Analysis of the Impact of the COVID-19 Pandemic on the Multidisciplinary Management of Breast Cancer: Review from the American Society of Breast Surgeons COVID-19 and Mastery Registries.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has resulted in rapid and regionally different approaches to breast cancer care. METHODS: In order to evaluate these changes, a COVID-19-specific registry was developed within the American Society of Breast Surgeons (ASBrS) Mastery that tracked whether decisions were usual or modified for COVID-19. Data on patient care entered into the COVID-19-specific registry and the ASBrS Mastery registry from 1 March 2020 to 15 March 2021 were reviewed. RESULTS: Overall, 177 surgeons entered demographic and treatment data on 2791 patients. Mean patient age was 62.7 years and 9.0% (252) were of African American race. Initial consultation occurred via telehealth in 6.2% (173) of patients and 1.4% (40) developed COVID-19. Mean invasive tumor size was 2.1 cm and 17.8% (411) were node-positive. In estrogen receptor-positive/human epidermal growth factor receptor 2-negative (ER+/HER2-) disease, neoadjuvant endocrine therapy (NET) was used as the usual approach in 6.9% (119) of patients and due to COVID-19 in an additional 31% (542) of patients. Patients were more likely to receive NET due to COVID-19 with increasing age and if they lived in the Northeast or Southeast (odds ratio [OR] 1.1, 2.3, and 1.7, respectively; p < 0.05). Genomic testing was performed on 51.5% (781) of estrogen-positive patients, of whom 20.7% (162) had testing on the core due to COVID-19. Patients were less likely to have core biopsy genomic testing due to COVID-19 if they were older (OR 0.89; p = 0.01) and more likely if they were node-positive (OR 4.0; p < 0.05). A change in surgical approach due to COVID-19 was reported for 5.4% (151) of patients. CONCLUSION: The ASBrS COVID-19 registry provided a platform for monitoring treatment changes due to the pandemic, highlighting the increased use of NET.

Covid-19 related oncologist's concerns about breast cancer treatment delays and physician well-being (the CROWN study).

PURPOSE: To examine how treatment delays brought on by the COVID-19 pandemic impacted the physical and emotional well-being of physicians treating these patients. METHODS: A cross-sectional survey of physician breast specialists was posted from April 23rd to June 11th, 2020 on membership list serves and social media platforms of the National Accreditation Program for Breast Centers and the American Society of Breast Surgeons. Physician well-being was measured using 6 COVID-19 burnout emotions and the 4-item PROMIS short form for anxiety and sleep disturbance. We examined associations between treatment delays and physician well-being, adjusting for demographic factors, COVID-19 testing and ten COVID-19 pandemic concerns. RESULTS: 870 physicians completed the survey, 61% were surgeons. The mean age of physicians was 52 and 548 (63.9%) were female. 669 (79.4%) reported some delay in patient care as a result of the COVID-19 pandemic. 384 (44.1%) and 529 (60.8%) of physicians scored outside normal limits for anxiety and sleep disturbance, respectively. After adjusting for demographic factors and COVID-19 testing, mean anxiety and COVID-19 burnout scores were significantly higher among physicians whose patients experienced either delays in surgery, adjuvant chemotherapy, radiation, breast imaging or specialty consultation. A multivariable model adjusting for ten physician COVID-19 concerns and delays showed that "delays will impact my emotional well-being" was the strongest concern associated with anxiety, sleep disturbance and COVID-19 burnout factors. CONCLUSIONS: Breast cancer treatment delays during the initial surge of the COVID-19 pandemic in the United States were associated with a negative impact on physician emotional wellness.

Low Rate of SARS-CoV-2 Infection in Adults With Active Cancer Diagnosis in a Nonendemic Region in the United States.

INTRODUCTION: The mortality rate in cancer patients with SARS-CoV-2 has been cited to be as high as 13% amidst a global pandemic. Here we present the prevalence of SARS-CoV-2 in adult patients with active cancer in a nonendemic cancer center at the time of the study. METHODS: All adult patients with an active history of cancer undergoing any elective surgery were screened for SARS-CoV-2 symptoms, including fever ≥ 38 degrees Celsius, chills, dyspnea, cough, sputum production, pharyngitis, myalgia/arthralgia, headache, anosmia, and nasal discharge. Both symptomatic and asymptomatic patients were tested for SARS-CoV-2 preoperatively via nasopharyngeal swab within 48 hours of surgery using an RT-PCR assay. Active cancer was defined as receipt of chemotherapy and/or radiation within 1 year of the SARS-CoV-2 test. Deidentified, institutional review board-exempt patient data were analyzed with IBM Statistical Package for the Social Sciences (SPSS) Version 26. RESULTS: Between March 16, 2020 and June 30, 2020, a total of 227 patients were tested preoperatively for SARS-CoV-2. Median age was 64.0 years (range 21 to 90). The majority of the cohort were White. Only 2 patients (0.8%) were positive for SARS-CoV-2. One 73-year-old woman undergoing hip replacement had Stage IV breast cancer and a 75-year-old man undergoing port placement had Stage IV retroperitoneal leiomyosarcoma. Neither patient had symptoms of SARS-CoV-2, underwent hospitalization for SARS-CoV-2, or proceeded to have the scheduled surgery after the positive test results until a 14-day quarantine period and a subsequent negative test result. Both patients subsequently received the procedures they were originally scheduled for with no complications. CONCLUSION: Careful consideration of resource allocation and treatment limitations for cancer patients should occur in lower endemic regions.