1. Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study
- Author
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Jamie J Kirkham, Ellen Copson, Baek Kim, Shelley Potter, Charlotte E. Coles, Nisha Sharma, Elizabeth Camacho, Kieran Horgan, Stuart McIntosh, Daniel R. Leff, Rachel O'Connell, Rajiv V. Dave, Chris Holcombe, Ramsey I. Cutress, Patricia Fairbrother, Christopher W. J. Cartlidge, Ashu Gandhi, Vicky P. Taxiarchi, Alona Courtney, Tim Rattay, Raghavan Vidya, Cliona C. Kirwan, Dave, Rajiv V. [0000-0001-6827-8090], McIntosh, Stuart A. [0000-0002-4123-9611], Potter, Shelley [0000-0002-6977-312X], Copson, Ellen [0000-0001-8994-4056], Apollo - University of Cambridge Repository, Cancer Research UK, Dave, Rajiv V [0000-0001-6827-8090], and McIntosh, Stuart A [0000-0002-4123-9611]
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Cancer Research ,692/700/784 ,medicine.medical_treatment ,Cohort Studies ,0302 clinical medicine ,Breast cancer ,Quality of life ,Surgical oncology ,Pandemic ,Epidemiology ,030212 general & internal medicine ,692/700/1538 ,Aged, 80 and over ,Covid19 ,health policy ,Middle Aged ,Health care economics ,Health policy ,Oncology ,030220 oncology & carcinogenesis ,Practice Guidelines as Topic ,Female ,Breast reconstruction ,Life Sciences & Biomedicine ,B-MaP-C study collaborative ,Cohort study ,Adult ,medicine.medical_specialty ,Breast Neoplasms ,Article ,1117 Public Health and Health Services ,692/4028/546 ,surgical oncology ,03 medical and health sciences ,breast cancer ,SDG 3 - Good Health and Well-being ,medicine ,Humans ,1112 Oncology and Carcinogenesis ,692/700/3934 ,Oncology & Carcinogenesis ,Aged ,Science & Technology ,business.industry ,SARS-CoV-2 ,COVID-19 ,health care economics ,medicine.disease ,Radiation therapy ,quality of life ,Emergency medicine ,692/4028/67/1347 ,business - Abstract
Background The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown.
- Published
- 2021
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