ABSTRACT
PURPOSE: The coronavirus disease 2019 (covid-19) caused by the severe acute respiratory syndrome coronavirus 2 (Sars-Cov-2) is at the origin of a global pandemic. This pandemic has prompted the current health system to reorganize and rethink the care offered by health establishments. We report the early and late toxicity in patients infected with covid-19 treated at the same time for early-stage breast cancer. MATERIAL AND METHODS: This is a monocentric prospective study of patients treated in our hospital between March and June 2020 who were diagnosed with covid-19 infection. The inclusion criteria were to be irradiated for early-stage breast cancer and to have a positive covid diagnosis on a polymerase chain reaction (PCR) test and/or a lung computed tomography (CT) scan and/or suggestive clinical symptoms. All of them needed 6 months follow-up clinic after the end of the radiotherapy with clinical examination, mammogram, as well as CT scan to evaluate the lung status. Radiotherapy consisted of breast or chest wall irradiation with or without lymph node irradiation, with protocols adapted to pandemic situation. The treatment-related toxicity was graded according to the Common Toxicology Criteria for Adverse Events (version 4.03). RESULTS: All 350 patients treated for early-stage breast cancer were studied. Of them, 16 presented clinical symptoms of covid-19 infection, and of them 12 had clinical, CT scan and PCR confirmation. This entire cohort of 12 patients with median age of 56years (range: 42-72 years) underwent their radiotherapy. During the radiotherapy, nine patients presented radiodermatitis: eight grade 1 (66%) and one grade 2 (8%). Two patients with lymph nodes irradiation presented grade 2 oesophagitis. Late toxicity was evaluated 6 months after the end of the radiotherapy, and there was no radiation or covid lung sequel on the CT scans. One patient presented covid-related dyspnoea, and two had fibrosis. CONCLUSION: The half-year follow-up of prospective covid-19 cohort, treated for early-stage breast cancer demonstrated an acceptable toxicity profile with few low-grade adverse events. It seems that the covid-19 infection does not appear to increase the side effects of radiotherapy. Therefore radiotherapy should not be delayed.
Subject(s)
Breast Neoplasms , COVID-19 , Radiodermatitis , Adult , Aged , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/drug therapy , Breast Neoplasms/radiotherapy , Female , Humans , Middle Aged , Prospective Studies , Radiodermatitis/etiology , SARS-CoV-2ABSTRACT
BACKGROUND: The COVID-19 pandemic has led to unprecedented challenges and restrictions in surgical access across Canada, including for breast reconstructive services which are an integral component of comprehensive breast cancer care. We sought to determine how breast reconstructive services are being restricted, and what strategies may be employed to optimize the provision of breast reconstruction through a pan-Canadian evaluation from the providers' perspective. METHODS: This was a cross-sectional survey of Canadian plastic and reconstructive surgeons who perform breast reconstruction. The 33-item web-based questionnaire was developed by a pan-Canadian working group of breast reconstruction experts and disseminated via email to members of the Canadian Society of Plastic Surgery. The questionnaire queried respondents on the impact of the COVID-19 pandemic and associated restrictions on surgeons' breast reconstruction practice patterns and opinions on strategies for resource utilization. RESULTS: Responses were received from 49 surgeons, who reported practicing in 8 of 10 Canadian provinces. Restrictions on the provision of breast reconstructive procedures were most limited during the First Wave of the COVID-19 pandemic, where all respondents reported at least some reduction in capacity and more than a quarter reporting complete cessation. Average reported reduction in capacity ranged from 31% to 78% across all 3 waves. Autologous, delayed, and prophylactic reconstructions were most commonly restricted. CONCLUSION: This study provides a pan-Canadian impact assessment on breast reconstructive services during the COVID-19 pandemic from the providers' perspective. To uphold the standards of patient-centred care, a unified approach to strategically reorganize health care delivery now and in the future is needed.
HISTORIQUE: La pandémie de COVID-19 a donné lieu à des défis et des restrictions sans précédent en matière d'accès aux interventions chirurgicales au Canada, y compris les services de reconstruction mammaire qui font partie intégrante des soins complets du cancer du sein. Les chercheurs ont voulu déterminer le mode de restriction des services de reconstruction mammaire et les stratégies possibles pour en optimiser la prestation grâce à une évaluation pancanadienne du point de vue des chirurgiens. MÉTHODOLOGIE: La présente étude transversale a été effectuée auprès de chirurgiens plasticiens et reconstructeurs canadiens qui font de la reconstruction mammaire. Un groupe de travail pancanadien d'experts de la reconstruction mammaire a préparé le questionnaire en ligne en 33 points, lequel a été transmis par courriel aux membres de la Société canadienne de chirurgiens-plasticiens. Le questionnaire portait sur les répercussions de la pandémie de COVID-19 et les restrictions connexes sur les modes de pratique de reconstruction mammaire des chirurgiens, de même que sur leurs avis et stratégies à l'égard de l'utilisation des ressources. RÉSULTATS: Un total de 49 chirurgiens, qui ont déclaré exercer dans huit des dix provinces canadiennes, ont répondu au sondage. Les restrictions imposées aux interventions de reconstruction mammaire ont été plus limitées pendant la première vague de la pandémie COVID-19, puisque tous les répondants ont rendu compte d'au moins une certaine restriction de la capacité et que plus du quart ont fait état de leur arrêt complet. La diminution moyenne de la capacité a varié de 31 % à 78 % dans l'ensemble des trois vagues. Ce sont les reconstructions autologues, tardives et prophylactiques qui ont surtout été touchées. CONCLUSION: La présente étude fournit une évaluation pancanadienne des incidences de la pandémie de COVID-19 sur les services de reconstruction mammaire du point de vue des chirurgiens. Pour maintenir les normes des soins axés sur les patients, il faudra procéder à une réorganisation stratégique unifiée de la prestation des soins, tant maintenant qu'à l'avenir.
Subject(s)
Breast Neoplasms , COVID-19 , Breast Neoplasms/epidemiology , Breast Neoplasms/therapy , Female , Humans , Pandemics , SARS-CoV-2ABSTRACT
INTRODUCTION: During the COVID-19 pandemic, the containment measures and the recommendations of several societies in oncology may have impacted the request for initial care for cancers. METHODS: In this monocentric retrospective study, the number and the characteristics of patients received for a first consultation for a breast or gynecologic tumor were compared between the containment period and a control period. The times from diagnosis to treatment and the type of initial care were compared too. RESULTS: During the outbreak, 91 patients were seen for a new request, versus 159 during the control period, a decrease of 43.5 %. Patients were older (62.9 versus 60.9 years old) but this difference was not significant. Tumor stage was not modified. Concerning senology, the time from the biopsy to the first consultation was 5.5 days longer during the outbreak (difference statistically insignificant). Among the 51 patients requiring a surgical treatment during the outbreak, 16 (31.48 %) were postponed after the end of the containment measures. After all, the average time from the consultation to the treatment was not modified. No modification of type of treatment was observed. DISCUSSION: At the height of the pandemic, benefits and risks of the cancer treatment had to be daily balanced against the risk of exposition to the COVID-19. The evaluation of practices for cancer care is essential to understand the real impact of COVID-19 outbreak on global cancer management, so as to get prepared to further crises.
Subject(s)
Breast Neoplasms/epidemiology , COVID-19/epidemiology , Genital Neoplasms, Female/epidemiology , Pandemics , SARS-CoV-2 , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Chi-Square Distribution , Female , Genital Neoplasms, Female/pathology , Genital Neoplasms, Female/surgery , Humans , Middle Aged , Quarantine , Retrospective Studies , Statistics, Nonparametric , Time-to-Treatment/statistics & numerical dataABSTRACT
OBJECTIVE: The exceptional health situation related to the SARS-Cov2 coronavirus pandemic (COVID-19) required a deep and very quickly adaptation of management practices in gynecological cancer. The main objective is to estimate the proportion of patients with treatment modifications. METHOD: This is a multicenter prospective study conducted in 3 university gynecological cancer departments (HCLyon, France) during the period of confinement (March 16 to May 11, 2020). All patients with non-metastatic breast cancer or gynecological cancer were included. The planned treatment, postponement, delay and organizational modifications (RCP, teleconsultations) were studied. RESULTS: Two hundred and five consecutive patients were included, average age 60.5±1.0. 7 patients (3.4%) had SARS-Cov-2 infection, 2 patients died. One hundred and twenty-two patients (59.5%) had a treatment maintained, 72 patients (35.1%) postponed, 11 patients (5.4%) cancelled. Of the 115 (56.1%) planned surgeries, 40 (34.8%) postponed, 7 cancelled (6.1%). 9 patients (7.8%) had a surgical modification. Of the 59 (28.8%) radiotherapy treatments scheduled, 24 (40.7%) postponed and 2 (3.4%) cancelled. Of the 56 (27.3%) chemotherapy treatment planned, 8 (14.3%) postponed and 2 (3.6%) cancelled. One hundred and forty-five patients (70.7%) have been discussed in multidisciplinary meeting. One hundred and fifty-eight patients (77%) had a teleconsultation system. CONCLUSION: Our study assessed the impact of the COVID-19 pandemic on therapeutic management of patients with gynecological cancer during the period of confinement. This will probably improve our management of an eventual epidemic rebound or future health crisis.