of mortality and morbidity being high. Limited data is available on the outcomes of universal screening of cancer patients with asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from lower-middle-income countries (LMICs). Objectives Our goal was to determine the prevalence of asymptomatic SARS-CoV-2 infection in patients with cancer attending the medical oncology department of a tertiary care hospital in Kerala and protect both patients and health care workers before proceeding with the systemic anticancer treatment. Materials and Methods This was a retrospective cohort study of screening patients receiving systemic anticancer therapy for COVID-19 among hospitalized patients from August 1, 2020, and both outpatients and hospitalized patients from September 1 to November 15, 2020. After clinical triaging, patients were subjected to universal screening with rapid antigen tests and/or reverse transcriptase-polymerase chain reaction (RT-PCR). Results A total of 1,722 SARS-CoV-2 tests (321 RT-PCR and 1,401 antigen tests) were performed among 1,496 asymptomatic patients before their scheduled chemotherapy/immunotherapy. Eight hundred forty-eight patients were screened more than twice. The patient cohort's median age was 59 years (range 01-92 years);44.98% of patients were males, and 55.01% were females. 58.77% of patients were on adjuvant or neoadjuvant chemotherapy and 41.22% on chemotherapy for metastatic cancer. The most common malignancy was breast cancer (26.53%), followed by lung (8.35%) and gastrointestinal (16.4%) cancers. The prevalence of asymptomatic infections in our study was 0.86%. Only one patient who had undergone chemotherapy after a negative SARS-CoV-2 test developed confirmed COVID-19 during subsequent testing. From these index cases, none of the other patients, health care workers, or their caretakers contracted COVID-19. Conclusion The prevalence of asymptomatic COVID-19 infections in our study was low (0.86%). With proper health education, clinical triaging, and screening of the high-risk group, it is possible to continue cancer treatment during the peak of the COVID-19 pandemic, even in LMICs.