Changes in the operative management of breast cancer during the COVID pandemic-single institution experience

Aims: COVID has had a wide ranging impact on surgical practice;including staffing issues, procedural prioritisation and changes to perioperative practice. We aim to compare The operative management of breast Cancer before and during year 1 of The pandemic. Method(s): A retrospective review of primary breast Cancer Surgery in women between 23/3/2020-23/3/2021 with sub-analysis looking at wave 1 of COVID (23/3/2020-23/7/2020), compared to pre-COVID (1/1/2018-31/12/2018). Data collected include type and complexity of surgery, re-operations and complications. Result(s): Pre-COVID, 606 cancers were included, with 217 (35.8%) Simple BCS, 241(39.8%) oncoplastic BCS, 88 (14.5%) Simple mastectomies and 60 (9.9%) mastectomies with immediate reconstruction. During COVID study period, a total of 398 cancers were included, with operative number (percentages) being 104(26.1%), 176(44.2%), 83(20.9%) and 35(8.8%) respectively. During wave 1, 47 cancers were diagnosed and operated on. The operative numbers (percentages) during initial wave COVID pandemic were 9 (19.1%), 25(53.2%), 12(25.5%) and 1(2.1%) respectively. Conclusion(s): In our unit COVID led to a shift of breast Cancer operative management to more BCS and Simple mastectomies. As a unit, we were able to maintain good oncoplastic BCS service, however, reconstruction options were limited.

Management of breast Cancer in different age groups during pandemic single Institute review

Introduction: COVID 19 has huge impact on healthcare in General and challenges in Cancer services in particular. In breast Cancer prioritization strategies for management have been introduced at start of pandemic by different medical associations Aim: We aim to see impact of prioritization strategy in treatment of premenopausal and postmenopausal breast Cancer patient. This is further stratified as under 50, 50 to 70 and over 70. Method(s): A prospectively collected database from March 2020 to March 2021 analysed. This include patient demographic, tumour characteristics, Neoadjuvanct endocrine NAET), Neoadjuvanct chemotherapy (NACT), primary endocrine (PE), type of surgery: breast conservation Surgery (BCS) with or without oncoplastic procedure, Mastectomy with or without reconstruction and utilization of private sectors. Result(s): Total 454 patients reviewed. Mean age 61 yrs (26-97yrs). Total patient less than 50 years were 116. BCS 66 (57%), Simple mastectomy 26 (22%), Mastectomy with reconstruction 24 (20%).In this group 45 patients were of fered NACT and 6 patients had NAET. Total patients older than 50 years were 236. BCS 191 (80%), Simple mastectomy 38 (16%) and Mastectomy with reconstruction 7(3%) patients. In this group 69 patients had NACT and 13 had NAET. Patients over 70 years were 102. BCS 57(56%), Simple mastectomy 25(24%), 1 (1%) had mastectomy and reconstruction. 8 patients had NACT, 13 had NAET and 30 had primary endocrine. Conclusion(s): Due to swift guidelines in pandemic times breast Cancer services were largely intact and provide standard care.

Challenges of delivering a tertiary breast Cancer service during the COVID-19 pandemic

Introduction: Delivering a breast service during The COVID-19 pandemic has been challenging. At our tertiary referral centre, we have had to coordinate care across multiple sites in order to maintain provision of services. This study looks at how this was achieved at The Nottingham breast Institute (NBI) by a team of 6 Consultant Surgeons. Method(s): This was a retrospective review of a prospective data base (managed by one Consultant oncoplastic surgeon) of all patients treated at The NBI over a period of 18 months, at The start The pandemic from March 2020 to October 2021. Data collected included patient demographics, hospital site, and type of surgery. Result(s): Over The 18 months 1191 patients were operated on. The average age was 57.8 years (range 17 to 86);as expected The commonest indication was Cancer (93.1%). 11.3% of those patients (125/1109) received neoadjuvant chemotherapy. of these 37.4% of patients (N=446) were operated on at our usual operative base site (NBI). 49.5% and The majority of cases (N=589) were performed across two independent hospitals and a smaller proportion (12.9%) was conducted at a fourth hospital which of fered 23 hour stay facilities. Conclusion(s): Despite The challenges of securing operative capacity, thus far, we have been able to deLiver over 1000 breast Cancer surgeries during The COVID-19 pandemic. This is due in part to multisite working, surgeon flexibility, and oversight of all The patient pathways collated on one database by a dedicated surgeon.