Wilke, L. G., Nguyen, T. T., Yang, Q., Hanlon, B. M., Wagner, K. A., Strickland, P., et al.

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.

Ann Surg Oncol. 2021 Oct;28(10):5535-5543. doi: 10.1245/s10434-021-10639-1. Epub 2021 Aug 24.

The coronavirus disease 2019 (COVID-19) caused a sudden change in approach to breast cancer care which varied by region. Early in the pandemic, several large U.S.-based medical societies, including American Society of Breast Surgeons (ASBrS) and the National Comprehensive Cancer Network (NCCN), collaborated to provide expert opinion regarding how to best prioritize patients diagnosed with breast cancer. These recommendations stratified patients based on patient disease acuity and risk of disease progression versus associated risk of intervention based on hospital resources and risk of exposure. The goal of these oncologic care guidelines was to help mitigate the potential impact of care disruption while trying to prevent the spread of COVID-19.

To establish the impact of these expert opinion guidelines and the impact of the pandemic on the management of breast cancer, the ASBrS established a COVID-19 module to the Mastery of Breast Surgery registry. The ASBrS COVID-19 working group anticipated that the number of patients treated with neoadjuvant endocrine therapy (endocrine therapy prior to surgery) would increase in a regionally dependent manner along with delays and alterations to patient’s breast surgeries. In this database, 177 surgeons entered demographic and treatment data on 2,791 patients. The average patient age was 62.7 years and 9% were African American. Initial breast surgery consultation occurred via telehealth in 6.2% of patients and 1.4% developed COVID-19.

As anticipated, the number of patients receiving neoadjuvant endocrine therapy (NET) increased and was found to increase by 31% due to COVID-19. Patients living in the northeast and southeast regions of the U.S. were more likely to receive NET due to COVID-19, which is in line with distribution of the initial COVID-19 outbreak. A change in surgical approach due to COVID-19 was seen in 5.4% of patients. As seen through this Mastery registry, the impact of the COVID-19 pandemic on breast cancer management has been unprecedented and patients experienced interruption of screening, delays in treatment and alterations of management. There was varied experience with this across the country based on where patients were located and the geographical impact of COVID-19. One of the biggest changes was increased use of NET, which may impact approaches to breast cancer in the future. Further research is needed to understand the impacts of these treatment changes on long-term outcomes.